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

Abstract

Introduction: The Oral CDx® brush biopsy (BB) method is a computer-assisted sample analysis that detects abnormal cells in all cell layers of the epithelium of the oral mucosa.

Brush Biopsy Sample Quality: Preliminary Investigation of a Metal Brush Prototype

“…Oral Potentially Malignant Disorders (OPMD) are morphologically altered oral mucosal tissue with higher risk of progression to cancer and usually revealed during clinical examination [1][2][3]. In these lesions, varying degrees of cellular atypia and tissue dysmaturation restricted to the epithelium may be observed and are termed as oral epithelial dysplasia [4,5].…”

“…The major histological criteria for diagnosis of an epithelial dysplasia are abnormal patterns of keratinization [6], hyperplastic basal cells, enlarged and hyperchromatic nuclei, and drop-shaped rete ridges [7], which may be present at the same site before the malignant changes develop [3,8].…”

“…Depending upon the extent of cytologically immature cells, OPMDs are usually grouped as low-grade dysplasia (combining mild and moderate dysplasia) or high-grade dysplasia (combining severe dysplasia and carcinoma in situ) [6]. Although controversial [3], the greatest likelihood for malignant transformation usually depends on the severity of dysplastic changes of the tissue [2,9,10]. OPMD might turn into carcinoma in a percentage varying between 5-18% [11,12], but the presence of moderate or severe dysplasia has been accepted to have the highest risk for malignant transformation [13,14], ranging from 11-36% with a mean time of 33.6 months [13].…”

“…The presence of symptoms that are not strongly indicative of carcinoma might result in diagnostic delay and poor prognosis [2,15]. Even the expert oral medicine specialists report difficulties in assessment of the risk of malignant transformation of OPMDs [16] and non-invasive diagnostic adjuncts including vital staining, optical imaging and brush biopsy cytology have been proposed in order to improve early detection of OPMDs with risk of malignant progression in oral mucosa [3,[17][18][19]. Unfortunately, their efficacy is yet to replace the histological examination, which is still accepted as the gold standard in oral mucosal lesion diagnosis [3,[18][19][20].…”

“…However, lack of a complete sampling containing cells from all layers of the stratified epithelium is a major drawback of the technique, especially in highly keratinized mucosal lesions [3,21,23], and in order to overcome this problem, newer collection devices or "cytobrushes" in addition to conventional plastic cytobrush have been developed [24,25].…”