Anthony P. Urbanek
D.D.S. M.D
Celebrating over 28 Years
Serving Middle Tennessee
Oral Surgeon Brentwood, Franklin, Nashville TN
Detection of oral cancer in the early asymptomatic stage dramatically improves cure rates and patient’s quality of life by minimizing extensive, debilitating treatments. The five year survival rate for patients with early, localized disease approximates 80 percent; for those with distant metastases, it is 19 percent.
Unfortunately, more than 50 percent of patients with oral cancer display evidence of spread to regional lymph nodes and metastases at time of diagnoses, and approximately two-thirds of patients have apparent symptoms, a negative prognostic indicator
Although screening has been emphasized as a method of reducing the morbidity and mortality associated with oral cancers, the visual detection of oral cancer at an early stage is significantly hindered by the dificulty in clinically differentiating premalignant and malignant lesions from similar looking bening lessions.
Early- stage oral cancer is asymptomatic. Furthermore, they often may appear innocuous, since the classic clinical characteristics associated with advanced oral cancers including ulceration, elevation, bleeding and cervical adenopathy usually are absent in early stage lesions.
In the need of more precise methods of identifying oral cancer in its early stages, the U.S collaborative OralCDx“ undertook a study to evaluate the sensitivity and specificity of OralCDx“.
OralCDx® is a simple brush biopsy test, that helps determine whether common oral white or red spots are potentially precancerous or cancerous. It is a rapidly conducted chair side procedure that results in minimal or no bleeding and requires no topical or local anesthesia.
OralCDx“ is indicated to test “everyday” harmless looking spots to help rule out the chance that they might be something more.
OralCDx“ was proven to be highly accurate by a large multi-center clinical trial (JADA Oct 1999). Recognizing its protective benefits, dental schools throughout the country are now teaching students to incorporate OralCDx“ testing into their routine clinical oral examination.
The OralCDx oral brush biopsy is a rapidly conducted chair side procedure that results in minimal or no bleeding and requires no topical or local anesthetic. A transepithelial brush biopsy is not a difficult or demanding procedure to master, as shown on the relatively low number of inadequate specimens obtained in this study by clinicians experienced in this technique. The great majority of inadequate samples were obtained at the onset trial, as investigators were becoming familiar with using the brush.
In addition to precancer and cancer detection, OralCDx can provide morphologic evidence of a variety of benign oral processes.
“...A transepithelial brush biopsy is not a difficult or demanding procedure to master”
A critical component of OralCDx is the use of image analysis of the oral brush sample.
Although automated cytology had been proposed in the late 1950s as a method of reducing false negative findings, early attempts that relied on analysis by algorithmic computers were not successful. This limitation was finally overcome by the application of no algorithmic, neural network computers that were developed in the late 1980s. By contrast, OralCDx uses an image analysis system that is adapted and optimized to detect epithelial abnormalities unique to oral brush biopsy samples, thereby enhancing its accuracy
“A critical component of OralCDx is the use of image analysis of the oral brush sample”
OralCDx laboratory pathologists undergo specialty training in oral cytology. Furthermore, the laboratory that analyzes these specimen functions exclusively in the interpretation of oral brush biopsy samples.
OralCDx is easily integrated into conventional dental or Oral Surgeon’s practice. The dentist or Oral Surgeon submits the specimen and receives a faxed report, usually within three days after the specimen arrives at the specialty laboratory. In addition, color images of cellular abnormalities from OralCDx specimens with “atypical” and “positive” results, with accompanying explanation, are mailed to the dentist or oral surgeon. These images enable the dentist or oral surgeon to demonstrate to the patient the abnormal test results.
What kind of OralCDx results should I expect if I perform many brush biopsies?
Based on data collected from over 150,000 specimens analyzed at CDx Laboratories, 85% are likely to be negative. Negative OralCDx results should be expected by the patient and the dentist, since most oral spots that appear benign will prove to be negative. This is similar to Pap smears, of which the overwhelming majority of results are negative. 15% will be abnormal - either "atypical" or "positive". If all patients that fall into the abnormal category undergo a scalpel biopsy, 20% to 38% of the specimens will prove to be precancer or cancer with the remaining being negative. OralCDx is one of the most highly predictive tests in medicine and compares favorably to other standard cancer tests such as the Pap smear and mammography.
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