Rose Bengal Staining, Microbiopsy and Scalpel Biopsy as a Cytology-cum-Histopathology based Diagnostic Scheme for Oral Dysplasias: A Pilot Study

Abstract

Introduction: Most Oral Squamous Cell Carcinoma (OSCC) is preceded by Oral Potentially Malignant Disorders (OPMDS). These disorders if diagnosed early can be prevented from converting into full blown malignancies. This points towards an ever increasing need for a more accurate, less invasive diagnostic tool to detect these lesions early. Aim: To analyse and compare the accuracy of 1% Rose Bengal (RB) dye and oral microbiopsies (using dermatologic ring curettes) with conventional scalpel biopsy in diagnosing oral epithelial dysplasias. Materials and Methods: This cross-sectional pilot study, included a total number of 26 male patients, age range between 40-60 years old, with oral white and red mucosal lesions attending the Outpatient Department (OPD) of Seema Dental College and Hospital, Rishikesh, Uttrakhand, India. After thorough clinical examination, 1% RB staining, microbiopsy, and scalpel biopsy was performed on all included participants. Parameters assessed included clinical signs indicative of dysplasia in red and white lesions such as increase thickness, nodularity, atrophic mucosa, erosion, ulcers and change in colour of mucosa with positive history of tobacco smoking. Hyperchromatic areas owing to increase stain intake (due to increased nuclear cytoplasmic ratio) was obtained after staning with RB dye and histopathological indicators of epithelial dysplasia (cellular and architectural changes) were observed after both microbiopsy and scalpel biopsy. Chi-square test was done to compare results of 1% RB staining and microbiopsies with scalpel biopsies. Results: Total 26 male patients were included with a mean age of 50 years. There was no statistically significant difference in the accuracy of microbiopsies (p-value=0.913) and 1% RB dye (p-value=0.393) as compared to conventional scalpel biopsy in delineating the epithelial dysplastic changes associated with OPMDS. Conclusion: Oral microbiopsy, is a relatively novel, accurate, and less invasive diagnostic tool. It has proved to be as effective as scalpel biopsy in diagnosing and grading epithelial dysplasia. Through this article, it was proposed that 1% RB staining, microbiopsy, and scalpel biopsy can be used in conjugation as a part of cytology-cum-histopathology based diagnostic scheme for oral clinically suspicious lesions.

Keywords

• first line diagnosis
• live staining
• oral cancer
• potentially malignant disorders