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Wang Y, Tang H, Wang K, Zhao Y, Xu J, Fan Y. Clinical evaluation of photodynamic therapy for oral leukoplakia: a retrospective study of 50 patients. BMC Oral Health 2024; 24:9. [PMID: 38172857 PMCID: PMC10765792 DOI: 10.1186/s12903-023-03791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Topical photodynamic therapy (PDT) has demonstrated encouraging results in the treatment of oral leukoplakia (OLK). However, data on the clinical efficacy of PDT in Chinese patients with OLK are still limited. METHODS Fifty patients diagnosed with OLK were enrolled, including patients with various dysplastic tissues. All patients received topical PDT with 5-aminolevulinic acid (5-ALA) as a photosensitizer. Clinical efficacy was evaluated 4 weeks after treatment. Follow-up was performed every 3 months during the first year and every 6 months during the second year. RESULTS The overall response rate was 68% (34/50): 12% (n = 6) complete and 56% (n = 28) partial responses. Aneuploidy was reduced in the patients with dysplastic lesions. Oral pain and local ulcers developed in 52% of the patients (n = 26). Patients with a long history of OLK including hyperplasia and dysplastic lesions, as well as those with non-homogenous lesions, were more likely to develop pain and ulcer. During follow-up, the recurrence rate of hyperplasia and dysplastic lesions was 32% (n = 16) and the malignant transformation rate of dysplastic lesions was 4% (n = 2). Lesions on the buccal mucosa were associated with recurrence (P = 0.044; OR: 0.108, 95% CI: 0.013-0.915). CONCLUSION Topical 5-ALA-mediated PDT is an effective treatment for OLK, particularly for homogenous leukoplakia, with few side effects. The buccal mucosa may be a protective factor that can reduce recurrence.
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Affiliation(s)
- Yanting Wang
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Haonan Tang
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Keyi Wang
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yuping Zhao
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Juanyong Xu
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yuan Fan
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
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Zabin Alotaibi K, Hameed Kolarkodi S. Effectiveness of adjunctive screening tools for potentially malignant oral disorders and oral cancer: A systematic review. Saudi Dent J 2024; 36:28-37. [PMID: 38375389 PMCID: PMC10874794 DOI: 10.1016/j.sdentj.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objectives To enhance the abilities of healthcare professionals to make informed treatment decisions and establish accurate diagnoses, it is essential to assess the diagnostic reliability of different adjunctive aids. This systematic review aimed to compare the accuracy of various adjunctive methods for diagnosing suspected oral cancer (OC) or potentially malignant oral disorders (OPMD) in adults against histopathological investigative results. Materials and methods The review protocol registered in the PROSPERO database (CRD42023463525) was developed in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy checklist. A comprehensive electronic search was conducted to identify relevant research articles published between January 2014 and April 2023 using the PubMed and EBSCO databases. The research question was meticulously structured following the participants' index test, reference standard, target condition, and study setting framework. To evaluate methodological quality and assess the risk of bias (RoB), the Quality Assessment for Diagnostic Accuracy Studies-2 tool was used. Results An initial search yielded 483 publications, which were reduced to 278 after removal of duplicates. Finally, 85 publications underwent full-text review by two investigators, which lead to 29 studies that met the inclusion criteria. Among these, 7% had a low RoB, 72% had an unclear RoB, and 21% had a high RoB. Applicability concerns were expressed in 59% of the studies with low concern, 31% with unclear quality evidence of concern, and 10% with high concern. Conclusion The review findings support the use of these diagnostic methods as valuable adjuncts to biopsy for the early detection of various OPMD and OC. They also highlight the importance of regular screening and awareness in reducing the global burden of OC, while acknowledging that they cannot replace the gold standards of surgical biopsy and histopathological evaluation.
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Affiliation(s)
- Khalid Zabin Alotaibi
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Al-Qassim, Saudi Arabia
| | - Shaul Hameed Kolarkodi
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Al-Qassim, Saudi Arabia
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Ribeiro MGM, Dolabella SS, Trento CL, Barros JDS, Freitas VS, Daltoé FP, Grando LJ, Machado MJ, Onofre FBDM, Onofre ASC. DNA-ICM as an adjuvant method applied on oral cytological specimens. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:714-721. [PMID: 38007692 DOI: 10.1016/j.oooo.2023.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate cytology diagnosis accuracy using adjuvant methods in clinical routine for oral cancer. STUDY DESIGN This prospective study was conducted on 98 patients with clinically potentially malignant or malignant oral cavity lesions. One oral lesion smear was taken from each patient using a cytobrush before biopsy and stored at PreservCyt Thinprep. Samples were cytologically analyzed, and DNA ploidy measurement was performed on the same slide. The diagnostic methods' accuracy was then calculated. RESULTS In clinical inspection, 61 patients had suspicious lesions for malignancy, whereas 37 had potentially malignant disorders. Cytology associated with DNA image cytometry presented a sensitivity of 81.2% and specificity of 90.9%. When analyzing lesions located in high-risk sites to oral malignancies individually, cytology associated with DNA image cytometry presented a sensitivity of 88.2%, specificity of 100.0%, accuracy of 90.0%, and Kappa value of 0.77 (CI 95%: 0.48-1.00). CONCLUSIONS Association between cytology and DNA image cytometry is an objective and non-invasive diagnostic method that demonstrated high sensitivity and specificity in diagnosing malignant epithelial squamous cell transformation in the oral cavity.
