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Cytology Detection of Oral Cancer

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3 min read


Oral cancer has emerged over the last decade to be the leading cause of mortality. Read the article to learn more.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At March 7, 2022
Reviewed AtMay 16, 2024

What Is Cytology?

Cytology is a branch of biology that deals with the structure and morphology of the body cells taken from tissues and bodily fluids. Cytology is the study of cells that is widely used in the medical field for diagnosis. The cells are taken single or in clusters. It aids in studying the morphology, structure, function, proliferation, pathology, and life of the cell under the microscope. It is mainly used in diagnosing or screening cancer, fetal abnormalities, and infectious organisms. The pathologist examines the cells from the sample to clarify the presence of abnormalities. The procedure is quite technique-sensitive as the results rely on the preparation of the cells before viewing them under the microscope.

What Are the Diagnostic Standards for Oral Cancer Detection?

Early-stage oral cancer lesions may be often asymptomatic and may mimic other systemic conditions. The advanced stages of cancer develop over a long period because the cells undergo multiple stages of abnormal biological differentiation and later proliferation. Hence, the ideal treatment at this early or pre-invasive stage offers the best prognosis and the chance of a cure for oral cancers.

A biopsy is the diagnostic gold standard dentists recommend for detecting oral premalignant and malignant lesions. However, with the use of scalpel biopsy (an invasive procedure) associated with potential morbidity, several adjunctive aids have gained popularity.

What Is the Scope of Exfoliative Cytology?

Exfoliative cytology is the preferred technique of analysis in dentistry. It is an improved biopsy version and a non-invasive, rapid, simple, easy-to-collect, and cost-effective method. It is advantageous, especially in developing countries and in areas of resource challenges. Exfoliative cytology is used to assess both normally appearing oral mucosa of usual epithelial changes associated with mild lesions to clinically and biologically diagnosable conditions like leukoplakia, oral squamous cell carcinoma, or premalignant lesions, and red and white lesions of the oral cavity.

Exfoliative cytology is the microscopic examination of desquamated or isolated cells from the surface of a lesion. It is performed mainly to visualize microbiological changes and to measure hormonal levels. The cells may be obtained by any of these procedures, such as the aspiration of washing cells by obtaining a smear or scraping. The technique can also be employed to obtain and study the secretions of sputum, urine, abdominal fluid, prostatic secretions, and vaginal fluid discharge.

Is Exfoliative Cytology an Ideal Diagnostic Technique?

The diagnosis of oral lesions depends mainly upon the criteria of cell atypia, including cellular keratinization and morphological deviations. Ideally, a diagnostic procedure should be relatively easy and simple. The high specificity of this diagnostic technique always relies upon the technique's capacity for specificity to avoid false-positive results. Exfoliative oral cytology has many benefits, including alleviating patient anxiety and fears, avoiding additional investigations, and even unnecessary treatment modalities.

The basic requirement fulfilled by a useful diagnostic technique like exfoliative cytology is that it is:

  • Easy to use.

  • Causes minimal patient discomfort.

  • Collects sufficient cells from the area to be analyzed.

What Are the Different Types of Cytology?

  • Traditional Exfoliative Cytology: The traditional methods of exfoliative cytology have no longer been used for investigation in recent decades, especially because of poor sensitivity and technique specificity for identifying dysplasias and malignancies or cancers. During the 1980s, cytobrush was the first innovative methodology for cervical smears (for gynecologic purposes). The use of the cytobrush eventually for diagnosing oral cancer revived, thus, a major interest in oral cytology procedures. Since then, various researchers have described different diagnostic techniques that have improved the sensitivity and specificity of conventional oral cytology.

  • Oral Brush Biopsy for Cancer Detection: The oral brush biopsy with computer-assisted analysis is another simple and non-invasive procedure. OralCDx is one of the computer-assisted methods for cellular sample analysis collected by using a patented brush. The technique is mainly designed to evaluate any kind of epithelial abnormalities and not just for detecting cancer or dysplasia-related etiology. In this technique, the computer analyzes the digital microscopic image of the collected cells obtained after scanning. It uses specialized neural network-based image processing to detect oral lesions. In the detection of both precancerous and cancerous cells, oral brush biopsy is recommended by most oral and maxillofacial surgeons.

  • Liquid Cytology: Liquid-based cytology offers improved smears or preparations rather than conventional cytology. This reduces the false-negative results compared to traditional cytology procedures. Issues about either sampling or fixation can be addressed in this manner, presenting a better understanding of cytological cells and a better outline. The advantage of this liquid-based cytology is that the pathologist can prepare one or more than one slide per sample collected. There remains enough material for other techniques besides the commonly used Pap stain, periodic acid-Schiff (PAS), methenamine silver stain, etc. Finally, the material preserved in the solution has a long shelf life, allowing for additional investigations, such as immunostaining.

