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Dr. Robert D. Fusco, Medical Director    
Using a Cytology Brush on an Ulcer

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Brushing an Ulcer
 
Here is an example of how a cytology brush can be used to test a stomach ulcer for cancer cells. This 62 year old man came to our hospital stating that he had vomited blood twice in past two weeks. After stabilizing his blood pressure with intravenous fluids, a gastroscopy examination was performed. A small, but deep, stomach (gastric) ulcer was found. Most stomach ulcers are not cancerous. But sometimes stomach ulcers are cancerous, so a biopsy was indicated. However, the patient had been on Coumadin, a "blood thinner," which can cause a biopsy site to bleed.

Therefore, an alternative sampling was used - cytopathology. "Cytos" means cell and "pathos" means abnormal. So, Cytopathology is the study of abnormal cells, like cancer cells. Using a technique similar to a PAP smears, a tiny nylon brush was passed through the center channel of the gastroscope. As the photo shows, this cytology brush was scraped across the surface of the ulcer collecting cells for analysis. Fortunately, no cancer cells were found and the bleeding has stopped; so no surgery was needed. The patient was discharged a few days later on medicine for his ulcer. He will return in 8 weeks for a recheck to make sure the ulcer has healed.

A cytology brush can also be used to take samples for conditions other than cance. Sometimes, this technique is used to test for infection such as a yeast infection, Candida, which is sometimes seen in the esophagus.
 

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