Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.

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Esophageal cytology may improve sensitivity for the detection of malignancy but can be difficult to interpret in the presence of inflammation. To assess the value of cytology in assessing patients with Barrett's esophagus a retrospective review was performed. One hundred and sixty two patients (87 esophageal/gastroesophageal junction adenocarcinoma, 65 non-dysplastic Barrett's esophagus and 10 dysplastic Barrett's esophagus) had biopsies and brushings taken for histological and cytological assessment. Eighty two of 92 patients with carcinoma or high-grade dysplasia had true positive malignant cytology. Seven of 65 patients with non-dysplastic but inflamed Barrett's esophagus had false positive malignant cytology. One of these patients had an esophagectomy on the basis of cytology but no tumor was found in the resection specimen. This translates into an 89% sensitivity and specificity of cytology for the detection of esophageal columnar neoplasia. Cytology from Barrett's esophagus can be misleading in the presence of severe inflammation. Cells from a benign Barrett's ulcer may appear frankly malignant when examined in isolation. Esophagectomy should not be performed on the basis of cytological evidence alone.