  • Oral Rinse Cytology: The oral rinse technique has been the earliest cytologic use for microbiological investigation and analysis of oral candidiasis and to study oral candidal colonization. This technique has been increasingly popular in recent decades for detecting oral cancers or oral squamous cell carcinomas. The technique relies upon the logic of "aberrant methylation" or a combination of marker genes in the oral rinse samples. These genes have high sensitivity and specificity for potential detection of oral cancers.

The recent potential of this technique is to detect non-invasively oral squamous cell carcinomas (OSCC). It has been useful in dental research about cancer cell morphology and genetics.

Hence, the advantages include distinctive cell morphology and visual clarity. The oral rinse-based preparation is an alternative technique to conventional smears. It can also be used whenever a surgical biopsy is impossible (such as in rural areas) due to the absence of trained healthcare workers or an armamentarium.


With further advancements in this emerging field of oral exfoliative cytology, interest and scope of oral cytology have emerged tremendously. This necessitates training staff and an armamentarium in a clinical setting for sample collection.

Frequently Asked Questions


How Does Cytology Diagnose Cancer?

Cytology or cytopathology diagnoses diseases by examining single cells and tiny clusters. It aids in cancer diagnosis. Malignancy on cytological slides is characterized by high cellularity, cellular enlargement, increased nuclear/cytoplasmic ratio, nuclear hyperchromasia, cell discohesiveness, prominent and massive nucleoli, aberrant nuclear chromatin distribution, and enhanced mitotic activity.


How Are Oral Cancers Detected?

Oral cancers can be detected through different tests, which include:
- Brush Biopsy or Exfoliative Cytology: A small brush or spatula gently scrapes the area to collect cancer-detecting cells.
- Incisional Biopsy: The doctor will extract tiny tissue samples for cancer testing.
- Indirect Laryngoscopy and Pharyngoscopy: The doctor examines the throat, tongue base, and larynx with a small mirror on a long handle (voice box).
- Direct (Flexible) Pharyngoscopy and Laryngoscopy: They may use an endoscope to examine the throat and mouth. Endoscopes are flexible tubes containing lights and lenses.


What Is Cytologic Testing Used to Detect?

Cytological testing is used to detect different types of oral cancers, and it is also used to check for problems with a fetus, for pap smears, to find infectious organisms, and in other ways to study and diagnose.


What Is the Most Commonly Identified Oral Cancer?

Most cases of mouth cancer are squamous cell carcinoma, which makes up nine out of ten cases. There are squamous cells all over the body, such as inside the mouth and under the skin.


Which Is Better, Cytology or Biopsy?

A cytology specimen is typically more convenient to collect than a tissue biopsy. The patient will experience less discomfort when compared to a biopsy.


How Accurate Is a Cytology Test?

Cytology helps diagnose invasive tumors (where the cancer cells grow quickly and spread) and carcinoma in situ (a group of abnormal cells found only where they first formed in the body).


When Is Cytology Recommended?

Cytology is most commonly recommended in cases of oral cancers and cervical cancers.


Is Cytology a Biopsy?

A cytology test is not the same as a biopsy. A biopsy involves the removal of tissue from a specific location of the body and its examination for malignancy. A cytology test extracts and examines fewer cells. The cytological morphology of the cells obtained is examined under a microscope during a cytology test.


Where Are Oral Cancers Mostly Found?

Cancers of the mouth and throat are most common in the mouth, tonsils, and the back of the throat, other parts like the gums, the floor of the mouth, and others.


How Cytology Test Is Done?

Whether a tissue or fluid sample is being analyzed and the type of cells being examined might affect the results of a cytology test. There are typically four stages of a cytology test, and they are as follows:
- Obtaining a Cell Sample to Study.
- Dealing with the cells in the sample.
- Looking at the cells in the sample.
- Disseminating the findings.


What Are the Cytologic Criteria of Malignancy?

On cytological slides, the general characteristics of malignancy are:
- High cellularity.
- Cellular enlargement.
- Increased nuclear/cytoplasmic ratio.
- Nuclear hyperchromasia.
- Cell discohesion.
- Prominent and extensive nucleoli.
- Aberrant distribution of nuclear chromatin.
- Enhanced mitotic activity.


What Does Negative Cytology Mean?

Negative cytology means no abnormal or cancerous cells, which is a good indication.


Can Cytology Be Wrong?

Like many other types of medical testing, a cytology test can produce a false negative or false positive result. Nevertheless, tissue biopsies can be more reliable in some circumstances than cytology tests.


Is Cytology Test Painful?

The cytology test may be uncomfortable, but usually, it is not painful.


What Are the Limitations of Cytology?

The main problems with cytological samples are:
- Many cytological substrates and fixatives must be tested again because most molecular assays are made on FFPE tissue blocks.
- The small number of cells and low nucleic acid yield.
- It may give false positive results.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



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