OP176: The value of the oral brush in identifying precancerous and cancerous lesions

Abstract

Despite advances in surgical and other treatment modalities, the prognosis of patients with oral squamous cell carcinoma (OSCC) remains poor. It is well known that the early detection of OSCC and recurrent lesions is of utmost importance in obtaining disease control. Besides difficulty in visually differentiating between benign and (pre) cancerous lesions, the detection is hampered by the fact that scalpel biopsy is an invasive activity with potential morbidity. It is therefore not recommended to biopsy lesions on a regular basis. An easily performed, non-invasive screening method suitable to monitor lesions over time is urgently needed. In addition, the current histopathological examination suffers from inter- and intra-observer variability. In a previous study we showed the prognostic value of DNA image cytometry (ICM). Aim of the present study is assessment of the possibility to determine ploidy status using an oral brush. This prospective study included 85 (23 premalignancies, 27 stage T1 and 31 stage T2 OSCC) patients who visited the department of Oral and Maxillofacial Surgery at the Radboud University Nijmegen Medical Center, The Netherlands, with a suspected (pre) malignant lesion of the oral cavity. Newly discovered lesions as well as suspected recurrent OSCC were included. Both a brush and biopsy specimen were obtained for each patient. All specimens were analysed using ICM according to a well-established procedure. A significant difference was observed between brushes from diploid biopsies and brushes from non-diploid biopsies ( p < .01). The brush was able to significantly differentiate between diploid and non-diploid lesions. This technique was able to correctly identify 50% of the non-diploid lesions with a corresponding specificity of 80%. The oral brush biopsy is not suitable to replace the conventional surgical biopsy, however it may be of additional value in monitoring (pre) malignant lesions over time.