Gastrointestinal Endoscopic Exfoliative Cytology

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Vol. 22, No. 10 October 2000

Refereed Peer Review

FOCAL POINT

KEY FACTS

#Endoscopic exfoliative cytology

is a useful and reliable adjunct to

mucosal biopsy for the diagnosis

of gastrointestinal (GI) tract

diseases in dogs and cats.

GastrointestinalEndoscopic ExfoliativeCytology: Techniques

and Clinical ApplicationIowa State University

Albert E. Jergens, DVM, MSClaire B. Andreasen, DVM, PhDKristina G. Miles, DVM, MS

ABSTRACT: Cytologic examination of exfoliative specimens obtained during endoscopy is a

useful and reliable adjunct to mucosal biopsy for the diagnosis of gastrointestinal (GI) tract

diseases in dogs and cats. Clinical advantages of endoscopic cytology include simplicity, ra-

pidity of diagnosis, and minimal invasiveness. Cytologic smears are graded on the basis of ob-jective criteria, including the presence and number of inflammatory, atypical, and epithelial

cells as well as the presence of bacteria, hemorrhage, debris/ingesta, and mucus. There is

high correlation between results obtained from endoscopic cytology and histologic examina-

tion, and discordant results are infrequent. Brush cytology is useful in detecting mucosal in-

flammation, whereas touch cytology is more likely to detect acute purulent and erosive mu-

cosal lesions. Alimentary lymphoma may be readily diagnosed using either technique. This

article provides an overview of how cytologic smears are prepared and evaluates their diag-

nostic accuracy.

A

dvances in endoscopy have revolutionized the detection of gastrointesti-nal (GI) tract diseases in companion animals.1–5 Histologic examination

of forceps biopsies is used to establish a definitive diagnosis of mucosaldisease. Endoscopic exfoliative cytology is a useful adjunct to biopsy for detec-tion of GI tract diseases in humans,6–9 and the results correlate highly with histo-logic observations in dogs and cats.10,11 However, little data12 exist that describethe findings made by using this diagnostic technique. This article reviews ourexperience using endoscopic exfoliative cytology in the diagnosis of canine andfeline GI tract diseases.

COLLECTION METHODS AND SMEAR PREPARATIONNumerous mucosal disorders are amenable to diagnosis by endoscopic cytology

(see Gastrointestinal Tract Disorders Amenable to Endoscopic Cytology). Cyto-logic specimens should be obtained after mucosal biopsy because this technique

CE

V

I Exfoliative cytology can

be performed easily along

with mucosal biopsy during

endoscopic examination of

the GI tract.

I Cytologic smears may be made

by the brush or touch techniqueand are graded by objective

criteria.

I Endoscopic cytologic specimens

have a high diagnostic accuracy

compared with histologic

specimens.

I Endoscopic cytology of the

canine and feline GI tracts aids

in differentiation of normal

mucosa from mucosa infiltratedby inflammatory cells or

neoplastic diseases.



has shown the highest diagnosticaccuracy for detecting GI tractdiseases in humans.13,14 Cytologicsmears may be prepared using thebrush or touch technique.

With the brush technique, asingle-use guarded cytology in-strument is passed through the ac-cessory channel of the endoscopeand advanced to the mucosa. Thebrush is extended beyond its pro-tective sheath and exfoliative spec-imens are obtained by rubbing thebrush vigorously on the mucosauntil slight hemorrhage occurs(Figure 1A). The brush is then re-tracted into its sheath and with-

drawn from the endoscope. Thebrush is again extended from itssheath and rolled across a glassslide to make a cytologic smear(Figure 1B). The brush should becarefully rotated 360˚ while tra-versing the slide’s surface, thereby ensuring maximum transfer of cel-lular material (Figure 1C).

