Cytological Findings Of The Esophagus Using Sponge Cytology On Patients Referred For Esophageal Endoscopy At Knh

Abstract

Background: Esophageal cancer is the 9th most common cancer in the world, and the 5th most common cancer in developing countries. In Kenya, it is the most common cancer in men and the third in women; with the highest mortality rate of 10.2%. Esophageal cancer has poor prognosis because most of the patients present in advanced stages of the disease when current treatment modalities are not very effective. There are known precancerous lesions which can be diagnosed through exfoliative cytology to improve the esophageal cancer survival rates and at the same time reduce its mortality. Sponge cytology, balloon cytology and sponge- mesh are screening methods which have been extensively studied and are now being assimilated into clinical practice. Studies have shown sponge cytology to be readily accepted by patients compared to the other methods. Hence it was the method of choice for this study.

Objective: To describe cytological findings of the esophagus using sponge cytology on patients referred for endoscopy at KNH. Design: A cross- sectional descriptive study.

Setting: Kenyatta National Hospital endoscopy unit.

Study Population: Both men and women who were referred for esophageal endoscopy.

Method: A calculated sample size of sixty (60) patients was recruited and a structured questionnaire used to collect socio-demographic data and risk factors for esophageal disease. Smears made from specimen collected using a cytosponge (Oesotest, Actimed Switzerland) were fixed then stained with Papanicolaou stain. The smears were reported using The Bethesda Reporting System 2001.

Results: All the 60 participants were blacks. The female to male ratio in this study was 2:1 (68.33% & 31.67% respectively). The peak age group was 41- 50 yrs (25.0%) and with mean age of 43.77 yrs (SD - 14.623). Majority of patients hailed from Central and Nairobi provinces. Of the clinical information elicited, persistent heartburn (59%) was most common complaint with dysphagia (8%) being among the least. Cytological findings were; (86.6%) NILM, intestinal metaplasia (10%), HSIL (1.7%) and SCC (1.7%). Among the 52 NILM patients, 9.6% were reported as inflammatory smears and 17.3% had candidiasis. Cytological findings compared well with endoscopic and biopsy findings with Kappa value of 0.588 (measure of agreement). This study reported few cases of esophageal cancer and therefore could not deduce a significant association between esophageal cancer and the associated risk factors. Conclusions: Majority of the patients in this study had non-neoplastic lesions and only a few with malignant lesions. Therefore, sponge cytology examination of the esophagus can be employed as a primary test whenever there is any suspicion of an esophageal lesion especially in clinical set-ups where endoscopy facilities and medical professionals are not available. Risk factors for esophageal cancer could not be assessed in this study hence, larger studies may be helpful in assessing the risk factors associated with esophageal cancer.