Low positive predictive value of the oral brush biopsy in detecting dysplastic oral lesions

Abstract

BACKGROUND:The authors evaluated the effectiveness of the oral brush biopsy technique as a diagnostic tool in detecting dysplastic oral lesions.METHODS:In this cross‐sectional study, pathologic reports (n = 152) from the scalpel biopsies (tissue samples) in patients who previously tested either “positive” (n = 3) or “atypical” (n = 149) for dysplasia by brush biopsy (OralCDx) were evaluated. Information on the age and sex of the patient, the site of the lesion, the brush biopsy results, and the histopathologic diagnosis of the scalpel biopsy was collected. The positive predictive values (PPVs) for “abnormal,” “atypical,” and “positive” brush biopsies were determined.RESULTS:Overall, the PPV of an abnormal brush biopsy was only 7.9% (95% confidence interval [CI], 4.2%‐13.4%), and the PPV of an “atypical” brush biopsy was 7.4% (95% CI, 3.7%‐12.8%). Of the 3 positive brush biopsies, only 1 was identified as dysplastic. The proportion of false‐positive biopsy results was as high as 92.1% (95% CI, 86.6%‐95.9%).CONCLUSIONS:The OralCDx technique overestimated dysplastic lesions and produced a high number of false‐positive results. Cancer 2009. © 2009 American Cancer Society.

Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer

“…In our study, performing brush biopsy simultaneously on the exact biopsy site could compensate this shortcoming. (9,17,18) and in contrast to results of other study with extremely high sensitivity (100%) (19) 100% PPV was higher than previous studies (38.3% 7.4%and 7.9%) (7,13), it can be due to higher prevalence of dysplasia and malignancy in our sample group (20). LR+ and LR-are two tools that combine information about the sensitivity and specificity of a test and are not commonly reported in oral medicine's literature.…”

“…Upon these results LBC gives better results and enhances sensitivity and specificity (12). It seems that OralCDx technique overestimates dysplastic lesions and has a low Positive Predictive Value (PPV) (13). Although diagnostic value of brush biopsy or LBC technique have been published previously but there are some pitfalls: First, in many brush biopsy studies not all of samples with different brush results underwent scalpel biopsy so the reported values for sensitivity, specificity, etc, could be questionable.…”

Cancer, pre-cancer and normal oral cells distinguished by dielectrophoresis

“…Furthermore, dysplastic oral keratinocytes have an electrophysiological phenotype distinct to cancerous oral keratinocytes which could prove significant in a diagnostic setting. Currently available OSCC detection techniques are subjective and show improved efficacy when employed by highly skilled and experienced clinicians [42,43]. However, these techniques are of most use in primary health care settings where handlers will be less experienced.…”

Transepithelial Brush Biopsy – Oral CDx® – A Noninvasive Method for the Early Detection of Precancerous and Cancerous Lesions

“…In the literature, sensitivity ranged from 92.3% [11] to 71.4% [12]; specificity ranged from 100% [13] to 32% [12]; the PPV ranged from 95.7% [14] to 7.9% [15]; and the NPV ranged from 60% [12] to 97% [11]. The PPV for the atypical findings was 42.9% and that for the positive findings was 100%, as was seen in a former study [16].…”