Liquid-based trans-epithelial flexible brush cytology of high-grade laryngeal mucosal lesions

Abstract

Laryngeal cytology, which was popular in the 1950s and 60s, has lost its appeal due to difficulties in obtaining adequate specimens and frequent false negative results which are often associated with smears of suboptimal quality. Flexible laryngoscope and brushes, and liquid-based cytology (LBC) allow for improved collection and quality of laryngeal mucosal samples. In LBC the cells are optimally fixed and significantly retrieved. The samples are virtually devoid of air drying artefact and obscuring elements such as blood, mucus, necrotic debris and inflammation. The diagnostic accuracies of liquid-based transepithelial flexible brush cytological (LBTEFBC) samples and flexible biopsies (FB) were compared with those of biopsy under general anaesthesia (BUA) in 49 and 46 patients respectively. Cytology specimens were graded and scored using a recently proposed oral cytological grading and scoring system. When compared with BUA, the cytology showed 97% sensitivity and 100% specificity, and FB yielded 77.1% sensitivity and 100% specificity. Reactive/mildly dysplastic lesions can be discriminated from high-grade dysplasias/invasive squamous cell carcinomas with 100% sensitivity and specificity. LBTFBC is a simple, cost-effective, relatively atraumatic office-based procedure, and with the recently proposed classification, it can be accurate in the detection of high-grade laryngeal lesions.