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Scrape cytology – can it replace punch biopsy in diagnosing oral lesions?

Bharti M Jha, Arpita Roy, Sayantan H Jana, Chandni Patel, Piyush Vaghela, Sonal Gupta.

Background: Oropharyngeal carcinoma is one of the leading causes of morbidity and mortality in Indian population due to increased use of tobacco chewing products. Mucosal biopsy is widely regarded as the gold standard for detecting oral carcinomas, but exfoliative cytology are increasingly used for early detection of malignancy and strict follow up in suspicious looking lesions.

Aims & Objective: The aim of this study was to see the reliability of oral scrape cytology to detect pre-malignant and malignant oral lesions in terms of sensitivity and specificity and to see whether it can replace biopsy for diagnosing the same.

Material and Methods: A total of 100 cases with oral lesions were included in the study. All patients underwent oral scrape cytology and 55 cases were followed up with punch biopsy. Sensitivity, specificity, positive and negative predictive values were calculated. Cytopathology and histopathology of premalignant and malignant lesions were compared using T test.

Results: Oral cancer is most common in male (M: F 7:1). Premalignant lesions were more common in the tongue, whereas the floor of mouth was more involved by malignant lesions. Four cases were marked insufficient on cytopathology. 25% of cases were false negatives. The sensitivity, specificity, positive predictive value and negative predictive value were 91.5%, 100%, 100% and 66.7%, respectively. Statistical analysis showed P of 0.7491 suggesting that there is no significant difference between histopathology and brush cytology in assessing clinically premalignant lesions but for clinically malignant lesions P values of 0.0001 suggesting that there is significant difference between histopathology and scrape smear cytopathology in assessing malignant lesions.

Conclusion: The high specificity and the high positive predictive value of oral scrape cytology makes it an ideal screening test for early detection of oral cancer. However, its low sensitivity means that it can miss cases of carcinoma, and should be followed up with biopsy with string clinical suspicion. Also, there is statistically significant difference between histopathological and cytopathological diagnosis in diagnosing dysplasia or carcinoma.

Key words: Oral Scrape Cytology; Oropharyngeal Carcinoma; Punch Biopsy; Diagnosis; Oral Lesions

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