Minimally invasive oesophageal 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 BromwichAmini Daudi, Ngowi Rehema Minde, Jackson Claver, Alex Mremi, Amos Mwasamwaja, Joachim Schüz, Rebecca C. Fitzgerald Valerie McCormack
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Oesophageal 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 oesophageal squamous cell carcinoma (ESCC) rates are high. We aimed to assess the feasibility of a capsule‐based diagnosis of oesophageal 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: oesophageal 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 aetiology and early‐detection research. Targeted sampling strategies and biomarker development will underpin the success of such initiatives. The study protocol is registered on (NCT04090554)