Clinical takeaways:
- A new one-hour brush test distinguished oral squamous cell carcinoma from leukoplakia and lichen planus with nearly 95.7% sensitivity across 545 patients, suggesting it could spare many patients an unnecessary scalpel biopsy.
- Because it's noninvasive and repeatable, the test is well suited for surveilling oral potentially malignant disorders, possibly catching malignant transformation earlier.
- Availability of the test is projected around 2028. Current biopsy-based diagnostic pathways remain the standard of care for now.
A promising, noninvasive biopsy brush test could accurately detect the presence of oral cancer within one hour, potentially preventing over 90% of painful scalpel biopsy procedures, according to a July 6 news article from Queen Mary University of London.
The test, qMIDS-V3, could also benefit individuals with oral potentially malignant disorders, or OPMDs, conditions characterized by abnormal tissue changes that can progress to cancer. OPMDs can be difficult to predict clinically; therefore, patients are vigilantly monitored, which poses shortcomings for patients and clinicians. Serial testing using qMIDS-V3 may not only detect oral cancer, but catching malignancies early can improve treatment outcomes and patient survival.
qMIDS-V3 was adapted from a microbiopsy-based multigene assay qMIDS-V2. The test uses a brush to collect a tissue sample, with results that are available in one hour. For patients, the test could end painful scalpel biopsies that are painful to endure and come with other side effects.
Figure 1: A graphical representation of the qMIDS-V3 workflow.Image courtesy of Teh et al. Licensed under CC BY 4.0 International.
Highly accurate and noninvasive
Preliminary results show that V3 is as accurate as its V2 predecessor, according to a study published in Biomarker Research. Of 1,000 samples tested from 545 patients, V3 differentiated oral squamous cell carcinoma (OSCC) from oral leukoplakia and oral lichen planus with a sensitivity of 95.7% and an overall accuracy rate of almost 96%, according to the study. False-positive and false-negative rates were 4.9% and 4.3%, respectively.
“We were genuinely astonished by the fact that the brush swab test performance is comparable to a microbiopsy … The clinical implications are significant: patients no longer need even a minimally invasive procedure to benefit from molecularly guided triage,” Muy-Teck Teh, a professor of molecular oral oncology at Queen Mary and lead author of the study, said.
The U.S. National Cancer Institute predicts that roughly 60,000 adults will be diagnosed in 2026. Oral cavity and pharynx cancers account for 2.9% of all cancers.
V3 offers a painless alternative to serial testing
Biopsying for OSCC can be very painful for patients, especially if it involves the tongue. Patients with OPMDs who must be continuously monitored are reticent to submit to multiple biopsy procedures. Clinicians, too, hesitate to perform repeated procedures, owing to risks such as infection and potential invasive damage the biopsy may cause to tooth and/or bone structure, which in some cases may not be worthwhile.
“Oral cancer survival is directly linked to how early it is found, yet our current diagnostic pathway is blunt -- most patients with a suspicious lesion end up having an invasive biopsy even when the overwhelming likelihood is that it is benign. This test changes that. It gives clinicians a rapid, accurate, and non-invasive way to triage patients, and crucially, it can be repeated. That means we can now monitor patients with persistent pre-malignant lesions regularly and systematically -- and pick up cancers much earlier than we would have been able to before,” Tey said in the article.
Queen Mary said it is actively seeking a commercial partner to help it further develop the test for clinical use. If all goes well, qMIDS-V3 could be available in 2028.