The touch technique involvesthe transfer of a mucosal speci-men from the biopsy forceps to a

glass slide using a hypodermic needle (Figures 2A and2B). Multiple cytologic imprints can be made by plac-ing a second slide on top of and at right angles to thefirst slide and applying light pressure (Figure 2C). Ex-cessive downward pressure and smearing should beavoided because this may result in cell rupture. Ideally,four slides (two slides using each cytologic technique)should be prepared for each organ being evaluated en-doscopically. Following smear preparation, slides shouldbe air-dried and stained with a Romanovsky-type stainfor evaluation (see Enhancing the Diagnostic Yield of Gastrointestinal Tract Endoscopic Exfoliative Cytology).

CRITERIA FOR CYTOLOGIC EXAMINATIONObjective criteria for evaluation of GI tract endo-

scopic exfoliative cytologic specimens have been de-scribed and validated.12 Briefly, a grading system basedon several categories is used (Table I). Cytologic gradesof 2 or lower for cellularity categories are generally notdiagnostically significant. A minimum of 10 micro-scopic fields should be evaluated on each slide before acytologic diagnosis is made. This grading system facili-tates consistent and rapid evaluation of cytologic prepa-rations (Figure 3).

PROSPECTIVE EVALUATIONOF ENDOSCOPIC CYTOLOGY

Over the past 3 years, endo-scopic exfoliative cytology hasbeen extensively performed in

our institution as an adjunct tomucosal biopsy for diagnosingchronic GI tract disease in dogsand cats. We have reported pre-liminary observations in 85 dogsand 23 cats in which cytologicfindings were compared with his-tologic observations.12 These datahave been expanded to includean additional 37 canine and 12feline cases; the histologic find-ings and diagnostic accuracy 15 of

the cytologic findings of thisstudy are summarized in Tables IIand III, respectively. Endoscopiccytology remains an extremely useful diagnostic technique thataids in the differentiation of nor-mal mucosa from mucosa infil-trated by inflammatory cells orneoplastic disease (Table II). Sim-ilarly, the correlation between re-sults obtained on cytologic versushistologic examination is high

(Table III) and compares favorably with results fromsimilar studies of humans with gastric mucosal dis-ease.16–18

Endoscopic cytology is extremely useful in detectingmucosal inflammation of varied causes. Mucosal infil-trates of lymphocytes and plasma cells were observedcommonly with inflammatory bowel diseases, small in-testinal bacterial overgrowth, intestinal lymphangiecta-sia, and Physaloptera species infection of the stomachand duodenum19 (Figure 4). Gastric spirillar organisms

were readily detectable by brush cytology in 57% of alldogs and cats but were infrequently observed in histo-

logic specimens. The high diagnostic sensitivity of thebrush technique in detecting gastric spirillar organismsin dogs and cats in our study was consistent with re-sults of other studies.20,21 Alimentary neoplasia (espe-cially lymphoma) may be diagnosed by either brush ortouch cytologic techniques; however, detection appearsdependent on the extent of cellular infiltration and mu-cosal disruption (e.g., ulceration, erosion), which may aid exfoliation. Some lymphomas may be difficult todifferentiate from severe lymphocytic-plasmacytic (LP)enteritis when larger lymphocytes are present (Figure5). Gastric adenocarcinomas may evade cytologic de-

Small Animal/Exotics Compendium October 2000

B R U S H T E C H N I Q U E I T O U C H T E C H N I Q U E I G A S T R I C S P I R I L L A R O R G A N I S M S

I Esophagus

—Esophagitis

—Stricturea

—Neoplasia

I Stomach

—Chronic gastritis

• Inflammatory bowel disease-associated

• Nematode-associated

—Ulcer/erosions

—Neoplasia/polyps

I Small intestine

—Fungal enteritis

—Neoplasia

—Inflammatory bowel disease; smallintestinal bacterial overgrowth

I Colon

—Inflammatory bowel disease

—Fungal colitis

—Neoplasia

—Inflammatory polyps

a Stricture associated with malignant neoplasia oractive esophagitis.

