Diagnostic accuracy of flexible endoscopic biopsy in carcinoma of the oesophagus and cardia.

The endoscopic diagnoses of 51 patients with carcinoma of the oesophagus and cardia were studied. Tissue for histology and cytology was obtained through either the flexible (28) or rigid (23) endoscope and the results compared. Squamous cell carcinoma was diagnosed accurately (100%) by either method. Adenocarcinoma was poorly diagnosed by flexible endoscopy (five out of 13 with one false positive) while rigid endoscopy remained accurate (six out of six). Misdiagnosis with the flexible endoscope has been shown to occur in the presence of inflammation of the mucosa or tumour infiltration of the submucosa of the lower oesophagus. This has been attributed to the inadequacy of the specimen size for accurate diagnosis in these circumstances.