In 173 patients with gastric cancer involving the cardia or the lower esophagus, endoscopic biopsy and/or brushing cytology were utilized in establishing the diagnosis microscopically. Biopsy was positive in 132 of 170 patients (77.0%) while brushing was positive in 78 of 93 patients (83.8%). However, a combined use of biopsy and brushing yielded a higher diagnostic accuracy of 88.0%. Endoscopic findings of the lower esophagus or the cardial orifice and diagnostic yields of the 2 methods were correlated. In patients with mucosal elevation, thick fold or a tight cardial stenosis as a pattern of esophageal involvement by gastric cancer on esophagoscopy, supplementary application of brushing increased diagnostic accuracy approximately 20% compared to that of biopsy alone. Brushing cytology should be utilized more frequently in gastric cancer involving the cardia to the lower esophagus, especially in the 3 types of esophageal involvement mentioned.