Oral brush biopsy using liquid-based cytology is a reliable tool for oral cancer screening: A cost-utility analysis

Majdy Idrees, Camile Farah, Philip Sloan, Omar Kujan

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


BACKGROUND: This study aimed to assess the diagnostic utility and associated cost of oral liquid-based brush cytology
(OLBC) in the diagnosis of oral cancer and oral potentially malignant disorders (OPMDs). METHODS: A total of 284 patients
with oral mucosal lesions were included. OLBC samples were collected from all patients immediately before undergoing
surgical biopsies. A liquid-based cytology slide was prepared from each OLBC sample for cytological evaluation using the
modified 2014 Bethesda cytology system. The results and the cost were compared with the histopathological outcomes.
RESULTS: The level of agreement between the two approaches was very good (weighted kappa = 0.824). The accuracy
of OLBC in differentiating between the different diagnostic groups was 91.69%, whereas the associated sensitivity and
specificity were 79.23% and 94.81%, respectively. The estimated cost of each OLBC sample was at least 26% less than the
cost of a single biopsy and more than 42% less in cases of multiple biopsied lesions. CONCLUSIONS: The proposed modifications of the Bethesda system can be adopted as a standardized system for oral cytological assessment. Our findings
support OLBC as a reliable adjunct to surgical biopsy in the diagnosis of OPMDs. This tool has potential for oral cancer–
finding and surveillance programs. Cancer Cytopathol 2022;0:1-9. © 2022 The Authors. Cancer Cytopathology published by
Wiley Periodicals LLC on behalf of American Cancer Society. This is an open access article under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the
original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Original languageEnglish
Pages (from-to)740-748
Number of pages9
JournalCancer Cytopathology
Issue number9
Publication statusPublished - Sept 2022


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