Application of Esophageal Sponge Cytology in Screening Esophageal Squamous Cell Carcinoma in a High-Risk Region of China

Abstract

Objective

To investigate the feasibility and accuracy of esophageal sponge cytology in screening esophageal squamous cell carcinoma (ESCC).

Methods

From May 2021 to June 2022, an opportunistic screening was performed in people aged 40–75 from a high-risk region for ESCC. Using an esophageal cell collector that was independently developed in China for esophageal sponge cytology, a positive cytology was determined as detection of atypical squamous cells or more severe lesions. The safety, tolerability, and accuracy of esophageal sponge cytology were compared with those of pathological examination after endoscopy and biopsy.

Results

A total of 1581 eligible participants were involved in the screening program, including 61 (3.86%) with high-grade lesions pathologically confirmed by endoscopic biopsy. No serious adverse events were reported during sampling. Major adverse events included vomiting during sampling (n = 2, 0.13%) and sore throat after sampling (n = 36, 2.27%). The majority of participants showed good tolerability and accessibility (n = 1568, 98.80%) accessed by the visual analogue scale (VAS). Esophageal sponge cytology offered a satisfactory diagnostic accuracy in screening advanced esophageal epithelial lesions, with a sensitivity of 98.36% (95%CI: 90.02%–99.91%) and a specificity of 91.15% (95%CI: 89.97%–92.84%), and a negative predictive value up to 99. 92% (95%CI: 99.53%–99.99%).

Conclusion

Esophageal sponge cytology is a highly feasible, safe, and accurate screening method for ESCC in a high-risk region of China.

Trial Registration

First Affiliated Hospital of Naval Medical University: NCT04609813