Evaluation of brushing cytology in the diagnosis of Helicobacter pylori gastritis

Helicobacter pylori (HP) is the cause of the most common infection in the world. It has been recognized as the major cause of peptic ulcer and an important risk factor for gastric malignancy. A variety of reliable methods are available for detecting HP during upper gastrointestinal endoscopy. Rapid urease test (RUT) is the cheapest method and histology is the most expensive; brush cytology is faster and cheaper than histology. The brushing cytology materials were obtained from the antrum of the stomach in 109 patients who suffered from dyspepsia and were candidates for endoscopy. The RUT and histology with hematoxylin-eosin staining were also performed on each patient separately. The infection status for each patient was established by a concordance of two test results. Seventy-eight of 100 patients (78%) were diagnosed as positive for Helicobacter pylori organisms using brushing cytology. The sensitivity and specificity of brushing cytology were 96% and 72% respectively. Sensitivity of brush cytology (96%) was higher than RUT (77.4%), and RUT was more specific than histology (100% vs 90%). Gastric brushing cytology provides an accurate, inexpensive and easy technique in the rapid detection of Helicobacter pylori infection. When additional information about the severity of mucosal damage or the presence of cell atypias is not necessary, histologic examination can be omitted, and a cost effective strategy for assessing HP status might consist of taking antral biopsies, the former for RUT and performing brush cytology slide, which should be stained and examined only when the RUT result is negative.