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Affiliation(s)
- Mariana Goveia Melo Ribeiro
- Federal University of Santa Catarina, Department of Clinical Analysis, Florianópolis, Santa Catarina, Brazil.
| | | | | | - Juliana da Silva Barros
- State University of Feira de Santana, Oral Cancer Center-NUCAO, Feira de Santana, Bahia, Brazil
| | - Valéria Souza Freitas
- State University of Feira de Santana, Oral Cancer Center-NUCAO, Feira de Santana, Bahia, Brazil
| | - Felipe Perozzo Daltoé
- Federal University of Santa Catarina, Department of Dentistry, Florianópolis, Santa Catarina, Brazil
| | - Liliane Janete Grando
- Federal University of Santa Catarina, Department of Dentistry, Florianópolis, Santa Catarina, Brazil
| | - Marcos José Machado
- Federal University of Santa Catarina, Department of Clinical Analysis, Florianópolis, Santa Catarina, Brazil
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Evaluation of Static DNA Ploidy Analysis Using Conventional Brush Biopsy-Based Cytology Samples as an Adjuvant Diagnostic Tool for the Detection of a Malignant Transformation in Potentially Oral Malignant Diseases: A Prospective Study. Cancers (Basel) 2022; 14:cancers14235828. [PMID: 36497310 PMCID: PMC9735754 DOI: 10.3390/cancers14235828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The accuracy of DNA image cytometry as an investigation method for potentially malignant disorders of the oral cavity is currently still a subject of controversy, due to inconsistently applied definitions of DNA aneuploidy, small cohorts and different application techniques of the method. The aim of this study was to examine the accuracy of the method as a supplementary diagnostic tool in addition to the cytological examination using internationally consented definitions for DNA aneuploidy. METHODS A total of 602 samples from 467 patients with various oral lesions were included in this prospective study. Brush biopsies from each patient were first cytologically examined and categorized by a pathologist, second evaluated using DNA image cytometry, and finally compared to either histological biopsy result or clinical outcome. RESULTS Using the standard definition of DNA aneuploidy, we achieved a sensitivity of 93.5%, a positive predictive value for the detection of malignant cells of 98.0%, and an area under the curve of 0.96 of DNA ploidy analysis for the detection of severe oral epithelial dysplasia, carcinoma in situ or oral squamous cell carcinoma. Importantly, using logistic regression and a two-step model, we were able to describe the increased association between DNA-ICM and the detection of malignant cells (OR = 201.6) as a secondary predictor in addition to cytology (OR = 11.90). CONCLUSION In summary, this study has shown that DNA ploidy analysis based on conventional specimens of oral brush biopsies is a highly sensitive, non-invasive, patient-friendly method that should be considered as an additional diagnostic tool for detecting malignant changes in the oral cavity.
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Yang G, Wei L, Thong BKS, Fu Y, Cheong IH, Kozlakidis Z, Li X, Wang H, Li X. A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection. BIOTECH 2022; 11:5. [PMID: 35822813 PMCID: PMC9245907 DOI: 10.3390/biotech11010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Early identification of the stage of oral cancer development can lead to better treatment outcomes and avoid malignant transformation. Therefore, this review aims to provide a comprehensive overview that describes the development of standardized procedures for oral sample collection, characterization, and molecular risk assessment. This can help investigators to choose the appropriate sampling method and downstream analyses for different purposes. Methods: This systematic review was conducted according to the PRISMA guidelines. Using both PubMed and Web of Science databases, four independent authors conducted a literature search between 15 and 21 June 2021. We used key search terms to broaden the search for studies. Non-conforming articles were removed using an EndNote-based and manual approach. Reviewers used a designed form to extract data. Results: This review included a total of 3574 records, after eliminating duplicate articles and excluding papers that did not meet the inclusion criteria. Finally, 202 articles were included in this review. We summarized the sampling methods, biopsy samples, and downstream analysis. The biopsy techniques were classified into tissue and liquid biopsy. The common sequential analysis of tissue biopsy includes histopathological examination such as H&E or IHC to identify various pathogenic features. Meanwhile, liquid samples such as saliva, blood, and urine are analyzed for the purpose of screening to detect mutations in cancer. Commonly used technologies are PCR, RT-PCR, high-throughput sequencing, and metabolomic analysis. Conclusions: Currently, tissue biopsies provide increased diagnostic value compared to liquid biopsy. However, the minimal invasiveness and convenience of liquid biopsy make it a suitable method for mass screening and eventual clinical adoption. The analysis of samples includes histological and molecular analysis. Metabolite analysis is rising but remains scarce.
