Article
Brush biopsy with computer-assisted evaluation, a new method for the diagnosis of cancer and precancer of squamous epithelial mucous membranes
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Published: | March 20, 2006 |
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For the detection of early stages of cancer and premalignant lesions of squamous epithelial mucous membranes it is important to differentiate these reliably from frequent benigne and inflamatory changes. This problem has not been solved until now. The clinical or endoscopic inspection permits only a rough assessment. Excisional- or forceps-biopsy, which allow a rather reliable histological diagnosis are invasive procedures that cannot be repeated without limitation and would be disproportionate for the frequent presumably benigne lesions. This gap in the diagnostic procedure can be filled by the “brush biopsy”, a new non-invasive method of obtaining a transepithelial tissue specimen, which in conjunction with a computer-assisted evaluation has been shown to be reliable and efficient. This test discriminates 3 diagnostic categories – negative, positive and atypical. Positive cases should be subjected to excisional biopsy. This procedure was developed by CDx-Laboratories (USA) and is offered with three special test kits – “Oral CDx” for oral lesions (1) and “Endo CDx” for laryngo-pharyngeal (2) or esophageal (3) lesions. The latter expecially for Barrett-esophagus. In Germany the “Oral CDx” has been employed since 2003. Since them a total of 5.390 biopsies have been evaluated. 82 % were negative, 11 % atypical, 2 % positive and 5 % inadequate. In 31 % additional important diagnostic information could be retrieved – most important candidal infection. In 103 cases the result of the brush biopsy could be compared with the final histological diagnosis. The sensitivity for dysplasia and carcinomas was 92,3 %, the specificity was 94.3 %. The implications of this new diagnostic method also for laryngeal and esophageal squamous epithelial lesions will be discussed.