title: Application of liquid-based transepithelial flexible brush cytology in the detection of high-grade laryngeal mucosal lesions.
abstract: BACKGROUND
  The aim of this study was to evaluate the effectiveness of liquid-based transepithelial flexible brush cytology (LBTFBC) in the detection of high-grade laryngeal mucosal lesions.
  
  
  METHODS
  Diagnostic accuracies of LBTFBC and flexible biopsy (FB) were compared with the gold standard of biopsy under general anaesthesia (BUA) in 49 and 46 patients, respectively. Using a flexible laryngoscope, transepithelial cytology and biopsy specimens were obtained with the aid of flexible brushes and biopsy forceps. Cytology specimens were graded and scored using a recently proposed oral cytologic grading and scoring system.
  
  
  RESULTS
  Cytology showed 97, 29% sensitivity, 100% specificity, 97.9% accuracy, and FB disclosed 77.1% sensitivity, 100% specificity, and 82.2% accuracy when compared with BUA. The best cutoff value for discriminating reactive/mildly dysplastic lesions from high-grade dysplasias/invasive squamous cell carcinomas (SCCs) was determined as a cytologic score of 3, with sensitivity and specificity of 100%.
  
  
  CONCLUSIONS
  LBTFBC is a simple office-based procedure, which in combination with the newly proposed classification scheme appears to be an accurate technique in the detection of high-grade laryngeal mucosal lesions. LBTFBC is more effective than FB owing to the enhanced range of sampling and ease of application. It effectively eliminates the need for general anaesthesia, and thus reducing theatre costs and the number of hospital admissions. LBTFBC is ideal for patients who require regular clinical examinations, where repeated biopsies may lead to significant vocal morbidity.
authors.affiliation: Division of Anatomical Pathology, Faculty of Medicine, University of Stellenbosch and NHLS, Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Amir
authors.initials: A
authors.lastname: Afrogheh
authors.forename: Andrew
authors.initials: A
authors.lastname: Pelser
authors.forename: Jos
authors.initials: J
authors.lastname: Hille
authors.forename: Rory
authors.initials: R
authors.lastname: Attwood
authors.forename: James
authors.initials: J
authors.lastname: Loock
authors.forename: Pawel Tomasz
authors.initials: PT
authors.lastname: Schubert
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006801:Humans; D007820:Laryngeal Mucosa / Q000473:pathology*; D007822:Laryngeal Neoplasms / Q000473:pathology*; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D012680:Sensitivity and Specificity
keywords: SurePath LBC; flexible biopsy; flexible brush cytology; flexible laryngoscopy; high grade disease; laryngeal cancer; laryngeal cytology; liquid based cytology; screening; transepithelial brush biopsy