In 173 patients with gastric cancer involving the cardia or the lower esophagus, endoscopic biopsy and/or brushing cytology were utilized in establishing the diagnosis microscopically. Biopsy was positive in 132 of 170 patients (77.0%) while brushing was positive in 78 of 93 patients (83.8%). However, a combined use of biopsy and brushing yielded a higher diagnostic accuracy of 88.0 per cent. Further, endoscopic findings of the lower esophagus or the cardial orifice and diagnostic yields of the two methods were correlated. In patients with mucosal elevation, thick fold or a tight cardial stenosis as a pattern of esophageal involvement by gastric cancer on esophagoscopy, supplementary application of brushing increased diagnostic accuracy approximately 20 per cent compared to that of biopsy alone. It is concluded that brushing cytology should be utilized more frequently in gastric cancer involving the cardia to the lower esophagus, especially in the three types of esophageal involvement mentioned above.