Brush Cytology: A Reliable Method to Detect Helicobacter pylori

Abstract

This study was conducted to verify the reliability of brush cytology in detecting Helicobacter pylori in an unselected group of patients with duodenal ulcer (DU) and nonulcer dyspepsia (NUD). Endoscopy was performed on 416 consecutive patients: group A, 94 with active DU; group B, 176 patients with DU after omeprazole (n = 78), ranitidine (n = 43), or triple anti-H. pylori therapy (n = 55); and group C, 146 patients with NUD. During endoscopy, the gastric mucosa was brushed and two biopsy samples from the antrum and body were obtained for histology. In 65 patients, culture of the brush-collected materials also was performed as was that from of biopsy samples. The overall frequency of H. pylori presence detected by brush cytology was significantly higher compared with that of histology (p < 0.001), particularly in group A (p < 0.05), group C (p < 0.05), and in patients with DU after omeprazole treatment (p < 0.01), but not in patients with DU after ranitidine or anti-H. pylori treatment. The overall frequency of H. pylori-positive cultures from the brush-collected material was higher compared with cultures from the biopsy samples (38.5% vs. 24.6%), particularly in the NUD group (32.6% vs. 16.3%). Brush cytology is more sensitive than histology, besides being faster and cheaper, for the assessment of H. pylori infection, particularly when the density of the bacteria is low.

Role of brush cytology in the diagnosis of neoplastic and non‐neoplastic upper gastrointestinal lesions

“…Contrary to what has been stated in the literature, BC missed H. pylori in eight of our cases, in which histology identified the organisms. MGG stain was satisfactory for detecting the organism and had no additional advantage.…”

“…Studies have shown the diagnostic accuracy of BC to range from 68% to 97.1% . The majority of the studies on BC have stressed its role in the diagnosis of malignant lesions, whereas only a few have dealt with non‐neoplastic lesions, most of them being cases of Helicobacter pylori (H. pylori) gastritis . BC is said to be particularly useful in stenosing lesions, the lesions with a bleeding tendency, flat lesions, or when there is a need for selective sampling from a larger area …”

5- Evaluation of Endoscopy Based Methods (Histopathology, Cytology and Urease Test) for the Detection of Helicobacter Pylori

“…Brush cytology: a sensitivity of 98% and specificity of 96% have been reported 10 . It is suggested and found to be more sensitive in some studies in comparison to biopsy histology [11][12][13] . Bacterial culture and sensitivity testing, String test 14 , Brushing urease test 15 .…”