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

Daniel R.S. Middleton*, Blandina T. Mmbaga, Maria O'Donovan, Behnoush Abedi-Ardekani, Irene Debiram-Beecham, Gissela Nyakunga-Maro, Venance Maro, Martin Bromwich, Amini Daudi, Timothy Ngowi, Rehema Minde, Jackson Claver, Alex Mremi, Amos Mwasamwaja, Joachim Schüz, Rebecca C. Fitzgerald, Valerie McCormack

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
3 Downloads (Pure)

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. 

Original languageEnglish
Pages (from-to)1208-1218
Number of pages11
JournalInternational Journal of Cancer
Volume148
Issue number5
Early online date21 Nov 2020
DOIs
Publication statusPublished - 01 Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
The study was funded by the International Agency for Research on Cancer (IARC) and partially supported by a Researcher Mobility Grant from Chemistry Biology Interface Division (CBID) of the Royal Society of Chemistry (RSC). Work was undertaken during the tenure of a Postdoctoral Fellowship at IARC, partially supported by the European Commission FP7 Marie Curie Actions—People—Co‐funding of regional, national and international programmes (COFUND).

Funding Information:
We gratefully acknowledge the technical support of Christine Carreira Romao at IARC, logistical support from Dr Aisling Redmond at the MRC Cancer Unit and knowledge exchange from Dr Michael Mwachiro at Tenwek Hospital, Bomet, Kenya. We thank Dr Partha Basu (IARC) and Dr Sokoine Kivuyo (NIMR) for their duties as independent study monitors. The study was funded by the International Agency for Research on Cancer (IARC) and partially supported by a Researcher Mobility Grant from Chemistry Biology Interface Division (CBID) of the Royal Society of Chemistry (RSC). Work was undertaken during the tenure of a Postdoctoral Fellowship at IARC, partially supported by the European Commission FP7 Marie Curie Actions?People?Co-funding of regional, national and international programmes (COFUND).

Publisher Copyright:
© 2020 International Agency for Research on Cancer (IARC/WHO); licensed by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.

Keywords

  • Africa
  • Cytosponge
  • esophageal cancer
  • squamous dysplasia

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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