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Affiliation(s)
- Guanghuan Yang
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Luqi Wei
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Benjamin K. S. Thong
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Yuanyuan Fu
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Io Hong Cheong
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France;
| | - Xue Li
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Xiaoguang Li
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
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Walsh T, Macey R, Kerr AR, Lingen MW, Ogden GR, Warnakulasuriya S. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst Rev 2021; 7:CD010276. [PMID: 34282854 PMCID: PMC8407012 DOI: 10.1002/14651858.cd010276.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Squamous cell carcinoma is the most common form of malignancy of the oral cavity, and is often proceeded by oral potentially malignant disorders (OPMD). Early detection of oral cavity squamous cell carcinoma (oral cancer) can improve survival rates. The current diagnostic standard of surgical biopsy with histology is painful for patients and involves a delay in order to process the tissue and render a histological diagnosis; other diagnostic tests are available that are less invasive and some are able to provide immediate results. This is an update of a Cochrane Review first published in 2015. OBJECTIVES Primary objective: to estimate the diagnostic accuracy of index tests for the detection of oral cancer and OPMD, in people presenting with clinically evident suspicious and innocuous lesions. SECONDARY OBJECTIVE to estimate the relative accuracy of the different index tests. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: MEDLINE Ovid (1946 to 20 October 2020), and Embase Ovid (1980 to 20 October 2020). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials to 20 October 2020. No restrictions were placed on the language or date of publication when searching the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the diagnostic test accuracy of the following index tests when used as an adjunct to conventional oral examination in detecting OPMD or oral cavity squamous cell carcinoma: vital staining (a dye to stain oral mucosa tissues), oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis (which test for the presence of biomarkers in blood or saliva). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors, independently and in duplicate. Studies were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. MAIN RESULTS This update included 63 studies (79 datasets) published between 1980 and 2020 evaluating 7942 lesions for the quantitative meta-analysis. These studies evaluated the diagnostic accuracy of conventional oral examination with: vital staining (22 datasets), oral cytology (24 datasets), light-based detection or oral spectroscopy (24 datasets). Nine datasets assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. Two studies were classed as being at low risk of bias across all domains, and 33 studies were at low concern for applicability across the three domains, where patient selection, the index test, and the reference standard used were generalisable across the population attending secondary care. The summary estimates obtained from the meta-analysis were: - vital staining: sensitivity 0.86 (95% confidence interval (CI) 0.79 to 0.90) specificity 0.68 (95% CI 0.58 to 0.77), 20 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; - oral cytology: sensitivity 0.90 (95% CI 0.82 to 0.94) specificity 0.94 (95% CI 0.88 to 0.97), 20 studies, sensitivity moderate-certainty evidence, specificity moderate-certainty evidence; - light-based: sensitivity 0.87 (95% CI 0.78 to 0.93) specificity 0.50 (95% CI 0.32 to 0.68), 23 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; and - combined tests: sensitivity 0.78 (95% CI 0.45 to 0.94) specificity 0.71 (95% CI 0.53 to 0.84), 9 studies, sensitivity very low-certainty evidence, specificity very low-certainty evidence. AUTHORS' CONCLUSIONS At present none of the adjunctive tests can be recommended as a replacement for the currently used standard of a surgical biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for oral cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation. Potentially eligible studies of blood and salivary biomarkers were excluded from the review as they were of a case-control design and therefore ineligible. In the absence of substantial improvement in the tests evaluated in this updated review, further research into biomarkers may be warranted.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, USA
| | - Mark W Lingen
- Pritzker School of Medicine, Division of Biological Sciences, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Graham R Ogden
- Division of Oral and Maxillofacial Clinical Sciences, School of Dentistry, University of Dundee, Dundee, UK
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Cruz BS, Schwarzmeier L, Carvalho B, Alves M, Carta C, Balducci I, Scholz JR, Almeida JD. Association between DNA ploidy and micronucleus frequency in chronic smokers and impact of smoking cessation. Hum Exp Toxicol 2021; 40:1374-1382. [PMID: 33541126 DOI: 10.1177/0960327121991904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tobacco use may initiate the process of oral carcinogenesis with clinically undetectable changes. Smoking cessation may prevent its progression. The objective of this study was to evaluate the association between DNA ploidy and micronucleus (MN) frequency in chronic smokers. Three groups were evaluated: Smoker Group, Former Smoker Group and Control Group. Exfoliative cytology was performed on the lateral border of the tongue and mouth floor. MN and DNA ploidy analyses were performed, as well as the correlation between the variables. The data showed a difference between the groups for the total MN (p = 0.0227), and the Smoker group had the highest mean (4.22 ± 4.12). The three groups did not differ statistically from each other on ploidy evaluation (p-value > 0.05). There was also an association between aneuploidy and increased MN frequency in the Former Smoker group (p = 0.0036). In conclusion, these results point out that there is a relationship between the frequency of MN and aneuploidy in former smokers. Moreover, smoking cessation, even for a short period of time, may promote the decrease of MN frequency caused by tobacco use.
