Brush biopsy sample quality: Preliminary investigation of a metal brush prototype

Abstract

Objective: To qualitatively investigate whether a prototype brush composed of metal bristles collects oral epithelial cells effectively for cytological evaluation of oral mucosal lesions. Material and Methods: Twenty patients with suspicious oral mucosal lesions were enrolled. Patients were asked to gargle with saline and to deposit the oral rinse into specimen cup. Then, oral mucosal cell samples were collected using a metal oral brush, via sweeping motion. Punch biopsy was performed for histological examination. All samples were evaluated with liquid based cytology (LBC) according to the cellularity, the depth of the epithelial layer, cellular integrity by an oral pathologist. Results: Oral rinse provided samples with 100% cellular integrity and cellularity, mostly from the intermediary layers. With metal brush, both inadequate cellularity and cellular integrity was observed in 25% of the cases. Cellular integrity was adequate in 65%, cellularity was adequate in 45% of the lesions. Samples were dominantly from the intermediary layers, but in one case, metal brush collected cells from the parabasal layer. Conclusion: The narrow spiral pitch and width of metal bristles may have resisted to release the cellular samples collected. With adjustment of the spiral pitch and diameter of metal brush bristles, its’ efficacy could be enhanced.