Brush off the brush biopsy.

Oral cancer in India is admittedly a major problem that necessitates a preventive or rather preemptive approach to nip a precancerous lesion in the bud.

A leukoplakic patch is diagnosable by the naked eye and helped by mouth mirrors. This is then required to be followed by the histological analysis. At that stage resorting to any half-hearted steps begets tentativeness, worry, delay and expenses.

Brush biopsy is an example in point. If negative, it does not satisfy or solve the issue. If positive, it demands the sequel of a punch biopsy.

In brush biopsy, the brush is the reality and the biopsy is the myth. Scraping off cells from over the mucosa is enforced exfoliative cytology. No one till today has called Pap smear as Pap biopsy. Let us rechristen brush biopsy as brush cytology to appreciate its irrelevance.

Oral precancer/cancer is a histological diagnosis and no cytological tentativeness. When brush biopsy is falsely negative, as it often is, it compels you to go for definitive punch biopsy. When positive, confirmation punch biopsy is mandatory. It is accepted and recognized as a gold standard, in the diagnosing procedure for precancer/cancer. Thus, for better or for worse, brush biopsy is redundant, superfluous and dispensable.

I have been working on oral precancer/cancer for over 40 years at Basic Dental Research Unit, Tata Institute of Fundamental Research, (on grant from National Institutes of Health, USA) in the field studies.[12]

For a definitive diagnosis of either precancer/cancer, “eyes must see, fingers must palpate, and punch that biopsies remain as the sheet anchor of unambiguous definitive histological diagnosis.” That does not keep either the physician or the patient in a lurch. Cytology has no room here, no scope.

In our extensive field studies in rural India, we have failed to find satisfactory correlation between cytology and histology.[3]

At a time, when nations, developed and underdeveloped, are grieving under the inflating budgets on health care, to add an expensive yet tentative procedure such as brush biopsy, should be regarded as out of question. Advanced dentistry will be no loser if brush biopsy is dropped from the armamentarium for diagnostic oral pathology.

The serious significance of being involved these days in oral cancer program is that the fait accompli cancers are not very amenable to treatment.

Today, the awareness has reached such a stage that there is a combined coordination of activism by public, medical facilities, as well as number of nongovernmental organizations, and therefore, the pragmatic clarity is to tackle the matter at oral precancer level only.

If we take precancer as a priority in our profession, then punch biopsy is our finality. In any field of health measure, less is more and objective should be minimum intervention with maximum benefits.

A punch biopsy is an answer.