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Affiliation(s)
- B S Cruz
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Lat Schwarzmeier
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Bfdc Carvalho
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Mgo Alves
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil.,Universidade Anhembi Morumbi, São José dos Campos, São Paulo, Brazil.,Universidade Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil
| | - Cfl Carta
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - I Balducci
- Department of Social Science and Pediatric Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - J R Scholz
- Heart Institute, University Hospital, Medical School, 42523University of São Paulo, São Paulo, Brazil
| | - J D Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
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Parfenova E, Liu KYP, Harrison A, MacAulay C, Guillaud M, Poh CF. An improved algorithm using a Health Canada-approved DNA-image cytometry system for non-invasive screening of high-grade oral lesions. J Oral Pathol Med 2021; 50:502-509. [PMID: 33275794 DOI: 10.1111/jop.13149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND DNA-image cytometry (DNA-ICM) is able to detect gross alterations of cellular DNA-content representing aneuploidy, a biomarker of malignancy. A Health Canada-approved DNA-ICM system, ClearCyte® in combination with a cytopathologist's review, has demonstrated high sensitivity (89%) and specificity (97%) in identifying high-grade oral lesions. The study objective was to create an improved automated algorithm (iClearcyte) and test its robustness in differentiating high grade from benign reactive oral lesions without a cytopathologist's input. METHODS A set of 214 oral brushing samples of oral cancer (n = 92), severe dysplasia (n = 20), reactive lesions (n = 52), and normal samples (n = 50) were spun down onto slides and stained using Feulgen-Thionin reaction. Following ClearCyte® scan, nuclear features were calculated, and nuclei categorized into "diploid," "hyperdiploid," "tetraploid," and "aneuploid" DNA ploidy groups by the ClearCyte® software. The samples were randomized into training and test sets (70:30) based on patient's age, sex, tobacco use, and lesion site risk. The training set was used to create a new algorithm which was then validated using the remaining samples in the test set, where sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS The proposed iClearCyte algorithm (>1 "aneuploid" cell or ≥ 1.7% combined "hyperdiploid" and "tetraploid" nuclei frequency) identified high-grade samples with sensitivity, specificity, PPV, and NPV of 100.0%, 86.7%, 89.7%, and 100.0%, respectively, in the test set. CONCLUSION The iClearCyte test has potential to serve as a robust non-invasive automated oral cancer screening tool promoting early oral cancer detection and decreasing the number of unnecessary invasive biopsies.
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Affiliation(s)
- Ekaterina Parfenova
- Faculty of Dentistry, Oral Medical and Biological Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Kelly Y P Liu
- Faculty of Dentistry, Oral Medical and Biological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Alan Harrison
- Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Calum MacAulay
- Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Martial Guillaud
- Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Catherine F Poh
- Faculty of Dentistry, Oral Medical and Biological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
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9
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Datta M, Laronde D, Palcic B, Guillaud M. The role of DNA image cytometry in screening oral potentially malignant lesions using brushings: A systematic review. Oral Oncol 2019; 96:51-59. [PMID: 31422213 DOI: 10.1016/j.oraloncology.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 07/05/2019] [Indexed: 01/22/2023]
Abstract
It is believed that the majority of oral cancers develop from oral potentially malignant lesions (OPML). Though they can be easily detected during screening, risk stratification is difficult. During screening clinicians often find it difficult to distinguish OPMLs from benign lesions, and predicting OPML at risk of malignant transformation is particularly challenging. DNA aneuploidy has been known to be a marker of malignancy in a number of sites including the oral cavity. We performed a systematic review to evaluate the effectiveness of DNA-ICM using brushings in differentiating OPMLs from benign/inflammatory lesions during screening and in predicting malignant transformation. MEDLINE, Pubmed, EMBASE electronic databases were systematically searched using a combination of keywords and subject headings. A total of 11 articles satisfied our inclusion criteria. These studies reported a wide range of sensitivity (16-96.4%) and specificity (90-100%) due to the differences in study design, definitions of high risk or low risk lesions and DNA-ICM protocol used. No long-term longitudinal studies were identified to assess the role of DNA-ICM using brushings in predicting malignant transformation. No studies evaluated the role of DNA-ICM in community screening settings. A number of studies combined DNA-ICM with other techniques like cytology or argyrophilic nucleolar organizer region counts leading to improved test results. In spite of DNA aneuploidy being accepted as a marker of malignancy, there is limited evidence of DNA-ICM using brushings being successful as an adjunct oral cancer screening tool. Longitudinal studies and large community screening studies need to be undertaken to draw stronger conclusion.
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Affiliation(s)
- Madhurima Datta
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Denise Laronde
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Cancer Control Research, BC Cancer, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
| | - Branko Palcic
- Imaging Unit, Integrative Oncology, BC Cancer, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
| | - Martial Guillaud
- Imaging Unit, Integrative Oncology, BC Cancer, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada; Department of Statistics, The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada.
