Clinical correlative study on early detection of oral cancer and precancerous lesions by modified oral brush biopsy and cytology followed by histopathology

Oral cancer accounts for 5% of all malignant tumors and 60% of these lesions are well advanced at the time of diagnosis. The early diagnosis could prevent a large number of deaths due to this disease. This study aims to evaluate and compare the clinical usefulness of exfoliative cytology, modified brush biopsy (without computer assisted analysis), and biopsy in early detection of oral premalignant and malignant lesions. Modified oral brush biopsy (using baby toothbrush) and exfoliative cytology was performed on 225 clinically diagnosed oral precancerous lesions (suspected) selected from among 1099 lesions in 877 patients. Scalpel or punch biopsy was performed based on clinic-cytological evidence (test result and/or clinical judgment) on only 117 lesions. All the specimens were analyzed manually in a double-blinded fashion. RESULTS were analyzed using Statistical package for Social Sciences version 12 (SPSS Inc., Chicago, IL, USA) and subjected to Fischer exact test. Of 117 lesions that underwent all the three tests, modified oral brush biopsy showed a reasonably higher specificity (68.42%) and sensitivity (81.69%) when compared with specificity (86.48%) and sensitivity (48.57%) of cytology. The results demonstrate that modified oral brush biopsy has higher efficacy than routine cytology and can be used as a potentially practical oral cancer screening tool in resource challenged settings. However, clinical judgment is of prime importance. Immediate biopsy is mandatory in highly suspicious lesions proposed under the diagnostic criteria of "clinically diagnosed carcinoma in situ".