Cytologic detection of esophageal squamous cell carcinoma and its precursor lesions using balloon samplers and liquid-based cytology in asymptomatic adults in Linxian, China

Objective To evaluate liquid-based balloon cytology as primary screening tool for detecting esophageal cancer in a high-risk population. Study Design Study subjects were 940 asymptomatic subjects ages 34 - 67 in Linxian, Henan Province, China, an area with a high incidence of esophageal carcinoma. We collected esophageal samples with balloon from all subjects into a liquid buffer (AutoCyte Preservative) and made thin-layer slides for cytologic screening using AutoCyte PREP (TriPath Imaging Inc., Burlington, North Carolina, U.S.A). Subsequent endoscopic biopsies on all subjects served as the gold standard. All tests were performed in an independent and blinded fashion. We compared the results of liquid-based cytology with the results of endoscopic biopsy. Results Carcinoma in situ and cancer were identified in 17 of 710 (2.4%) subjects who had results of endoscopic biopsy and liquid-based balloon cytology. Taking atypical squamous cells of undetermined significance, favor neoplastic (ASCUS-N) as the cytologic threshold for detecting esophageal cancer, the sensitivity and the specificity of liquid-based balloon cytology were 76.5% and 76.0%, respectively. Conclusion The accuracy of liquid-based technique (AutoCyte PREP) was much better than with previous balloon smear cytology. It may he an alternative for a primary screening for esophageal and cardia stomach cancer in low-resource settings where endoscopy is not available,.