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Current evidence on DNA aneuploidy cytology in noninvasive detection of oral cancer. Oral Oncol 2019; 101:104367. [PMID: 31300271 DOI: 10.1016/j.oraloncology.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/02/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023]
Abstract
DNA-aneuploidy cytology as a promising noninvasive tool in diagnosing oral precancer and cancer has been proposed in 2015. In this letter, we identified 9 studies on DNA aneuploidy cytology with special emphasis on using fresh tissue sample in detection of oral precancer and cancer. Evidence was updated as follows, for detection of OSCC in general oral lesions, the pooled sensitivity and specificity was 84.8 and 99.0 respectively; for discrimination of dysplasia and OSCC form oral lesions, the sensitivity and specificity was 75.7 and 76.8 respectively. On the whole, current evidence on the theme is not robust, and multicenter prospective studies are needed to consolidate the evidence.
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Assessment of the cancerization risk for oral potentially malignant disorders by clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry. Eur Arch Otorhinolaryngol 2019; 276:2549-2557. [PMID: 31263980 DOI: 10.1007/s00405-019-05520-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/14/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To explore the feasibility of assessing the cancerization risk of oral potentially malignant disorders (OPMD) through a clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry. METHODS We collected the baseline clinical data of 269 patients; then, performed autofluorescence, brush biopsy with DNA-image cytometry and histopathological examination. Then, we obtained the significant factors by univariate logistic analysis, constructed the clinical risk model by multiple logistic regression and selected the optimal cutoff value according to the maximum Youden index. Finally, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical risk score ≥ cutoff value, autofluorescence and brush biopsy with DNA-image cytometry, and plotted the receiver-operating characteristic (ROC) curves and decision curve analysis (DCA). RESULTS The clinical risk model is represented by the formula: 1 × gender + 1.6 × age group + 1 × lesion site + 1.4 × local stimulus + 1.5 × drink. The area under the curve (AUC) was 0.83, and the optimal cutoff score was 3. The AUC indicated that the clinical risk score ≥ 3 (0.74) and autofluorescence (0.77) had a certain diagnostic values, while brush biopsy with DNA-image cytometry (0.92) displayed a good value. Besides, the DCA showed that all three tests had clinical significance. CONCLUSIONS The cancerization risk of patients can be assessed by the clinical risk model combined with sequence application of autofluorescence and brush biopsy with DNA-image cytometry, to decide whether histopathological examination or other intervention measures should be selected.
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Liu Y, Gao Y, Chen XJ, Hua H. [DNA cytometry of exfoliated cells in the diagnosis of oral potential malignant disorders]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:16-20. [PMID: 30773538 DOI: 10.19723/j.issn.1671-167x.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficiency of oral mucosa disease, especially oral squamous cell carcinoma (OSCC) and oral potential malignant disorders (OPMDs) by DNA cytometry compared with histopathological diagnosis, so as to find a convenient, simple and low-invasive method for screening and follow-up. METHODS 203 subjects with OSCC, OPMDs and other oral mucosa disease without dysplasia according to the inclusion criteria and exclusion criteria were recruited from Peking University School and Hospital of Stomatology. The mean age was (52.44±13.55) years, 98 males and 105 females. Brush biopsy was taken before scalpel biopsy at the same site. The brush biopsy sample was screened by moticytometer system for DNA cytometry after Feulgen stain, and histopathological examination were taken for the scalpel tissue. Data from DNA cytometry were used to calculate the parameters, such as sensitivity, specificity, positive and negative predictive values, odds ratios, Youden index (YI), positive and negative likelihood ratios, compared with the golden standard, histopathological diagnosis. DNA cytometry and histopathological diagnosis were performed back to back. RESULTS Totally, 42 OSCC and 4 tumor in situ (TIS), 39 oral leukoplakia (OLK) with dysplasia (17 mild dysplasia, 13 medium dysplasia and 9 severe dysplasia), 29 OLK with hyperplasia, 1 verrucous OLK, 83 oral lichen planus (OLP) and 5 inflammation were included in our research. We grouped the OSCC, TIS and dysplasia as the positive group and others without dysplasia as the negative group, the sensitivity of DNA cytometry was 79.07%, the specificity was 81.20%, and the diagnostic accuracy was 80.30%,We grouped the OSCC and TIS as the tumor group, OLP, OLK with hyperplasia and inflammation as the non-tumor group, The sensitivity of DNA cytometry in diagnosing OSCC and TIS was 95.65%, and the specificity was 81.2%, The diagnostic accuracy was 85.28%. positive predictive values 66.67%, negative predictive values 97.94%, ratio odds 95, positive likelihood ratio 5.09, negative likelihood ratio 0.05, and Youden index 0.77. For the dysplasia, we grouped the different dysplasia together as the dyaplasia group, OLP, OLK with hyperplasia and inflammation as the non-tumor group, the sensitivity of DNA cytometry in diagnosing dyaplasia is 60%, the specificity is 81.2%. The diagnostic accuracy is 75.8%, positive predictive values 52.17%, negative predictive values 85.59%, ratio odds 6.48, positive likelihood ratio 3.19, negative likelihood ratio 0.49, and Youden index 0.41. CONCLUSION DNA cytometry is convenient and low-invasive, which can be used as an adjuvant method for screening the early OSCC and OPMDs, monitoring the prognosis of OSCC after surgery. Further large-scale and long period prospective studies are necessary to validate the better value of DNA cytometry.