Gastrointestinal Tract DisordersAmenable to Endoscopic Cytology



tection because of their multifocal and deeply infiltra-tive nature and the surrounding fibrosis that preventsexfoliation of representative cells (Figure 6).22

Discordant results be-tween cytologic and histo-logic findings were un-commonly observed. Thepercentages of false-positive

results (11 of 314 pairedcytologic specimens; 3.5%) and false-negative (24of 314 paired cytologicspecimens; 7.6%) results inour study were low andcomparable to those of sim-ilar studies in humans.8,18,23

The reasons for discordanceare diverse but include dif-ficulty in differentiatingmild inflammatory lesions

from normal; technicalcomplications caused by poor orientation of tissueduring embedding for his-tologic examination or in-advertent sampling of amucosal lymphoid aggre-gate; the presence of focal,fibrotic, or deeply infiltra-tive mucosal lesions; andthe presence of functionalGI tract disease.24

CLINICALAPPLICATIONSCase 1: ChronicPostprandialVomiting in a DogClinical Synopsis

A 13-year-old neuteredpoodle was referred be-cause of 3 weeks of spo-radic vomiting episodesthat generally occurred 8

to 12 hours after eating.The vomitus frequently contained partially digest-ed food and bile. Appetiteand activity were normal,and no diarrhea or weightloss was reported. Physicalexamination revealed analert, mildly obese dog.

Initial diagnostic tests (i.e., complete blood count, serumbiochemical profile, urinalysis, direct/indirect fecal exam-inations, survey abdominal radiography) showed no ab-

Compendium October 2000 Small Animal/Exotics

G A S T R I C M U C O S A I C Y T O L O G I C F I N D I N G S I H I S T O L O G I C E X A M I N A T I O N

Figure 1B

Figure 1C

Figure 1—Brush cytologic technique. ( A ) Theguarded cytology brush is extended beyond itsprotective sheath and has abraded the gastricmucosa. (B) The exfoliated material is streakedacross a glass slide to make a monolayer for cy-tologic examination. (C) To prepare the slide,the brush should be rotated 360° to maximizetransfer of cellular material.

Figure 1A

Figure 2B

Figure 2C

Figure 2—Touch cytologic technique. ( A ) Us-ing forceps, a biopsy sample is obtained fromthe gastric mucosa. (B) The mucosal specimenis transferred from the forceps using a hypo-dermic needle. (C) A mucosal specimen isplaced between two glass slides to make cyto-logic imprints.

Figure 2A



normalities. An upper GI series using liquid bariumdemonstrated partial pyloric outflow obstruction. UpperGI tract endoscopy (i.e., gastroscopy, duodenoscopy) wasperformed.

Endoscopic/Cytologic Observations

Endoscopic examination revealed

no abnormalities of the proximalstomach and gastric body. Withinthe antrum, a large polypoid mass

was observed adjacent to the py-lorus obstructing the pyloric open-ing. Brush cytologic specimens of the mass consisted of a uniformpopulation of benign gastric epithe-lial cells with no evidence of malig-nancy (Figure 7). A cytologic diag-nosis of epithelial hyperplasia wasmade. Owner consent was given for

gastrotomy and the mass was suc-cessfully removed.

Assessment Endoscopic cytology allowed a

rapid intraoperative tentative diag-nosis of epithelial hyperplasia. Theclient had requested humane eu-thanasia for her dog if gastric malig-nancy were detected; therefore, thisfacilitated a therapeutic decision of polypectomy. Histologic examina-

tion of the excised mass confirmed the cy-tologic findings (adenomatous polyp). Fol-lowing surgery, vomiting episodes ceasedand the dog was discharged.

Case 2: EpisodicRegurgitation in a CatClinical Synopsis

A 5-year-old neutered domestic shorthaircat was admitted for episodic regurgitationof 2 weeks’ duration. A moderately de-creased appetite and weight loss (1 kg) werealso reported by the owner. Physical exami-nation revealed a thin, active cat with afever (104˚F). Initial laboratory tests (i.e.,complete blood count, serum biochemicalprofile, urinalysis, feline leukemia virus

[FeLV] ELISA, cervical/thoracic radiogra-phy) revealed mild anemia (hematocrit,28%), a positive FeLV test, and lateral dis-placement of the midcervical trachea. Ultra-

sound evaluation of the cervical region and an esopha-gram confirmed the presence of a periesophageal oresophageal wall mass. Esophagoscopy was performed thefollowing day.


