Cytohistologic Diagnosis of Material Aspirated from Stomach: Accuracy of Diagnosis of Cancer, Ulcer and Gastritis from Paraffin-Embedded Washings

Abstract

The embedded section technic used in examination of exfoliated material obtained in stomach washings permits a cytohistologic diagnosis of gastric carcinoma, ulcer, and gastritis. When this technic is employed there is a minimal distortion of cells, and numerous mucosal fragments dislodged from lesions by washing remain intact. The cells of a group are not separated, and one sees a single layer of cells in normal architectural arrangement. The sediment is concentrated, so that more material can be examined in a shorter time. Material is obtained by introducing and withdrawing 30 cc. of normal saline (1) following an Ewald Meal, (2) following an alcohol-histamine meal, or (3) on a fasting, empty stomach. The washing is fixed in an equal volume of 10% formaline, and in the laboratory is further fixed by the addition of sufficient saturated picric acid soln. to solidify and precipitate the mucus. The material is filtered and handled like tissue. Sections are stained with hematoxylin-Orange G-eosin. The normal stomach contains squamous cells, mucus, scattered granulocytes, normal gastric mucosal cells and little or no fibrin and erythro-cytes. Acute gastritis is characterized by intracytoplasmic granulocytes in the mucosal epithelium. In chronic gastritis there are abundant leukocytes in the subepithelial stroma, with inconstant intracytoplasmic granulocytes in the mucosal epithelium. Atropic gastritis presents numerous goblet cells in the mucosal epithelium. Ulcer is characterized by a fibrin mass containing enmeshed leukocytes. Carcinoma is recognized by clusters of large irregular cells with hyperchromatic nuclei and prominent nucleoli. 78 proved cases are discussed. Carcinoma was diagnosed correctly in 13 of 27 cases, or 48.1%. (On review, 18 cases (66.7%) were diagnosed cancer.) There were 3.9% false positives. 20 of 24 patients (83.3%) with proved ulcer were diagnosed correctly, and there were 11.1% false positives. Six of 9 patients with gastritis were diagnosed correctly. There were 16.7% false positives. 11 of 18 proved normal cases (61.1%) were diagnosed correctly, and there were 10% false positives. 90% of lesions of the stomach can be recognized by employing this technic.