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Affiliation(s)
- Y Liu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X J Chen
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - H Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Shi A, Min W, Xiang L, Xu W, Jiang T. Value of automatic DNA image cytometry for diagnosing lung cancer. Oncol Lett 2018; 16:915-923. [PMID: 29963164 PMCID: PMC6019940 DOI: 10.3892/ol.2018.8723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 02/02/2018] [Indexed: 01/21/2023] Open
Abstract
The present study aimed to investigate the diagnostic value of automatic DNA image cytometry (DNA-ICM) for diagnosing lung cancer. A total of three different types of samples from 465 cases were included: Bronchoalveolar lavage fluid (BALF), 386 samples; pleural effusion cases, 70 samples; and fine-needle aspiration procedures, 9 samples. Two methods, liquid-based cytology (LBC) and automatic DNA-ICM, were used to assess the samples, and the pathological results of 120/465 cases were reviewed. The results of DNA-ICM were compared with those of LBC and pathology. There were 57 cases of lung cancer without aneuploidy and 49 cases without evidence of malignant tumor, but with the presence of heteroploid cells. The positive diagnostic rate for BALF samples using LBC was significantly higher compared with that for DNA-ICM (P<0.05). No statistically significant difference was observed in the positive diagnostic rate between DNA-ICM and LBC in pleural effusion samples. For DNA-ICM in BALF, pleural effusion and all samples, no statistically significant differences were identified between the positive diagnostic rates of lung squamous carcinoma and lung adenocarcinoma. The positive diagnostic rate of LBC combined with DNA-ICM was not significantly improved. In non-small cell lung cancer (NSCLC) cases, the difference in the maximum value of DNA (DNAmax) was positively correlated with tumor stage (P<0.05), but no significant correlations were observed among DNA max, tumor type and tumor location. In small-cell lung cancer (SCLC) cases, no significant correlations were observed among DNAmax, tumor staging or tumor location. The differences in the DNAmax values of squamous cell carcinoma, adenocarcinoma, SCLC and NSCLC were not statistically significant. In the present study, the area under the receiver operating characteristic curve for LBC (0.936) was significantly greater compared with that for DNA-ICM (0.766) (P<0.05). DNA-ICM has medium diagnostic value in lung cancer, and the DNAmax was positively correlated with tumor stage in NSCLC. DNA-ICM may serve as a supplement to LBC, but it is not recommended as a sole procedure for lung cancer screening.
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Affiliation(s)
- Anqi Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wang Min
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Lai Xiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wu Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Tao Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Liu Y, Li Y, Fu Y, Liu T, Liu X, Zhang X, Fu J, Guan X, Chen T, Chen X, Sun Z. Quantitative prediction of oral cancer risk in patients with oral leukoplakia. Oncotarget 2018; 8:46057-46064. [PMID: 28545021 PMCID: PMC5542248 DOI: 10.18632/oncotarget.17550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/28/2017] [Indexed: 12/16/2022] Open
Abstract
Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma. We have developed an oral cancer risk index using DNA index value to quantitatively assess cancer risk in patients with oral leukoplakia, but with limited success. In order to improve the performance of the risk index, we collected exfoliative cytology, histopathology, and clinical follow-up data from two independent cohorts of normal, leukoplakia and cancer subjects (training set and validation set). Peaks were defined on the basis of first derivatives with positives, and modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Random forest was found to be the best model with high sensitivity (100%) and specificity (99.2%). Using the Peaks-Random Forest model, we constructed an index (OCRI2) as a quantitative measurement of cancer risk. Among 11 leukoplakia patients with an OCRI2 over 0.5, 4 (36.4%) developed cancer during follow-up (23 ± 20 months), whereas 3 (5.3%) of 57 leukoplakia patients with an OCRI2 less than 0.5 developed cancer (32 ± 31 months). OCRI2 is better than other methods in predicting oral squamous cell carcinoma during follow-up. In conclusion, we have developed an exfoliative cytology-based method for quantitative prediction of cancer risk in patients with oral leukoplakia.
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Affiliation(s)
- Yao Liu
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yicheng Li
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, North Carolina, USA
| | - Yue Fu
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Tong Liu
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xiaoyong Liu
- Department of Pathology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xinyan Zhang
- Beijing Institute of Dental Research, School of Stomatology, Capital Medical University, Beijing, China
| | - Jie Fu
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xiaobing Guan
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Tong Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Xiaoxin Chen
- Cancer Research Program, Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, North Carolina, USA
| | - Zheng Sun
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
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Identification of Malignancy-Associated Changes in Histologically Normal Tumor-Adjacent Epithelium of Patients with HPV-Positive Oropharyngeal Cancer. Anal Cell Pathol (Amst) 2018; 2018:1607814. [PMID: 29713583 PMCID: PMC5866869 DOI: 10.1155/2018/1607814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/28/2022] Open
Abstract
The incidence of HPV-positive oropharyngeal cancer (HPV+ OPC) is increasing, thus presenting new challenges for disease detection and management. Noninvasive methods involving brush biopsies of diseased tissues were recently reported as insufficient for tumor detection in HPV+ OPC patients, likely due to differences between the site of tumor initiation at the base of involuted crypts and the site of brush biopsy at the crypt surface. We hypothesized that histologically normal surface epithelial cells in the oropharynx contain changes in nuclear morphology that arise due to tumor proximity. We analyzed the nuclear phenotype of matched tumor, tumor-adjacent normal, and contralateral normal tissues from biopsies of nine HPV+ OPC patients. Measurements of 89 nuclear features were used to train a random forest-based classifier to discriminate between normal and tumor nuclei. We then extracted voting scores from the trained classifier, which classify nuclei on a continuous scale from zero (“normal-like”) to one (“tumor-like”). In each case, the average score of the adjacent normal nuclei was intermediate between the tumor and contralateral normal nuclei. These results provide evidence for the existence of phenotypic changes in histologically normal, tumor-adjacent surface epithelial cells, which could be used as brush biopsy-based biomarkers for HPV+ OPC detection.