E P I T H E L I A L H Y P E R P L A S I A I F E L I N E L E U K E M I A V I R U S I E S O P H A G O S C O P Y

I Excellent mucosal biopsy technique should be used to maximize

diagnostic yield25,26 and corroborate cytologic observations.

I Cytologic specimens should be obtained after mucosal biopsy.I Cytologic specimens should be obtained regardless of the

endoscopic appearance of the mucosa.

I The brush and touch techniques complement each other and should

both be performed.

I When making touch impressions, excessive pressure should be

avoided because it may result in cell rupture. Overzealous brushing

produces hemorrhage, confounding leukocyte interpretation.

I Objective grading criteria should be used when assessing

gastrointestinal tract cytologic specimens.

I Appropriate patient history and endoscopic observations should be

communicated to the cytopathologist(s) to facilitate diagnosticinterpretation.

Enhancing the Diagnostic Yield ofGastrointestinal Tract Endoscopic Exfoliative Cytology

TABLE I

Gastrointestinal Cytologic Grading Criteria

Category Grading Scheme

Inflammatory cells Scored 0–7, which corresponds toNeutrophils, lymphocytes, plasma 0–7 cells/50× oil-immersion field;cells, eosinophils, macrophages if >7 cells/field, a grade of 7 is assigned

Atypical cellsCells with altered nuclear/cytoplasmiccharacteristics

Epithelial cells Grade corresponds to number of Evaluated as cell clusters clusters/10× field

Bacterial flora Scored 0–7:

Gastric spirillar organisms, oral flora, 0 = noneenteric rods and cocci 1–2 = slight

3–4 = moderateHemorrhage 5–7 = markedPresence of peripheral blood

Debris/ingesta Plant material or pigmented particulatematter

MucusDiffuse basophilic mucinous material



Endoscopic/Cytologic Observations A large, smooth-surfaced, eroded mass occluding the

proximal esophageal lumen was seen by esophagoscopy.The mass did not arise from the mucosa but projected

into the lumen as a periesophageal structure. Cytologicspecimens were obtained by both endoscopy and fine-needle aspiration of the mass under ultrasound guid-ance. Examination of cytologic preparations showed ahomogenous population of large immature lympho-cytes consistent with a diagnosis of lymphosarcoma(Figure 8). Histologic specimens of esophageal mucosa

were nondiagnostic.

Assessment Clinical observations and diagnostic testing were con-

sistent with a diagnosis of primary esophageal disease. Ex-


L U M E N I L Y M P H O S A R C O M A I A L I M E N T A R Y N E O P L A S I A I V O M I T I N G E P I S O D E S

Figure 3A

Figure 3C

Figure 3D

foliative cytology allowed a diagnosis of periesophagealneoplasia to be made despite the absence of histologic

confirmation of lymphosarcoma. This case emphasizesthe adjunctive role of GI tract endoscopy in the diagnosisof alimentary neoplasia. The cat was treated with multi-ple-drug chemotherapy for lymphosarcoma, leading torapid remission of clinical signs and radiographic lesions

within 2 weeks. Clinical signs of regurgitation returned 9months later, prompting euthanasia.

Case 3: Anorexia and Weight Loss in a CatClinical Synopsis

A 12-year-old neutered domestic shorthair cat with a1-year history of intermittent anorexia, vomiting, and

weight loss was evaluated. Vomiting episodes were typi-cally cyclic (occurring over 48 hours) and would then re-solve. Weight loss exceeding 8 lb was confirmed. Onphysical examination, the cat was alert and active, but re-duced lean muscle mass was noted. Over the previous 12months, a variety of diagnostic tests had been performedin a step-wise fashion, including routine hematology, uri-nalysis, multiple serum total thyroxine tests, abdominalradiography, and serology for FeLV and feline immuno-deficiency virus. Prophylactic dewormings and dietary trials resulted in little clinical improvement. Upper GItract endoscopy was then performed.

