Use of Oral Rub and Rinse Technique for Oral Cancer Screening: Results from a Community-based Program in an LMIC.

BACKGROUND

Oral cancer screening programs can aid in the early identification of potentially malignant oral lesions. The objective of the present study was to evaluate the effectiveness of the Oral Rub and Rinse (ORR) technique as an oral cancer screening tool and to test its potential in detecting genetic alterations in exfoliated cells obtained through ORR.

METHODS

The screening programs were conducted in rural Dakshina Kannada and Udupi districts in Karnataka. All adults with red and/or white lesions were included in the study. Samples were collected using the ORR technique, and smears were prepared. In parallel, Conventional Exfoliative cytology (CEC) smears were also prepared.  ORR samples and tissue biopsy were obtained from Classes III, IV, and V cases. Seven Oral Squamous Cell Carcinoma (OSCC) tissue samples, 7 OSCC ORR samples, and five control samples were randomly selected. The presence of single nucleotide polymorphisms (SNP) in USP9X and DDX3X were checked through Sanger sequencing. Diagnostic agreement between the ORR and CEC technique was assessed using the McNemar test.

RESULTS

A total of 2514 individuals were screened, of which 217 patients with red/ white lesions were included in the study. There was good agreement between the exfoliative cytology and ORR. The sensitivity of the ORR was 84.54%, specificity 85.83%, positive predictive value 82.83%, and negative predictive value 87.29%. Overall, the diagnostic accuracy of the ORR technique was 85.25%. Although none of the samples showed the presence of target SNPs in USP9X and DDX3X genes, the utility of the ORR technique as a tool for conventional and molecular studies was confirmed.

CONCLUSION

The present study highlights the usefulness of the ORR technique as an effective tool in population-based oral cancer screening programs. Further, the cells obtained from ORR are an excellent source of DNA and can potentially identify genetic alterations with high accuracy.