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Minimally invasive esophageal sponge cytology sampling is feasible in a Tanzanian community setting.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Middleton, Daniel RS  ORCID logo  https://orcid.org/0000-0003-2450-8610
Mmbaga, Blandina T 
O'Donovan, Maria 
Abedi-Ardekani, Behnoush 
Debiram-Beecham, Irene 

Abstract

Esophageal sponge cytology is an endoscopy alternative well accepted by patients with extensive data for accuracy in the context of adenocarcinoma. Few studies have assessed its feasibility in asymptomatic community members, and fewer still in East Africa, where esophageal squamous cell carcinoma (ESCC) rates are high. We aimed to assess the feasibility of a capsule-based diagnosis of esophageal squamous dysplasia (ESD), an ESCC precursor, which may benefit epidemiological and early detection research. We collected Cytosponge collections in 102 asymptomatic adults from Kilimanjaro, Tanzania. Uptake, acceptability and safety were assessed. Participants scored acceptability immediately following the procedure and 7 days later on a scale of 0 (least) to 10 (most acceptable). Slides from paraffin-embedded cell clots were read by two pathologists for ESD and other pathologies. All participants (52 men, 50 women, aged 30-77) swallowed the device at first attempt, 100 (98%) of which gave slides of adequate cellularity. Acceptability scores were 10 (53%), 9 (24%), 8 (21%), 7 (2%) and 6 (1%), with no differences by age, sex or time of asking. Cytological findings were esophageal inflammation (4%), atypical squamous cells of uncertain significance (1%), low-grade dysplasia (1%), gastritis (22%) and suspected intestinal metaplasia (6%). Setting-specific logistical and ethical considerations of study implementation are discussed. We demonstrate the safety, acceptability and feasibility of Cytosponge sampling in this setting, paving the way for innovative etiology and early-detection research. Targeted sampling strategies and biomarker development will underpin the success of such initiatives. The study protocol is registered on ClinicalTrials.gov (NCT04090554).

Description

Keywords

Africa, Cytosponge, esophageal cancer, squamous dysplasia, Adult, Aged, Cytodiagnosis, Esophageal Neoplasms, Esophageal Squamous Cell Carcinoma, Female, Humans, Male, Middle Aged, Precancerous Conditions, Specimen Handling

Journal Title

Int J Cancer

Conference Name

Journal ISSN

0020-7136
1097-0215

Volume Title

148

Publisher

Wiley
Sponsorship
MRC (MR/W014122/1)