Figure 3E

Figure 3B

Figure 3—( A ) Brush cytolo-gy of the colon showing twoclusters of uniform epithelialcells with round to oval nu-clei and confluent basophiliccytoplasm. (B) Touch cytol-

ogy of the colon showing se-vere suppurative inflamma-tion and diffuse bacterialflora. (C) Brush cytology of the stomach showing gastricspirillar organisms that areembedded within superficialmucus. (D) Touch cytology of the colon showing a clus-ter of malignant lympho-cytes containing large prom-inent nuclei and multiplenucleoli. (E) Brush cytology

of the colon showing hem-orrhage (grade 4–5) with asingle cluster of epithelialcells. Hemorrhage may oc-cur in association with tissuefriability or iatrogenic trau-ma.



Endoscopic/Cytologic Observations Endoscopic examination of the esophagus and stomach

was unremarkable. Visualizationof the proximal duodenum re-vealed marked mucosal granulari-ty and friability. Multifocal erosive

lesions were apparent throughoutmost of the distal duodenum and jejunum. Small intestinal brushand touch cytologic specimens

were similar with moderate-to-se-vere LP inflammation (Figure 9).Histologic examination of muco-sal biopsy specimens confirmedthe cytologic finding of LP enteri-tis (Figure 10). Gastric mucosalspecimens were histologically nor-mal.


P R O X I M A L D U O D E N U M I L Y M P H O C Y T I C - P L A S M A C Y T I C E N T E R I T I S I P R E D N I S O N E

TABLE III

Diagnostic Accuracy of Cytologic Specimens Obtained During Endoscopy15

Sampling Site

Value a Stomach Small Intestine Colon

Sensitivity (%) 73 92 86

Specificity (%) 97 80 100

Positive predictive value (%) 91 92 100Negative predictive value (%) 89 80 75

a Diagnostic indices calculated using standard formulas.

TABLE II

Distribution of Histologic Findings in Which Endoscopic Cytology Was Also Performed12

Biopsy Site

Histologic Finding Stomach Small Intestine Colon

Normal 88 31 12Spirochetes 3 NA NA Inflammation

Lymphocytic-plasmacytic 25 91a 18Eosinophilic 4 3 NA Mixedb 8 3 8

NeoplasiaLymphosarcoma 3 4 2

Adenocarcinoma 1 NA Atrophy/fibrosis 7 3 Total cytologiesc 139 135 40

NA = Not applicable.a Includes inflammation seen with lymphangiectasia, bacterial overgrowth, and Physaloptera species infection.b Denotes suppurative, eosinophilic, and/or granulomatous inflammation.c Paired brush and touch cytologic specimens.

Assessment Severe LP enteritis was readily detectable using endo-

scopic exfoliative cytology. Themagnitude of intestinal inflamma-tion was marked as evidenced by ahigh (5 of 6) cytologic grading

score, numerous sites of lympho-cytic infiltration within the epithe-lium, and observation of largegranular lymphocytes in brushspecimens. Treatment of this catincluded feeding a commercially prepared hypoallergenic diet andadministration of prednisone andmetronidazole at immunomodu-lating doses. Remission of signsoccurred over 4 months, and drugadministration was discontinued.

Figure 4—Brush cytology of the small intestineshowing mild lymphocytic-plasmacytic inflamma-tion with clusters of lymphocytes (arrow ) embed-ded within duodenal epithelium.



Case 4: ChronicIntermittentVomiting in a DogClinical Synopsis

A 1-year-old spayed

Whippet was referred forendoscopic evaluation of chronic vomiting. Cyclicvomiting episodes overthe preceding 4 monthshad been nonresponsiveto dietary therapies andrepeated dewormings.Diagnostic evaluation(i.e., hematology, serumbiochemistries, urinaly-sis, fecal examinations,

abdominal radiography)by the referring veteri-narian showed no abnor-mal results. Upper GItract endoscopy was per-formed.

