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Jiang C, Li X, Chen R, Yang Y, Wang Y. Enzyme-labeled liquid-based cytology (ELLBC): a new noninvasive diagnostic method for bladder cancers. J Cancer Res Clin Oncol 2024; 150:169. [PMID: 38546889 PMCID: PMC10978622 DOI: 10.1007/s00432-024-05613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/07/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Based on liquid-based cytology, we performed an enzyme histochemical staining using acid phosphatase as a marker and termed it ELLBC. The aim of this study was to investigate the value of ELLBC in the diagnosis of bladder cancer. METHODS Fifty patients who were initially diagnosed with suspected bladder cancers (hematuria or bladder irritation symptoms, urinary ultrasound suggestive of bladder mass) at the Second Affiliated Hospital of Anhui Medical University (Anhui, China) from January 2022 to December 2022 were selected as the study subjects, all of whom underwent ELLBC, CC, and histopathology Histopathology was used as the gold standard to calculate the diagnostic efficacy of ELLBC, CC and ELLBC combined with CC in bladder cancer. RESULTS Histopathological examination revealed 35 positive cases in 50 patients, including 15 cases of high-grade uroepithelial carcinoma (HGUC) and 20 cases of low-grade uroepithelial carcinoma (LGUC.) The sensitivity of ELLBC was 82.86%, the specificity was 93.33%, the positive predictive value (PPV) was 96.67%, the negative predictive value (NPV) was 70.00%, and the accuracy was 86.00%; CC had a sensitivity of 37.14%, specificity of 80.00%, PPV of 81.25%, NPV of 35.29%, and accuracy of 50%; ELLBC combined with CC had a sensitivity of 88.57%, specificity of 73.33%, PPV of 88.57%, NPV of 73.33%, and accuracy of 84.00%. The sensitivity and specificity of ELLBC were higher than that of CC, and the difference was statistically significant (p < 0.05), ELLBC combined with CC achieved higher sensitivity, but the diagnostic accuracy decreased. For clinical staging, the diagnostic accuracy was 86.36% for ELLBC and 40.91% for CC in patients in Stage I, and 90.91% for ELLBC and 36.36% for CC in patients in Stage II. CONCLUSION ELLBC has high clinical application value for the diagnosis of bladder cancer and can provide new options and methods for the early screening of bladder cancer.
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Affiliation(s)
- Chao Jiang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, China
| | - Xiang Li
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, China
| | - Ruilong Chen
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, China
| | - Yongliu Yang
- Department of Pathology, Hefei Cancer Hospital, Chinese Academy of Sciences, No. 68 Yangqiao Road, Hefei, 230088, China
| | - Yi Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, China.
- Anhui Provincial Institute of Translational Medicine, Hefei, 230601, China.
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Kühn JP, Speicher S, Linxweiler B, Körner S, Rimbach H, Wagner M, Solomayer EF, Schick B, Linxweiler M. Dual Sec62/Ki67 immunocytochemistry of liquid-based cytological preparations represents a highly valid biomarker for non-invasive detection of head and neck squamous cell carcinomas. Cytopathology 2024; 35:113-121. [PMID: 37787092 DOI: 10.1111/cyt.13310] [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: 07/20/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Head and neck squamous cell carcinomas (HNSCC) are frequently diagnosed in advanced stages, which limits therapeutic options and results in persistently poor patient outcomes. The aim of this study was to use liquid-based swab cytology (LBC) in combination with dual immunocytochemical detection of migration and proliferation markers Sec62 and Ki67 in order to allow non-invasive early detection of HNSCC as well as to analyse the diagnostic validity of this method for predicting the malignancy of suspicious oral lesions. METHODS 104 HNSCC patients and 28 control patients, including healthy patients (n = 17), papilloma (n = 1) and leukoplakia patients (n = 10), were included in this study. For all patients, an LBC swab followed by simultaneous immunocytochemical detection of Sec62 and Ki67 was performed. Immunocytochemical as well as cytopathological results were correlated with histological diagnoses and clinical findings. RESULTS All HNSCC patients (100%) showed dual Sec62/Ki67 positivity, and all control patients except for the papilloma patient were negative for Sec62/Ki67 (96.4%), resulting in a 100% sensitivity and 96.4% specificity of Sec62/Ki67 dual stain for non-invasive detection of HNSCC. The positive predictive value was 99% and the negative predictive value was 100%. Sec62 expression levels showed a positive correlation with tumour de-differentiation (p = 0.0489). CONCLUSION Simultaneous immunocytochemical detection of Sec62/Ki67 using LBC represents a promising non-invasive and easy-to-apply tool for the early detection of HNSCC in routine clinical practice. This novel technique can help to avoid incisional biopsies and reduce the frequency with which general anaesthesia is used in diagnostic procedures in patients with suspicious oral lesions.
