Liquid-based oral brush cytology in the diagnosis of oral leukoplakia using a modified Bethesda Cytology system.

OBJECTIVES: This study aimed to develop diagnostic criteria to identify oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs) using oral liquid-based brush cytology (OLBC), and to compare its accuracy with the gold standard of surgical biopsy and histopathological diagnosis of oral leukoplakia. METHODS: A total number of 134 samples were collected. All patients underwent Orcellex® brush biopsy with liquid-based cytology immediately prior to diagnostic surgical biopsy. A preliminary study was first performed utilizing samples from 4 distinct lesion groups (20 samples) to revise the 2014 Bethesda Cytology system for use with OLBC specimens. RESULTS: Five diagnostic groups of OLBC for the diagnosis of OSCC and OPMDs with relevant cytopathological features were established. From the 114 samples in the test group, 101 were included. The other 13 were excluded due to inadequate cellularity. The test showed sensitivity, specificity, positive predictive value and negative predictive value of 75%, 76%, 76% and 75%, respectively, and an accuracy of 75%. The use of the oral brush sampling technique was well accepted by multiple clinicians; however, local anaesthetic was suggested to be useful prior to performing the brush biopsy. CONCLUSIONS: Oral liquid-based brush cytology using the Orcellex® brush and ThinPrep® system is a simple and minimally invasive procedure for adequate intraepithelial sampling and can be used as an adjunct for the early detection of oral cancer. The modified Bethesda system established useful means for OLBC assessment that can be utilized in future studies to increase the standardization of oral cytology assessment.

The utility of oral brush cytology in the early detection of oral cancer and oral potentially malignant disorders: A systematic review.

OBJECTIVES: This systematic review aimed to analyze the published evidence for the use of oral brush cytology for the early detection of oral cancer and oral potentially malignant disorders (OPMDs). METHODS: Literature was systematically searched through several databases: MEDLINE, EMBASE, PubMed, SCOPUS, Cochrane Library, and Web of Science. Additional review was performed through cross-checks on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of oral brush cytology on human tissues and its applications in the diagnosis, screening, or surveillance of oral cancer or OPMDs. RESULTS: The search strategy resulted in 343 abstracts or full-text articles, of which 36 met the inclusion criteria. The year of publication ranged from 1994 to 2017, and a total of 4302 samples from OPMDs, oral squamous cell carcinoma, and healthy controls have been investigated. Baby toothbrush, cytobrush, OralCDx® , and Orcellex® are the brushes that were used to obtain transepithelial mucosal samples for conventional and liquid-based cytology evaluation. CONCLUSIONS: Findings from this study indicate that meaningful evidence-based recommendations for the implementation of a minimally invasive technique to be utilized as an adjunctive tool for screening and early detection of oral cancer and OPMDs are complicated from the reported studies in the literature. There is need for well-designed clinical studies to assess the accuracy of oral brush cytology utilizing validated cytological assessment criteria for the diagnosis and prediction of OPMDs.

Synchronous occurrence of odontogenic keratocyst and ameloblastoma: A case report and review of the literature.

Odontogenic keratocyst (OKC) and ameloblastomas are distinct histopathologically diagnosed odontogenic lesions of the oral cavity. Both are primarily located in the posterior regions of the mandible, however, they can involve the maxilla as well. The occurrence of both an OKC and ameloblastoma in a patient is very uncommon. This case demonstrated such a lesion in the mandible of a 57 years old female. The diagnostic work-up and features of both lesions are illustrated with special focus on histopathological variances distinguishing OKC from ameloblastoma with the support of immunohistochemistry. This case highlights the importance of identifying accurate diagnoses for such lesions which may prompt clinical implications. Clinico-pathologic understanding of both lesions signifies the need for careful management plan and prevention of recurrence. Previously reported simultaneous occurrences of odontogenic cysts and/or tumors in the oral cavity are also reviewed.

The Gingival Oral Lichen Planus: A Periodontal-Oral Medicine Approach.

We present a case of a 77-year-old female who suffered from oral lichen planus (OLP) involving her gingiva and bilateral buccal mucosa for over 6 months. We showed that oral hygiene measures and conventional periodontal treatment and strict maintenance were sufficient to control the gingival involvement of OLP. The mechanism of OLP is complex and not yet fully understood. The focus of discussion in our case was that knowledge and understanding of gingival pathology are fundamental for a determined management approach. Our case was managed according to the suggested protocols in previous case studies. A multidisciplinary approach allowed for accurate diagnosis and treatment tailored to the presented case.