CytID is an easy, pain-free, chair-side procedure for assessment of common oral cavity diseases. With its soft cyto-brush sample collection kit, CytID finally provides dentists with a quality option for assessing these lesions when biopsy is not warranted or possible.
The test is based on an objective measure of gross changes in the nuclear DNA content of oral epitheliall cells; thereby, providing information about the pre-cancerous or cancerous state of a lesion.
Liquid-based cytology is an adjunctive procedure that utilizes advanced technology compared to conventional exfoliative cytology smear. The CytID process significantly reduces the clumping and overlapping of debris laden cells that result when collected cells are directly smeared onto a glass microscope slide at the chair side. Liquid-based cytology is a painless procedure that utilizes a cell harvester (e.g., brush) to obtain a noninvasive collection of epithelial cells from the various levels of the surface epithelium. The brush head is submerged and rubbed against the side walls (ribs) and then twirled within a bottle of alcohol-based fixative; this technique helps maximize the number of collected cells available for microscopic examination by a pathologist.
Liquid-based brush cytology is not a substitute for the traditional, “gold standard” invasive, surgical biopsy technique that removes architecturally intact tissue, but it may yield important screening information when the patient cannot afford, refuses, or is too ill to undergo a surgical biopsy procedure.
Navone et al. described their study using liquid cytology on oral lesions and reported a sensitivity of 95.1% and a specificity of 99.0% as compared to a conventional histological diagnosis from an incisional biopsy. The positive predictive value was 96.3% and negative predictive value of 98.7%.
"Both this study and the literature demonstrate that conventional oral cytology has a better sensitivity and predictive positive value than has the conventional cervical smear test, whilst its specificity is similar. Both sensitivity and specificity were better in liquid based than in conventional cytology and there were fewer inadequate samples."
"In conclusion, the main reason for the use of oral brush biopsy is not to find a substitute for scalpel biopsy, but rather to take advantage of a first-level test able to identify dysplastic cells or molecular alterations which would be an indication for histological control, even in clinically apparently benign oral lesions."
Navone R. et al. The impact of liquid-based oral cytology on the diagnosis of oral squamous dysplasia and carcinoma. Cytopathology, 18, 356-360. 2007
In addition to reporting a survey of 132 dentists in the state of Virginia on their use and training of oral cytology, Kaugars et al. provide a brief review of the available literature on oral cytology. Their summary states that the average sensitivity of oral cytology is 87.3% (from 1300+ cases in 18 studies). The average specificity was 99.1% from 16,420 cases from 7 studies.
Kaugars et al. The use of exfoliative cytology for the early diagnosis of oral cancers: Is there a role for it in education and private practice? J Cancer Educ. 13(2): 85-89. 1998
"Conventional cytology and liquid-based cytology demonstrated a diagnostic concordance with histopathology of more than 90%. Therefore, if properly indicated and executed, they can be routinely used as complementary diagnostic methods."
Vidal et al. Conventional Cytology versus liquid-based cytology for prevention and early diagnosis of oral squamous cell carcioma (OSCC). Odontol Clín-Cient, Recife 10 (1) 31-36. 2011
Hayama reported on the comparison between conventional smears and liquid based oral cytology. In addition to other benefit, they demonstrated an advantage by using liquid cytology in the ability to discern the changes in the cytological patterns.
"In regard to specimen adequacy, the slides processed by liquid-based preparations were advantageous for presenting a thin and uniform distribution of cellular material, in addition to a clear background due to reductions in both cell overlapping and the presence of blood. Owing to these improvements, the liquid-based preparation yielded specimens wherein the cellular morphology was more clearly seen."
"In the examination of the oral carcinoma lesions the liquid-based preparations also presented advantages over the conventional smears as they allowed for a better observation of cytological abnormalities and changes in the nuclear-cytoplasm ratio."
Hayama et al. Liquid-based preparations versus conventional cytology: specimen adequacy and diagnostic agreement in oral lesions. Med Oral Patol Oral Cir Bucal. 10(2): 115-122. 2005
Babshet et al. used an off-the-shelf toothbrush to sample the mucosal tissue. The cytologic smear (not liquid cytology as in CytID) was compared to a punch biopsy and histological analysis.
They reported a sensitivity of 77% and aspecificity of 100% as compared to a conventional histological diagnosis from an incisional biopsy.
"There is no statistically significant difference between histopathological and cytopathological diagnosis in diagnosing dysplasia or carcinoma."
"Brush cytology is useful in screening of suspicious oral lesions."
Babshet et al. Efficacy of oral brush cytology in the evaluation of the oral premalignant and malignant lesions. J Cytol, 28(4), 165-172. 2011
Remmerbach et al. compared exfoliative cytology to that of a scalpel biopsy. They reported a sensitivity of 94.6%and a specificity of 99.5% as compared to a conventional histological diagnosis from an incisional biopsy. The positive predictive value was 98.1% andnegative predictive value of 98.5%.
"Clinically four seemingly benign lesions were detected as malignant by cytology. In these cases a scalpel biopsy would not have been taken routinely, because even for an experienced surgeon the clinical aspect was not suspicious for cancer."
"The clinical advantages of exfoliative cytology are evident: non-invasive, relatively painless and fast obtainment. Every dentist can perform an oral swab cytology, which represents a low budget procedure, revealing high compliance (e.g., even when used repeatedly for monitoring; often patients are not inclined to repeated scalpel biopsies) and up to now no contradiction for swabbing is known."
"Cytologic investigation of smears from macroscopically suspicious oral lesions is an easily practicable, cheap, quick, non-invasive, painless and accurate screening method that may help to reduce the occurrence of invasive and thus fatal squamous cell carcinomas."
Remmerbach et al. Cytologic and DNA-cytometric early diagnosis of oral cancer. Anal Cell Pathol. 22(4), 211-221. 2001