title: Comparison of spatula and cytobrush cytological techniques in early detection of oral malignant and premalignant lesions: a prospective and blinded study.
abstract: BACKGROUND
  The use of oral cytology to diagnose malignant and premalignant lesions at an early stage is considered crucial. The aim of this study was to evaluate the diagnoses of the spatula and the cytobrush techniques compared with the gold standard histopathological findings, analysed according to different diagnostic criteria.
  
  
  METHODS
  Cytological smears were obtained from 76 suspicious oral malignant lesions and 116 oral leukoplakia lesions using two techniques: cytobrush plus cell collector and metal spatula. Subsequently, a surgical biopsy was performed on each lesion to achieve a histopathological diagnosis. Evaluation was conducted with respect to three different diagnostic criteria.
  
  
  RESULTS
  The sensitivity for diagnosing carcinoma in clinically malignant cases was 89.58% and 60.42% for cytobrush and spatula techniques, respectively. Inclusion of severe dysplastic cases for 'high-risk' lesions increased the sensitivity up to 96.36% and 78.18% for two techniques, respectively. In leukoplakia lesions, malignant and severely dysplastic cells were diagnosed at a sensitivity of 88.89% in the cytobrush and 55.56% in the spatula techniques. Extending the criteria by defining malignant or any dysplastic findings as positive, sensitivity was increased to 98.02% and 89.11% for the spatula and the cytobrush techniques, respectively. Specificity for both techniques increased to 100%. The difference between the diagnoses of histopathology and the spatula cytology was statistically significant (P < 0.01), while no such difference was found with the cytobrush technique (P > 0.1).
  
  
  CONCLUSIONS
  The cytobrush, unlike the spatula, is a useful screening instrument for early diagnosis of suspicious oral lesions and could therefore contribute to improved oral cancer prognosis.
authors.affiliation: Faculty of Medicine, University of Ruhuna, Karapitiya, Sri Lanka.
authors.forename: P G C L
authors.initials: PG
authors.lastname: Nanayakkara
authors.affiliation: Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: W L
authors.initials: WL
authors.lastname: Dissanayaka
authors.affiliation: Faculty of Medicine, University of Ruhuna, Karapitiya, Sri Lanka.
authors.forename: B G
authors.initials: BG
authors.lastname: Nanayakkara
authors.affiliation: Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: E A P D
authors.initials: EA
authors.lastname: Amaratunga
authors.affiliation: Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: W M
authors.initials: WM
authors.lastname: Tilakaratne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D003584:Cytological Techniques / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000166:cytology; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: biopsy; oral cancer; oral cytobrush; oral cytology; oral premalignant lesions; spatula