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Lima CF, Alves MGO, Carvalho BFDC, de Lima TA, Coutinho-Camillo CM, Soares FA, Scholz J, Almeida JD. Is DNA ploidy related to smoking? J Oral Pathol Med 2017; 46:961-966. [PMID: 28730665 DOI: 10.1111/jop.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the oral cavity, genomic instability is caused by long-term exposure to carcinogens. The aim of this study was to evaluate the relationship between smoking and DNA ploidy. METHODS Cytological material was obtained from patients participating in the Outpatient Smoking Treatment Program of the Heart Institute (INCOR-HCFMUSP), and of the Discipline of Oral Medicine (ICT-UNESP). The inclusion criteria for all groups were the absence of a history of malignant tumors, absence of clinical signs of changes in the selected area, and alcohol consumption of less than 3 units per week. Group 1:30 smokers before smoking cessation treatment; Group 2:30 non-smokers; Group 3:30 ex-smokers abstinent for at least 1 year. Cytological smears were collected from the floor of the mouth and border of the tongue and stained by Feulgen. Aneuploidy was evaluated using the ACIS® III system. RESULTS The Kruskal-Wallis test showed no statistically significant difference (P = .4383) between the groups studied. No association between tobacco consumption and aneuploidy was observed in group 1 (P = 1) or group 2 (P = .68; Fisher's exact test). CONCLUSION Smoking was not associated with changes in DNA content or the incidence of aneuploidy in normal oral mucosa.
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Affiliation(s)
- Celina Faig Lima
- School of Dentistry, Universidade Braz Cubas, Mogi das Cruzes, Brazil.,Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Monica Ghislaine Oliveira Alves
- School of Dentistry, Universidade Braz Cubas, Mogi das Cruzes, Brazil.,Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Bruna Fernandes do Carmo Carvalho
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Thaynara Alves de Lima
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | | | | | - Jaqueline Scholz
- Medical School, Outpatient Program for the Treatment of Smoking, Heart Institute São Paulo, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Janete Dias Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
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Yang X, Xiao X, Wu W, Shen X, Zhou Z, Liu W, Shi L. Cytological study of DNA content and nuclear morphometric analysis for aid in the diagnosis of high-grade dysplasia within oral leukoplakia. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:280-285. [PMID: 28732697 DOI: 10.1016/j.oooo.2017.05.509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To quantitatively examine the DNA content and nuclear morphometric status of oral leukoplakia (OL) and investigate its association with the degree of dysplasia in a cytologic study. STUDY DESIGN Oral cytobrush biopsy was carried out to obtain exfoliative epithelial cells from lesions before scalpel biopsy at the same location in a blinded series of 70 patients with OL. Analysis of nuclear morphometry and DNA content status using image cytometry was performed with oral smears stained with the Feulgen-thionin method. RESULTS Nuclear morphometric analysis revealed significant differences in DNA content amount, DNA index, nuclear area, nuclear radius, nuclear intensity, sphericity, entropy, and fractal dimension (all P < .01) between low-grade and high-grade dysplasia. DNA content analysis identified 34 patients with OL (48.6%) with DNA content abnormality. Nonhomogeneous lesion (P = .018) and high-grade dysplasia (P = .008) were significantly associated with abnormal DNA content. Importantly, the positive correlation between the degree of oral dysplasia and DNA content status was significant (P = .004, correlation coefficient = 0.342). CONCLUSION Cytology analysis of DNA content and nuclear morphometric status using image cytometry may support their use as a screening and monitoring tool for OL progression.
