Advantages and difficulties of brush cytology in the identification of early oral cancer

Abstract

Background: Early oral cancer is asymptomatic and highly curable, but unfortunately most cancers are advanced by the time when they are discovered, so the mortality is relatively high. The aim of this study was to refer the advantages as well as the difficulties of brush cytology in the identification of early oral cancer. Methods: Cytological smears obtained from of the oral mucosa of 36 patients were evaluated. The materials were taken with a cytobrush by scraping the surface of the suspected lesions, fixed with cytospray fixative and stained with the Papanicolaou method, whereas the residual was prepared by the liquid-based technique Thin-Prep 2000. Results: There were 29 inflammatory and mild dysplastic lesions, three cases with mild dysplasia only and two cases with severe dysplasia possible carcinoma. Another two showed squamous cell carcinoma. Histological examination of possible malignant and malignant cases showed well differentiated squamous cell carcinomas, so wide excisions were performed. Conclusion: Oral cytology is well accepted by the patient and attractive option for the early diagnosis of the oral cancer. It is useful when the lesion is large or multiple or the patients refuse biopsy. However there are factors that contribute to a false negative diagnosis such as the selection of the site of biopsy, necrosis, blood crusting, lack of adequate training, and the fact that malignant features of squamous cell carcinoma can be subtle resembling dysplasia.