Oral brush biopsy using liquid-based cytology is a reliable tool for oral cancer screening: A cost-utility analysis: Oral brush biopsy for oral cancer screening

Abstract

Background: This study aimed to assess the diagnostic utility and associated cost of oral liquid-based brush cytology (OLBC) in the diagnosis of oral cancer and oral potentially malignant disorders (OPMDs).

Methods: A total of 284 patients with oral mucosal lesions were included. OLBC samples were collected from all patients immediately before undergoing surgical biopsies. A liquid-based cytology slide was prepared from each OLBC sample for cytological evaluation using the modified 2014 Bethesda cytology system. The results and the cost were compared with the histopathological outcomes.

Results: The level of agreement between the two approaches was very good (weighted kappa = 0.824). The accuracy of OLBC in differentiating between the different diagnostic groups was 91.69%, whereas the associated sensitivity and specificity were 79.23% and 94.81%, respectively. The estimated cost of each OLBC sample was at least 26% less than the cost of a single biopsy and more than 42% less in cases of multiple biopsied lesions.

Conclusions: The proposed modifications of the Bethesda system can be adopted as a standardized system for oral cytological assessment. Our findings support OLBC as a reliable adjunct to surgical biopsy in the diagnosis of OPMDs. This tool has potential for oral cancer-finding and surveillance programs.

Keywords: brush biopsy; cost analysis; oral liquid-based brush cytology; oral potentially malignant disorders.

FIGURE 1

(A) Normal superficial and intermediate squamous cells. (B) A sheet of atypical squamous cells of undetermined significance (note there is a slight increase in N/C ratio ≤ 10% with even chromatin distribution) (×400). (C) Sheets of immature squamous cells exhibiting slightly enlarged nuclei with dense chromatin suggestive of changes consistent with oral lichen planus/lichenoid lesion (×400). (D) Sheets of degenerative squamous cells associated with lymphocytes suggestive of changes consistent with oral lichen planus/lichenoid lesion. Note there is a slight increase in N/C ratio ≤ 10% with even chromatin distribution (×400). (E) Squamous intraepithelial lesion (low grade). Note the increase in N/C ratio ≤ 50% (×500). (F) Squamous intraepithelial lesion (high grade). Note the increase in N/C ratio > 50% and ≤ 75% (×500). (G) Squamous cells suggestive of OSCC. Note the massive increase in N/C ratio ≥ 75% (×500). N/C indicates nuclear/cytoplasmic ratio; OSCC, oral squamous cell carcinoma