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Affiliation(s)
- Xi Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Xiao
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Wenyan Wu
- Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xuemin Shen
- Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zengtong Zhou
- Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Linjun Shi
- Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Ye X, Zhang J, Tan Y, Chen G, Zhou G. Meta-analysis of two computer-assisted screening methods for diagnosing oral precancer and cancer. Oral Oncol 2015; 51:966-975. [PMID: 26384539 DOI: 10.1016/j.oraloncology.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/27/2022]
Abstract
The early diagnosis of oral precancer and cancer is crucial and could have the highest impact on improving survival rates. A meta-analysis was conducted to compare the accuracy between the OralCDx brush biopsy and DNA-image cytometry in diagnosing both conditions. Bibliographic databases were systematically searched for original relevant studies on the early diagnosis of oral precancer and oral cancer. Study characteristics were evaluated to determine the accuracy of the two screening strategies. Thirteen studies (eight of OralCDx brush biopsy and five of DNA-image cytometry) were identified as having reported on 1981 oral mucosa lesions. The meta-analysis found that the area under the summary receiver operating characteristic curves of the OralCDx brush biopsy and DNA-image cytometry were 0.8879 and 0.9885, respectively. The pooled sensitivity, specificity, and diagnostic odds ratio of the OralCDx brush biopsy were 86% (95% CI 81-90), 81% (95% CI 78-85), and 20.36 (95% CI 2.72-152.67), respectively, while these modalities of DNA-image cytometry were 89% (95% CI 83-94), 99% (95% CI 97-100), and 446.08 (95% CI 73.36-2712.43), respectively. Results of a pairwise comparison between each modality demonstrated that specificity, area under the curve (AUC), and Q(∗) index of DNA-image cytometry was significantly higher than that of the OralCDx brush biopsy (Z=2.821, p<0.05; Z=1.711, p<0.05; Z=1.727, p<0.05), but no significant difference in sensitivity was found (Z=1.520, p>0.05). In conclusion, the meta-analysis of the published studies indicated that DNA-image cytometry is more accurate than the OralCDx brush biopsy in diagnosing oral precancer and oral cancer.
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Affiliation(s)
- Xiaojing Ye
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Jing Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Yaqin Tan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Guanying Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Gang Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China.
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Quantitative risk stratification of oral leukoplakia with exfoliative cytology. PLoS One 2015; 10:e0126760. [PMID: 25978541 PMCID: PMC4433206 DOI: 10.1371/journal.pone.0126760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/07/2015] [Indexed: 11/19/2022] Open
Abstract
Exfoliative cytology has been widely used for early diagnosis of oral squamous cell carcinoma (OSCC). Test outcome is reported as “negative”, “atypical” (defined as abnormal epithelial changes of uncertain diagnostic significance), and “positive” (defined as definitive cellular evidence of epithelial dysplasia or carcinoma). The major challenge is how to properly manage the “atypical” patients in order to diagnose OSCC early and prevent OSCC. In this study, we collected exfoliative cytology data, histopathology data, and clinical data of normal subjects (n=102), oral leukoplakia (OLK) patients (n=82), and OSCC patients (n=93), and developed a data analysis procedure for quantitative risk stratification of OLK patients. This procedure involving a step called expert-guided data transformation and reconstruction (EdTAR) which allows automatic data processing and reconstruction and reveals informative signals for subsequent risk stratification. Modern machine learning techniques were utilized to build statistical prediction models on the reconstructed data. Among the several models tested using resampling methods for parameter pruning and performance evaluation, Support Vector Machine (SVM) was found to be optimal with a high sensitivity (median>0.98) and specificity (median>0.99). With the SVM model, we constructed an oral cancer risk index (OCRI) which may potentially guide clinical follow-up of OLK patients. One OLK patient with an initial OCRI of 0.88 developed OSCC after 40 months of follow-up. In conclusion, we have developed a statistical method for qualitative risk stratification of OLK patients. This method may potentially improve cost-effectiveness of clinical follow-up of OLK patients, and help design clinical chemoprevention trial for high-risk populations.
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DNA content status using brush biopsy with image cytometry correlated with staging of oral leukoplakia: a preliminary study. Oral Oncol 2014; 51:59-63. [PMID: 25459158 DOI: 10.1016/j.oraloncology.2014.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oral leukoplakia (OL) is the best-known potentially malignant disorder of oral cancer. The hypothesis was tested that DNA content abnormality may contribute to risk prediction of malignant potential of OL. METHODS All OLs were staged according to a clinicopathologic classification and OL-staging system. DNA content status was investigated in a blinded prospective series of OL using brush biopsy with image cytometry, and examined the correlation of DNA content with the clinicopathologic features and OL-staging system in this preliminary study. RESULTS Among 65 patients with OL, 27 (41.5%) was identified as DNA content abnormality. The frequency (77.8%) of DNA content abnormality in tongue was higher than that (22.2%) in other oral sites (χ(2) test, P=0.038), and moderate or severe dysplasia had a higher frequency (63.0%) of DNA content abnormality than that (37.0%) of no or mild dysplasia (χ(2) test, P=0.022). Moreover, the odds ratio of DNA content abnormality in high-risk patient group was 5.74-fold (95% confidence interval, 1.81-18.20; P=0.003) increase compared with low-risk patient group. Importantly, the positive correlation between OL-staging system and DNA content status was significant (P=0.018, correlation coefficient=0.292). CONCLUSION Our findings showed that DNA content status correlated with OL-staging system, suggesting that DNA content abnormality in OL as detected by image cytometry was an early event in oral carcinogenesis. The further large-scale prospective studies with clinical endpoints are warranted to validate the value of DNA image cytometry.
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