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Dr. Ron Loewenstein OralCDx Laboratories Email: brushtest@oralcdx.com Phone: 845-369-7096 Website: www.CDxDiagnostics.com

Objective: The usefulness of the transepithelial brush biopsy was evaluated for choosing treatment pathways for patients with suspicious areas in the mouth who had previously undergone resection surgery from oral cavity cancers. Its benefit was evaluated for minimizing additional biopsy and disfigurement by providing information to assist in a more accurate treatment decision that could prevent unnecessary surgical biopsy. Methods: Over the past 2 years, brush biopsies were performed on patients with a past history of oral cancer who presented with a suspicious lesion during periodic reevaluation. During this period, brush biopsy was performed and pathology results were evaluated with provided clinically relevant information to support the most appropriate treatment decision. Results: In a review of 22 cases, evaluation of brush biopsy specimens revealed abnormal or dysplastic cells in 27% of cases; these patients either underwent surgical biopsy or definitive treatment. In 72% of cases abnormal or dysplastic cells were not identified; these patients were placed on a periodic reevaluation protocol. Conclusions: Transepithelial brush biopsy can provide information useful for monitoring patients with past history of oral cancer who present with suspicious lesions. Findings from the brush biopsy can be utilized to create a plan to either definitively treat the patient or to place the patient on an observation schedule.

Transepithelial monitoring for reoccurrence of oral cavity cancer R Buechler MD1; D Carroll, MD, PhD2; R Loewenstein, DDS2; P Seltzer2

1Houston ENT, 2OralCDx Laboratories

In review of 22 cases, evaluation of brush biopsy specimens revealed abnormal or dysplastic cells in 27% of cases. These patients were either scheduled for surgical biopsy or were provided definitive treatment without undergoing a surgical biopsy.

In 72% of cases, abnormal or dysplastic cells were not identified; these patients were placed on a periodic reevaluation protocol.

Transepithelial brush biopsy can be used to aid the surgeon in deciding on the appropriate treatment pathway, specifically when monitoring patients with past history of oral cancer who present with a tissue changes of unknown significance. The high sensitivity of the transepitheial brush biopsy allows it to be utilized to rule out dysplastic or cancerous change in abnormally appearing scarred tissue thus minimizing the situations where additional resection and disfigurement may be required. Its high specificity also allows placing the patient into definitive treatment where the results from the brush test indicated presence of dysplasia or abnormal cells, as this information was enough evidence to make decisions to move forward with treatment of the lesion.

Over a 2 year period, brush biopsies were performed on patients with a past history of oral cancer who presented with a suspicious lesion during periodic reevaluation.

The examining doctor performed the brush biopsy by placing the brush bristles on the lesion, rotating until a blush red or pinpoint bleeding was obtained. The specimen was transferred to a slide, and a fixative was applied, then sent with a completed test requisition form to OralCDx Laboratories. In the laboratory, the slide was stained by a histological technician, and then scanned by a digital analyzer using an algorithm for detection of abnormal cells.

The pathological results were reviewed in conjunction with previously obtained clinically relevant information for treatment decision outcomes. Results were evaluated by the doctor to rule out the presence of dysplasia from the submitted tissue specimen.

The outcomes and clinical treatment decisions were correlated with the brush biopsy findings to understand how this biopsy’s information plays a role in treatment pathways.

Transepithelial brush biopsy can provide information useful for monitoring patients with past history of oral cancer who present with suspicious tissue changes.

Findings from transepithelial brush biopsy can be utilized in some cases to place a patient into definitive treatment or on an observation schedule, sparing unnecessary surgical intervention.

In the treatment of oral cancer, patients often undergo tumor or lesion resection surgery which frequently results in tissue scarring.

Follow-up evaluation and surveillance for recurrence is often complicated as scar tissue from a previous resection may visually mimic abnormal tissue changes on clinical inspection and repeated biopsy can result in more disfigurement, possible myo-facial dysfunction, pain, recovery time, and possible higher morbidity.

Attempting to minimize additional biopsy and disfigurement in suspicious areas with resection from previous oral cavity cancers, this study utilized and evaluated the pathological results provided by a transepithelial brush biopsy prior to making further treatment decisions.

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DISCUSSION RESULTS ABSTRACT

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