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Oral Brush Biopsy - A routine diagnostic procedure

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Dr Chetna Bogar's picture
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Joined: 26 Sep 2011

A biopsy obtained by passing a bristled catheter into suspected areas of disease and removing cells that are entrapped in the bristles for microscopic examinations is brush biopsy.

The high mortality rate from oral cancer is due to several factors, but undoubtedly, the most significant is delayed diagnosis. Studies have demonstrated that the survival and cure rate dramatically increase when oral cancer is detected in its precancerous stage or as an early stage disease. For example, the 5-year survival for patients with localized disease is approximately 80% whereas it is 20% for those with distant metastases. Unfortunately, approximately two thirds of patients at the time of diagnosis are symptomatic, and over 50% display evidence of spread to regional lymph nodes and metastases. Therfore it is the need of the hour that the clinicians be well-equipped with an accurate diagnostic technique that will increase the detection of early stage of oral-cancer so that the morbidity and mortality associated with advanced oral-cancer be reduced. Oral brush biopsy is one such advancement which was introduced todental profession in the year 1999.A commercial company by name OralCDX introduced it in the year 2000.

The oral brush biopsy was introduced to the dental profession in 1999. This biopsy method utilizes an improved brush to obtain a complete transepithelial biopsy specimen with cellular representation from each of the three layers of the lesion: the basal, intermediate, and superficial layers. Unlike previous cytology instruments, which collect only exfoliated superficial cells, when used properly and rubbed against an area of suspect tissue aggressively (to the point of minor bleeding) the biopsy brush penetrates to the basement membrane, removing tissue from all three epithelial layers of the oral mucosa, although as with all brush collection methods it does not maintain the architecture of the cells relationship to each other.. The oral brush biopsy does not require topical or local anesthetic and causes minimal bleeding and pain. The brush biopsy instrument has two cutting surfaces, the flat end of the brush and the circular border of the brush. Either surface may be used to obtain the specimen

The brush biopsy provides dentists with a diagnostic screening test similar to a Pap smear. Whereas the Pap smear is a procedure performed on all women and a brush biopsy is used only in patients with a visible mucosal spot, both tests are adjuncts to the clinical examination and are used to identify a disease at an early and curable stage, both are simple to perform, office-based, painless tests; and both procedures can be integrated into the daily routine of practice. Given the difficulty in clinically differentiating premalignant and early malignant oral lesions from those that are benign, the brush biopsy allows practitioners to test lesions that are encountered daily. When a positive result is returned by the OralCDx laboratory system, conventional, gold standard, incisional or punch biop sy must be performed.

ORAL BRUSH BIOPSY
5-15% of the general population has an oral lesion. Oral cancer has a 50% mortality rate because it is not detected early enough.
The oral CDx brush biopsy is a reliable non-invasive and simple chair side procedure to determine if an oral lesion is benign or potentially harmful. Precancerous and early stage oral cancerous lesions can be determined. It is essential that these early stage malignancies be checked to improve diagnosis. The painless procedure can be done without local anesthetic.

The oral biopsy brush is pressed against the lesion and rotated 5-10x or more depending on the thickness of the lesion. The cellular material collected on the brush is then transferred onto a glass slide.

All brush biopsy specimens are sent to OralScan Laboratories for computer image analysis, assisted identification and display of any abnormal cells.

OralScan Laboratories will fax a report with a pathologist's explanatory results within three days after the specimen is received by the lab. If a positive report is obtained it will be necessary to obtain a histological section to grade the abnormality once it is identified in order to completely characterize the lesion histologically.

Discussion
We the dental professionals should aim at reducing the morbidity and mortality rates due to advanced oral-cancers. This can however be achieved only by early diagnosis and treatment of oral-cancers. This can be made possible by easy and non-invasive techniques like oral brush biopsy. By introducing this technique into our routine diagnostic techniques and by creating awareness among patients this can be made possible. But however there is one major disadvantage in this attempt of ours and that is the cost of the technique which may appear to be too expensive for the patients.

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