The efficacy of oral brush biopsy with computer-assisted analysis in identifying precancerous and cancerous lesions

Abstract

BackgroundCancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies. There is a paucity of reliable diagnostic methods to detect early malignancies. This study was performed to evaluate the sensitivity and specificity of brush biopsy in identifying oral premalignant and malignant lesions.MethodsOral brush and scalpel biopsies were performed on 85 consecutive patients presenting with an oral lesion deemed to be minimally suspicious by clinical examination and the results were compared.ResultsOf 79 patients with adequate brush biopsy samples with matching scalpel biopsies, 27 revealed histopathologic evidence of dysplasia or carcinoma, 26 of which were independently identified with the oral brush biopsy (sensitivity: 96.3% - 95% CI, 87%-100%). 52 oral lesions did not reveal any histopathologic evidence of dysplasia or carcinoma and of these, brush biopsy reported 47 as "negative" and 5 as "atypical"(specificity of "positive" brush biopsy result is 100%- 95% CI, 93%-100%; specificity for "atypical" brush biopsy result is 90.4%- 95% CI, 82%-97%. The positive predictive value of an abnormal oral brush biopsy was 84% and the negative predictive value was 98%.ConclusionOur study demonstrated that the oral brush biopsy is an accurate test in identifying oral premalignant and malignant lesions, even if minimally suspicious.

Evaluation of an innovative oral brush for potential applications using liquid based cytology

“…In the scientific or commercial field, no cytobrush specifically designed for oral use has emerged, except for the Oral CDx brush, which was distributed as part of a kit. Oral CDx is quite similar to a conventional brush for oral cytology except that the collection device differs, and computer-assisted screening is employed (17,18). The oral CDx system has been shown to be capable of obtaining transepithelial specimens.…”

“…The oral CDx system has been shown to be capable of obtaining transepithelial specimens. Several studies have assessed the accuracy of the Oral CDx and reported high sensitivity and specificity for detection of oral squamous cell carcinoma and precancerous lesions in comparison with scalpel biopsy (16,(18)(19)(20). However, there has been some controversy about the sensitivity and specificity of this system (17,19,21,22).…”

Adjunctive diagnostic techniques for oral lesions of unknown malignant potential: Systematic review with meta-analysis

“…A total of 48 articles were identified as eligible for qualitative analysis, 37 of which were “modern era” articles and, thus, eligible for inclusion in the aggregated quantitative analysis . One pair of articles reported data from the same study, but, in this case, the “duplicate” aided in the reconstitution of raw data.…”

“…Data were included in the quantitative analysis and aggregated for comparison for any techniques that had at least three includable datasets. This left 25 articles across five different adjuncts . These techniques were COE (three datasets), cytology (12 datasets), toluidine blue vital staining (eight datasets), laser‐induced autofluorescence (LIAF) spectroscopy (four datasets) and diffuse reflectance spectroscopy (DRS; three datasets).…”

Transepithelial Brush Biopsy – Oral CDx® – A Noninvasive Method for the Early Detection of Precancerous and Cancerous Lesions

“…It is difficult to evaluate our data in relation to the literature, because there are great differences in how the parameters are calculated. Hohlweg-Majert et al, [6], for example, summarized the atypical and positive cell abnormalities to calculate the sensitivity and specificity; other authors [12,17] calculated them separately. The sensitivity of our findings was remarkably high if one considered that we included also the atypical results of the BBs.…”