Endoscopic/ Cytologic Observations

Both esophagoscopy and gastroscopy failed to

show mucosal abnormal-ities in this dog. In theproximal duodenum,several nematodes wereobserved along the mu-cosa, which also con-tained multifocal attach-ment sites. Extraction of two parasites confirmedthem to be nongravid fe-male Physaloptera species.Mucosal specimens ob-

tained for histologic/cy-tologic evaluation con-firmed the presence of LP enteritis (Figure 11).Gastric biopsies werenormal histologically.

Assessment Brush cytology is extremely useful in detecting mucosal inflamma-

tion of various causes (Table II). Our experiences indicate that Phys- aloptera species infection is frequently accompanied by intense mucosalinfiltrates of lymphoid cells that contribute to clinical signs.19 Treatment


G A S T R O S C O P Y I N E M A T O D E S I P A R A S I T E I M U C O S A L I N F L A M M A T I O N

Figure 5A

Figure 5B

Figure 5—Cytologic discordance in small intesti-nal lymphoma. ( A ) Touch cytologic specimencontaining numerous large immature lympho-cytes (arrows ) interpreted as lymphoma. (B) His-tologic section obtained by endoscopic forcepsbiopsy showing villus atrophy, edema, and dif-

fuse lymphocytic-plasmacytic (LP) infiltration of the lamina propria. The initial histologic diagno-sis was severe LP enteritis. Repeat duodenal bi-opsy with histologic examination 7 days laterconfirmed the cytologic finding of lymphoma.

Figure 6B

Figure 6C

Figure 6—Cytologic discordance in gastric ade-nocarcinoma. Cytologic specimens obtainedfrom the periphery of gastric erosions and thegastric body were interpreted as suppurative in-flammation ( A ) and normal epithelial cells (B),respectively. (C) Histologic review of biopsy specimens confirmed a diagnosis of gastric ade-nocarcinoma. Note the presence of isolatedsignet ring cells deep within the gastric mucosa(arrow ).

Figure 6A

Figure 7—Brush cytology obtained from a py-loric mass. A uniform population of gastricepithelial cells with oval nuclei and confluentcytoplasm can be observed. The cytologic inter-pretation was epithelial hyperplasia.



of this dog with pyrantel(administered once) andmetronidazole (to reducemucosal cellular infil-trates) was curative.

Case 5: Tenesmusand IncreasedFrequencyof Defecationin a DogClinical Synopsis

A 1-year-old spayedboxer was referred for en-doscopic evaluation of colonic disease. The ani-mal had been straining to

defecate and had shownan increased frequency of defecation for over 3 weeks.The feces were generally

well formed but were en-cased by mucus. Physicalexamination, includingthorough digital exami-nation of the rectum, re-vealed no abnormalities.Initial diagnostic tests(i.e., hematology, serum

biochemistries, urinaly-sis, survey abdominal ra-diography, and multiplefecal analyses) were unre-markable. The adminis-tration of multiple an-thelmintic drugs also hadfailed to alleviate signs.Following preparation

with an oral lavage solu-tion, colonoscopy was per-formed.

Endoscopic/Cytologic Observations Excellent cleansing with the lavage solution allowed full visualiza-

tion of all mucosal surfaces. Most striking was the appearance of dis-crete nodules along the entire descending colonic mucosa, which wasconsistent with marked lymphoid hyperplasia. Similar, but fewer, le-sions accompanied by multifocal erosions were observed in the trans-verse colon. Brush cytologic specimens showed moderate LP infiltratesin all colonic regions (Figure 12). Moderate to severe LP colitis wasconfirmed histologically from examination of mucosal biopsy speci-mens.


C O L O N I C D I S E A S E I A N T H E L M I N T I C D R U G S I D I S C R E T E N O D U L E S

Figure 8—Brush cytology procured from a peri-esophageal mass. Numerous large immaturelymphocytes (arrows ) with large nuclei and mul-tiple nucleoli can be observed. The cytologic in-terpretation was lymphoma.

