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. 2022 Sep;130(9):740-748.
doi: 10.1002/cncy.22599. Epub 2022 Jun 15.

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

Majdy Idrees  1 , Camile S Farah  2   3   4   5 , Philip Sloan  6   7   8 , Omar Kujan  1
Affiliations

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

Majdy Idrees et al. Cancer Cytopathol. 2022 Sep.

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.

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Conflict of interest statement

The author made no disclosures.

Figures

FIGURE 1
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
See this image and copyright information in PMC

References

    1. Warnakulasuriya S, Kujan O, Aguirre‐Urizar JM, et al. Oral potentially malignant disorders: a consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Dis. 2020;27(8):1862–1880. - PubMed
    1. Iocca O, Sollecito TP, Alawi F, et al. Potentially malignant disorders of the oral cavity and oral dysplasia: a systematic review and meta‐analysis of malignant transformation rate by subtype. Head Neck. 2019;42(3):539–555. - PubMed
    1. Idrees M, Kujan O, Shearston K, Farah CS. Oral lichen planus has a very low malignant transformation rate: a systematic review and meta‐analysis using strict diagnostic and inclusion criteria. J Oral Pathol Med. 2020;50(3):287–298. - PubMed
    1. Yang E, Tan M, Schwarz R, Richards‐Kortum R, Gillenwater A, Vigneswaran N. Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(6):670–681. - PMC - PubMed
    1. Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: recognition, grading and clinical significance. Oral Dis. 2021;27(8):1947–1976. - PubMed