A critique to the article "Pina PSS, Mendes AT, Correa L, Coracin FL, de Sousa SCOM. The role of exfoliative cytology in diagnosis of oral lesions. Clin Oral Investig. 2024 Dec 6;29(1):2. doi: 10.1007/s00784-024-06080-9. PMID: 39641812."

Abstract

Objective: This letter critiques the study by Pina PSS et al., titled "The role of exfoliative cytology in the diagnosis of oral lesions," published in Clinical Oral Investigations (doi: https://doi.org/10.1007/s00784-024-06080-9 ). The study aimed to evaluate the utility of oral exfoliative cytology and highlighted its limited effectiveness in diagnosing oral diseases.

Materials and methods: Among 1000 cases, the authors misclassified prosthetic stomatitis (denture stomatitis) as a distinct clinical entity separate from candidiasis, despite its fungal etiology. This classification approach could compromise the accuracy of exfoliative cytology.

Results: In 817 cases (81.7%), clinicians provisionally diagnosed fungal lesions, with significant disagreement between provisional and cytological diagnoses. However, the absence of histological examination as a gold standard precludes evaluating the accuracy of both "clinical examination alone" and "exfoliative cytology." Thus, the disagreement lacks actionable clinical implications.

Conclusion: The authors advocated to restrict the utilization of exfoliative oral cytology particularly for diagnosing fungal disease, and occasionally when oral cancer is suspected. On the contrary, we consider that exfoliative oral cytology adds little value to a thorough patient anamnesis and clinical examination in fungal disease diagnosis, and may be proposed in rare cases. Its primary utility lies in assessing the malignant potential of oral mucosal lesions rather than fungal or viral infections.

Clinical relevance: The findings reveal the need to enhance clinicians' skills in provisional diagnosis rather than focusing on the limitations of exfoliative cytology. Concluding that oral cytology has limited applications in oral disease diagnosis, as the study suggests, appears unwarranted.