Computer-assisted analysis of oral brush biopsies at an oral cancer screening program

Abstract

Background: Dentists and dental hygienists attending a health screening program were screened for oral cancer. Select oral epithelial lesions were evaluated by oral brush biopsy with a computer-assisted method of analysis (OralCDx, OralScan Laboratories Inc., Suffern, N.Y.).

Methods: After those who had oral epithelial lesions were identified, the clinical characteristics of each lesion were recorded. Participants with abnormal oral brush biopsy results ("positive" and "atypical") subsequently underwent incisional biopsy of their lesions by an oral surgeon.

Results: A total of 930 dentists and dental hygienists were screened over a four-day period at each of the American Dental Association's 1999 and 2000 annual sessions. Eighty-nine people (9.7 percent) with 93 oral epithelial lesions were identified and evaluated by brush biopsy. Seven of the 93 oral lesions-all benign appearing in their clinical appearance-were determined to be "atypical" or "positive." Of these, three were diagnosed as precancerous by scalpel biopsy and histologic evaluation.

Conclusions: Computer-assisted brush biopsy analysis is a valuable adjunct to the oral screening examination. The identification of three innocuous-looking precancerous lesions in this low-risk group of dentists and dental hygienists underscores the necessity of evaluating all oral lesions of unknown etiology.

Clinical implications: As 9.7 percent of the screened dentists and dental hygienists had epithelial oral lesions, general dentists most likely routinely encounter an even higher percentage of oral lesions in their patients. The minimally invasive brush biopsy lets general dentists evaluate these lesions. Like Pap smears and mammograms, this tool can help identify precancers and potentially curable cancers.