Figure 11—Brush cytology of the proximal duo-denum. Lymphocytes (arrows ) are clusteredaround and adjacent to intestinal epithelial cells.Cytologic interpretation was lymphocytic-plas-macytic inflammation.

Figure 10—Histologic section of intestinal mu-cosa with severe diffuse lymphocytic-plasmacytic(LP) infiltration of the lamina propria with villusblunting and dilation of the central lacteals. Thehistologic diagnosis was severe LP enteritis.

Figure 9A

Figure 9B

Figure 9—Brush cytology of the small intestine.( A ) Clusters of small lymphocytes (arrow ) are em-bedded within normal intestinal epithelial cells.(B) A mixed population of inflammatory cells,lymphocytes, and neutrophils (asterisks ) can beseen with epithelial cells and a large granularleukocyte (arrow ). The cytologic interpretation

was severe lymphocytic-plasmacytic inflammation.



Assessment Gastrointestinal tract endoscopic

cytology provided a reliable tenta-tive diagnosis while awaiting histo-logic review of biopsy specimens.

Cytologic lesions were most pro-nounced in brush specimens, which is typical with mucosal in-flammation. Specific therapy forthis dog included dietary modifica-tion (low-residue diet) and drugtherapy (immunomodulating dosesof prednisone and metronidazole).The dog showed excellent responseto therapy and clinical signs re-gressed over 6 weeks. Drugs weregradually tapered, and the dog has

been maintained on diet alone.

SUMMARYIn conclusion, we believe that endoscopic cytology,

which is a simple technique, is useful in the diagnosis of GI diseases in dogs and cats. The results of our prospec-tive study indicate that the combined brush and touchcytology with mucosal biopsy under direct endoscopic vi-sualization are useful in the diagnosis of GI inflammationand malignancy in a significant number of cases. We rec-ommend that endoscopic cytology be routinely used asan adjunctive diagnostic technique whenever mucosal

biopsy is performed.

REFERENCES1. Johnson GF, Twedt DC: Endoscopy and laparoscopy in the

diagnosis and management of neoplasia in small animals.Vet Clin North Am Small Anim Pract 7:77–92, 1977.

2. O’Brien JA: Esophagoscopy, in Anderson NV (ed): Veteri- nary Gastroenterology, Philadelphia, Lea & Febiger, 1980, pp81–83.

3. Johnson GF: Gastroscopy, in Anderson NV (ed): Veterinary Gastroenterology, Philadelphia, Lea & Febiger, 1980, pp84–88.

4. Johnson GF: Duodenoscopy, in Anderson NV (ed): Veteri- nary Gastroenterology, Philadelphia, Lea & Febiger, 1980, pp

89–90.5. Happe RP, van der Gaag I: Endoscopic examination of the

esophagus, stomach, and duodenum in the dog. JAAHA 19:197–206, 1983.

6. Swarts JM, Ragins AB, Bernstein A, et al: Diagnosis of gas-tric cancer by cytological examination of gastric washings.Gastroenterology 14:265–274, 1950.

7. Bemvenutti GA, Hattori K, Levin B, et al: Endoscopic sam-pling for tissue diagnosis in gastrointestinal malignancy.Gastrointest Endosc 21:159–161, 1975.

8. O’Donoghue JM, Horgan PG, O’Donohoe MK, et al: Ad- junctive endoscopic brush cytology in the detection of uppergastrointestinal malignancy. Acta Cytol 39:28–34, 1995.

9. Debongnie JC, Mairesse J, Donnay M, et al: Touch cytology

a quick, simple, sensitive screeningtest in the diagnosis of infections of the gastrointestinal mucosa. Arch Pathol Lab Med 118:1115–1118,1994.

10. Jergens AE, Andreasen CB, Hage-moser WH: The use of endoscopic

cytology in the diagnosis of gas-trointestinal disease. J Vet Intern Med 11:115, 1997.

