Brush biopsies in diagnostic tests for oral cancer

Early diagnosis of potentially malignant oral lesions is important for a favourable prognosis. Usually, the diagnosis is based on the analysis of a surgical biopsy. A brush biopsy, where cell samples are collected from the surface of the lesion with a brush is a simple and less invasive procedure. The cells are then stained an analysed under a microscope or in a flow cytometer to detect dysplastic epithelial signs.

Reading time approx. 6 minutes Published: February 25, 2022 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: February 25, 2022 Report no: ut202204 Registration no: SBU 2021/418

Question

What systematic reviews are there on the diagnostic accuracy of brush biopsies and cytology for assessment of oral lesions?

Identified literature

One relevant systematic review was identified.

Table 1. Systematic reviews with low/medium risk of bias.
Included studies	Population/Intervention	Outcome and Results
Walsh et al, 2021 [1] Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions
Study design: – Cross-sectional diagnostic test accuracy studies and Randomized studies of diagnostic test accuracy. – 63 studies (79 datasets for the quantitative meta-analysis)	Population: Patients (16 and above) referred to secondary care facility for further investigation of a clinically evident suspicious or innocuous oral lesions Oral potentially malignant disorders – Leukoplakia, erythroplakia, proliferative verrucous Intervention: 3 Index tests used and evaluated: – Vital staining (20 studies) – Oral cytology (20 studies; 16 used harvested cells with a brush) – Light-based detection and oral spectroscopy (23 studies) – Combination of different index tests (9 studies) Reference tests: – Surgical or punch biopsy with histological assessment – Each study participant did one or more diagnostic tests as well as a surgical biopsy	Diagnostic accuracy for oral cancer or oral potentially malignant disorder (OPMD) Oral cytology In 1496 dysplastic lesions out of 2892 – Sensitivity 0.90 (95% CI 0.82 to 0.94) – Specificity 0.94 (95% CI 0.88 to 0.97) Oral cytology after brush biopsy: In 995 dysplastic lesions out of 1950 – Sensitivity 0.91 (95% CI 0.81 to 0.96) – Specificity 0.94 (95% CI 0.87 to 0.97)
Authors' conclusion: “At present none of the adjunctive tests can be recommended as a replacement for the currently used standard of a surgical biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for oral cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation.”

References

Walsh T, Macey R, Kerr AR, Lingen MW, Ogden GR, Warnakulasuriya S. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst Rev. 2021;7(7):CD010276. Available from: https://doi.org/10.1002/14651858.CD010276.pub3.

Literature search

Cochrane Library via Wiley (CDSR, Cochrane Protocols & CENTRAL)

Date: 19 October 2021

Title: Brush biopsies as a diagnostic test for oral cancer
The final search result, usually found at the end of the documentation, forms the list of abstracts. :au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search terms		Items found
1.	oral:ti,ab,kw	177 335
2.	brush* NEAR/3 (cytolog* OR biops*):ti,ab,kw	171
3.	MeSH descriptor: [Neoplasms] explode all trees	84 044
4.	(cancer* OR leukoplakia* OR malign* OR lesion*):ti,ab,kw	222 668
5.	3 OR 4	247 597
6.	MeSH descriptor: [Diagnosis] explode all trees	347 283
7.	diagnos*:ti,ab,kw	245 761
8.	6 OR 7	505 668
9.	MeSH descriptor: [Sensitivity and Specificity] explode all trees	15 693
10.	(sensitivit* OR specificit* OR accura* OR (diagnos* NEAR/3 accura*)):ti,ab,kw	92 455
11.	9 OR 10	97 901
Combined sets
12.	1 AND 2 AND 5	21
13.	8 OR 11	553 172
Final result
14.	12 AND 13	15 CDSR/2 CENTRAL/13

Embase via Elsevier

Date: 19 October 2021

Title: Brush biopsies as a diagnostic test for oral cancer
The final search result, usually found at the end of the documentation, forms the list of abstracts. /de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search terms		Items found
1.	oral:ti,ab,kw	906 591
2.	(brush* NEAR/3 (cytolog* OR biops*)):ti,ab,kw	3 902
3.	'neoplasm'/exp OR cancer:ti,ab,kw OR leukoplakia:ti,ab,kw OR malign:ti,ab,kw OR lesion:ti,ab,kw	6 670 575
4.	'diagnosis'/exp OR 'diagnostic procedure'/exp OR diagnos*:ti,ab,kw	20 614 454
5.	'sensitivity and specificity'/exp OR sensitivit:ti,ab,kw OR specificit:ti,ab,kw OR accura:ti,ab,kw OR ((diagnos NEAR/3 accura*):ti,ab,kw)	2 563 782
Combined sets
6.	1 AND 2 AND 3	278
7.	4 OR 5	21 252 480
Final result
8.	6 AND 7	276

Ovid MEDLINE(R) ALL <1946 to October 15, 2021

Date: 19 October 2021

Title: Brush biopsies as a diagnostic test for oral cancer
The final search result, usually found at the end of the documentation, forms the list of abstracts. .ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Search terms		Items found
1.	oral.ti,ab,kf.	649 309
2.	(brush* adj3 (cytolog* or biops*)).tw,ab,kf.	2 222
3.	exp Neoplasms/ or (cancer* or leukoplakia* or malign* or lesion*).ti,ab,kf.	4 801 982
4.	exp Diagnosis/ or "Diagnostic Techniques and Procedures"/ or diagnos*.ti,ab,kf.	10 333 798
5.	exp "Sensitivity and Specificity"/ or (sensitivit* or specificit* or accura).ti,ab,kf. or (diagnos adj3 accura*).ti,ab,kf.	2 269 757
Combined sets
6.	1 AND 2 AND 3	204
7.	4 OR 5	11 460 101
Final result
8.	6 AND 7	187

Page published February 25, 2022

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