What biopsy technique should be used to sample an esophageal ulcer?
The exact number of biopsies required for maximal sensitivity and specificity is not clearly established, but several studies suggest the range of 8 to 10 . It is important to obtain biopsy samples from the ulcer margin and from the ulcer base. This is because biopsy of the ulcer edge reveals a cytopathic effect that is present in squamous epithelium associated with HSV; conversely, CMV resides in granulation tissue in the ulcer base. The role of culture and cytologic examination for esophageal ulcers is not settled. If all biopsies are negative for viral, bacterial, fungal, and parasitic infections, a diagnosis of IEU can be made.