11. Tobey JC, Willard MD, Krehbiel JD: Comparison of cytologic andhistopathologic evaluations of duo-denal biopsies. Proc Am Coll Vet Pathol, Albuquerque, NM, Novem-ber 1977.

12. Jergens AE, Andreasen CB, Hage-moser WA, et al: Cytologic exami-nation of exfoliative specimens ob-tained during endoscopy for diagnosisof gastrointestinal tract disease indogs and cats. JAVMA 213:1755–1759, 1998.

13. Zargar SA, Khuroo MS, Mahajan R, et al: Endoscopic fineneedle aspiration cytology in the diagnosis of gastro-oeso-phageal and colorectal malignancies. Gut 32:745–748, 1991.

14. Malhotra V, Puri R, Chinna RS, et al: Endoscopic tech-niques in the diagnosis of upper gastrointestinal tract malig-nancies—A comparison. Acta Cytol 40:929–932, 1996.

15. Ransohoff DF, Feinstein AR: Problems of spectrum and biasin evaluating the efficacy of diagnostic tests. N Engl J Med 299(17):926–930, 1978.

16. Au FC, Koprowska T, Berger A, et al: The role of cytology in the diagnosis of carcinoma of the stomach. Surg Gynecol Obstet 151:601–604, 1980.

17. Gupta R, Roger K: Endoscopic cytology and biopsy in the

diagnosis of gastroesophageal malignancy. Acta Cytol 27:17–22, 1983.18. Lan CS: Critical evaluation of the cytodiagnosis of fibrogas-

troendoscopic samples obtained under direct vision. Acta Cy- tol 34(2):217–220, 1990.

19. Jergens AE, Greve JH: Endoscopy case of the month: Chron-ic vomiting in a dog. Vet Med 87(9):873–876, 1992.

20. De Francesco F, Nicotina PA, Picciotto M, et al: Helicobac- ter pylori in gastroduodenal diseases: Rapid identification by endoscopic brush cytology. Diagn Cytopathol 9:430–433,1993.

21. Happonen I, Saari S, Castren L, et al: Comparison of diag-nostic methods for detecting gastric Helicobacter -like organ-isms in dogs and cats. J Comp Pathol 115:117–127, 1996.

22. Andreasen CB, Jergens AE: Oral cavity, gastrointestinal tract,

and associated structures, in Raskin RE, Meyer DJ (eds):Veterinary Cytology . Philadelphia, WB Saunders Co, 2000, inpress.

23. Rout N, Singh SP, Satpathy BK, et al: Rapid cytodiagnosisof endoscopic biopsy specimens in gastroesophageal malig-nancy. Trop Gastroenterol 14:99–103, 1993.

24. Jergens AE, Moore FM: Endoscopic biopsy specimen collec-tion and histopathologic considerations, in Tams TR (ed):Small Animal Endoscopy . St. Louis, Mosby, 323–340, 1999.

25. Hitt ME: Biopsy of the gastrointestinal tract, in Bonagura JD (ed): Current Veterinary Therapy XI . Philadelphia, WBSaunders Co, 675–678, 1995.

26. Golden DL: Gastrointestinal endoscopic biopsy techniques.Vet Clin North Am Small Anim Pract 23:239–244, 1993.


C Y T O L O G I C L E S I O N S I D I E T A R Y M O D I F I C A T I O N I D R U G T H E R A P Y

Figure 12—Brush cytology of the colon. Colonicepithelial cells and lymphocytes (arrows ) are in-dicative of lymphocytic inflammation.



About the AuthorsDrs. Jergens and Miles are affiliated with the Department of Veterinary Clinical Sciences and Dr. Andreasen with the Depart-

ment of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames. Dr. Jergens is a Diplomate of the

American College of Veterinary Internal Medicine, Dr. Andreasen is a Diplomate of the American College of Veterinary Patholo-

gists, and Dr. Miles is a Diplomate of the American College of Veterinary Radiology.


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Gastrointestinal Endoscopic Exfoliative Cytology