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

OBJECTIVES: To address critiques of the original study entitled "The role of exfoliative cytology in diagnosis of oral lesions," emphasizing the method's diagnostic value and limitations. METHODS: Lesions were categorized based on provisional diagnoses provided by clinicians to the Pathology Service. Table II presents the frequency of lesion categories, including fungal lesions such as prosthetic stomatitis, which is known to have a fungal etiology. RESULTS: A notable disagreement was observed between the clinicians' provisional diagnoses and the final diagnoses obtained through exfoliative cytology. CONCLUSIONS: Oral candidiasis was the most frequently identified lesion. No cytological features suggestive of squamous cell carcinoma were observed. Although exfoliative cytology can reveal morphological changes associated with malignancy risk, it should be considered a presumptive diagnostic tool, especially in at-risk patients. CLINICAL RELEVANCE: Despite its diagnostic potential, exfoliative cytology has a limited role in the routine diagnosis of oral lesions. The findings underscore the critical importance of biopsy for definitive diagnosis and highlight the need for improved diagnostic acumen among clinicians.