It depends on the clinical features. For Eg. for a fluctuant swelling, i would prefer a FNAC. For an deep ulcerative lesion (Pt. ruled out for active infection, substance abuse, application of creams) - Brush biopsy; For superficial erythematous presentation - Exfoliative pap cytology; But these are initial diagnosis. If I have a strong suspicion, based on my diagnostic algorithm, I would prefer histopathological study as my starting point from multiple site.

Thank you, Rooban, that is my opinion too.

Thank u Heinz for starting a lively topic, even though academically Brush biopsy with comp asst diagnosis appeals, In India FNAC for fluctuant and gold standard incisional biopsy after toludine blue stain would be the, approach. In India most common is the sq cell carcinoma and that too advanced.

Dear Durgesh Bailoor, I thank you for your comment. I have asked this question deliberately. Our health insurances tend to prescribe the methods of the most important individual physicians diagnostics. They do not justify this with medical knowledge, but with problems of payment. I was told to many of my requests that these restrictions are based on a global standard. I doubt it. You give another argument. The Fine needle aspiration cytology (FNAC) in the diagnosis of granulomatous lymphadenitis is described in Ulster Med J. 2006 January; 75 (1): 59-64 and is the most significant technique of Oral Pathology (Ireland). You show very well that the diagnostic repertoire depends on the actual pathological volumes. Fine. I am sampling comments in this connection now. Thanks.

Thank you, dear Ghaly, this is a clear way. I'll take that up in my argument collection

I totally agree with Dr Ghaly's opinion, especially in clinically malignant suspicion. Unfortunately, in all other methods there might be a false diagnosis.

Thanks Apostolos. I believe that this way the debate secures a brilliant quality on very important diagnostic features. I am pleased about achieving a very clear opinion in science.

If it is suspesious lesion better to start with biopsy and histopathology

Thanks, Soliman, that's true.

Only histopathology

Biopsy & Histopathology will give the best result.

In suspect lesions, incisional biopsy and histopathology. Greetings from Rio!

Thank you, dear Ruchi, Usha and Alexandre. Please remember my comment of April, 25. this year. I am very happy to get so many good ideas of positive criticism. I will hold on to this weekend a morning-lecture at the congress in Hamburg and praise your good thoughts in it. Collegial respect to you,

Sincerely, Heinz

I'll add my best greetings from Dersum, Germany!

The histopathologic diagnosis is the most reliable method and you may also safe the patient life by early diagnosis. if the result is negative you won't loss anything.

Thank you, dear Mohamed, for this clearing.

biopsy is the gold standard in suspecious cases, if still in doubt,one can also go for advanced techiques like immunohistochemistry or PCR, but from clinical point of view i will say one should go for biopsy as soon as posible in case of suspecious pathology.

Always biopsy and histopathology.

Definately biopsy and histopathology

Regards