Role of Histology and Cytology in Esophageal Diseases

Histologic confirmation of the clinical and endoscopic impression is required in many patients with esophageal diseases, thereby necessitating the procurement of endoscopic biopsy specimens or cytologic brushings. Cytologic examination of endoscopic fine needle aspiration specimens from periesophageal and celiac axis lymph nodes in patients with invasive carcinoma is commonly used for preoperative staging. Cytologic preparation obtained from a normal esophagus typically results in a cellular sample of squamous epithelial cells that are similar to those designated as “intermediate” and “superficial” cells in a cervical smear. The diagnosis of esophageal involvement by eosinophilic gastroenteritis, therefore, is a diagnosis of exclusion. Other considerations include collagen vascular disease, pill/drug-induced esophagitis, infections including parasitic infestation, and, of course, gastroesophageal reflux disease. In some types of infectious esophagitis, histologic or cytologic evaluation can offer a specific diagnosis when the infectious organisms are identified.