Swedish Agency for Health Technology Assessment and Assessment of Social Services
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.
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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.
| 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 |
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| 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.” |
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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
| 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” |
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| 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
| 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 |
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| 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
| 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. |
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| 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 |
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