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Affiliation(s)
- Jan Philipp Kühn
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefanie Speicher
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Barbara Linxweiler
- Department of Gynecology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sandrina Körner
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hugo Rimbach
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Mathias Wagner
- Department of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Bernhard Schick
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
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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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Qin X, Zhang M, Zhou C, Ran T, Pan Y, Deng Y, Xie X, Zhang Y, Gong T, Zhang B, Zhang L, Wang Y, Li Q, Wang D, Gao L, Zou D. A deep learning model using hyperspectral image for EUS-FNA cytology diagnosis in pancreatic ductal adenocarcinoma. Cancer Med 2023; 12:17005-17017. [PMID: 37455599 PMCID: PMC10501295 DOI: 10.1002/cam4.6335] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND AIMS Endoscopic ultrasonography-guided fine-needle aspiration/biopsy (EUS-FNA/B) is considered to be a first-line procedure for the pathological diagnosis of pancreatic cancer owing to its high accuracy and low complication rate. The number of new cases of pancreatic ductal adenocarcinoma (PDAC) is increasing, and its accurate pathological diagnosis poses a challenge for cytopathologists. Our aim was to develop a hyperspectral imaging (HSI)-based convolution neural network (CNN) algorithm to aid in the diagnosis of pancreatic EUS-FNA cytology specimens. METHODS HSI images were captured of pancreatic EUS-FNA cytological specimens from benign pancreatic tissues (n = 33) and PDAC (n = 39) prepared using a liquid-based cytology method. A CNN was established to test the diagnostic performance, and Attribution Guided Factorization Visualization (AGF-Visualization) was used to visualize the regions of important classification features identified by the model. RESULTS A total of 1913 HSI images were obtained. Our ResNet18-SimSiam model achieved an accuracy of 0.9204, sensitivity of 0.9310 and specificity of 0.9123 (area under the curve of 0.9625) when trained on HSI images for the differentiation of PDAC cytological specimens from benign pancreatic cells. AGF-Visualization confirmed that the diagnoses were based on the features of tumor cell nuclei. CONCLUSIONS An HSI-based model was developed to diagnose cytological PDAC specimens obtained using EUS-guided sampling. Under the supervision of experienced cytopathologists, we performed multi-staged consecutive in-depth learning of the model. Its superior diagnostic performance could be of value for cytologists when diagnosing PDAC.
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Affiliation(s)
- Xianzheng Qin
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Minmin Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Chunhua Zhou
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Taojing Ran
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yundi Pan
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yingjiao Deng
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Xingran Xie
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Yao Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Tingting Gong
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Benyan Zhang
- Department of PathologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Ling Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Dong Wang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Lili Gao
- Department of PathologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Duowu Zou
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
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Fiwek P, Irga-Jaworska N, Wojtylak S, Biernat W, Emerich K, Pomiecko D. Assessment of Cytological Changes in the Oral Mucosa in Young Hematological Patients Treated with Systemic Chemotherapy. J Clin Med 2023; 12:jcm12072665. [PMID: 37048748 PMCID: PMC10095229 DOI: 10.3390/jcm12072665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Background and Objectives: The primary objective of the undertaken study was to determine the morphological changes that occur within the oral epithelium in children undergoing chemotherapy following a diagnosis of hematological malignancies. Materials and Methods: The study group consisted of 18 patients diagnosed with leukemia or lymphoma undergoing treatment with chemotherapy. Swabs (liquid-based cytology) were collected from the oral cavity for microscopic evaluation at baseline, during the chemotherapy cycle with oral mucositis symptoms present, and upon completion of the cycle. Both the neutrophil count and oral mucositis (OM) were registered using the WHO (World Health Organization) scale. The control group included 41 children who were generally healthy. All samples underwent microscopical analyses at the Department of Pathology, Medical University of Gdansk, Poland. Results: A total of 190 cytological preparations were evaluated. The baseline preparations revealed similar cytological images, and the superficial cells of the epithelial layers were seen. A significant (p < 0.01) increase in the number of cells in the intermediate layer of the oral epithelium, as well as a decrease (p < 0.01) in the volume of cells in the superficial layers, was observed in further stages of cytostatic treatment. Conclusions: A decrease in the percentage of superficial epithelial cells with a corresponding increase in the number of intermediate epithelial cells is considered to be a result of toxic damage to the oral mucosa during chemotherapy.
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Affiliation(s)
- Paula Fiwek
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Hematology and Oncology, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Szymon Wojtylak
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Katarzyna Emerich
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Dagmara Pomiecko
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
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Kokubun K, Nakajima K, Yamamoto K, Akashi Y, Matsuzaka K. Evaluation of oral brush liquid-based cytology for oral squamous cell carcinoma: a comparative study of cytological and histological diagnoses at a single center. BMC Oral Health 2023; 23:145. [PMID: 36906554 PMCID: PMC10007825 DOI: 10.1186/s12903-023-02839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE Liquid-based cytology is highly useful in oral cytology. However, there are only few reports on the accuracy of this method. The current study aimed to compare oral liquid-based cytological and histological diagnoses and to evaluate items that should be considered in oral cytological diagnosis for oral squamous cell carcinoma. METHODS We included 653 patients who underwent both oral cytological and histological examinations. Data on sex, specimen collection region, cytological and histological diagnoses, and histological images were reviewed. RESULTS The overall male-to-female ratio was 1:1.18. The tongue was the most common specimen collection region, followed by the gingiva and buccal mucosa. The most common cytological examination result was negative (66.8%), followed by doubtful (22.7%) and positive (10.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis were 69%, 75%, 38%, and 92%, respectively. Approximately 8.3% of patients with a negative cytological diagnosis had a histological diagnosis of oral squamous cell carcinoma. Furthermore, 86.1% of histopathologic images of cytology-negative squamous cell carcinomas exhibited well-differentiated keratinocytes lacking atypia on the surface. The remaining patients developed recurrence, or they had low cell counts. CONCLUSION Liquid-based cytology is useful in screening oral cancer. However, a cytological diagnosis of superficial-differentiated oral squamous cell carcinoma is occasionally inconsistent with the histological diagnosis. Therefore, histological and cytological examinations should be performed if tumor-like lesions are suspected clinically.
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Affiliation(s)
- Katsutoshi Kokubun
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
| | - Kei Nakajima
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kei Yamamoto
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Yoshihiko Akashi
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kenichi Matsuzaka
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
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Ishii S, Sakaguchi W, Sugai M, Nagumo T, Koeda S, Ozawa M, Kitamura T, Yamamura M, Akiyama H, Tsukinoki K, Nakamura A. Analysis of false-negatives in exfoliative cytology in oral potentially malignant disorders: A retrospective cohort study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e390-e395. [PMID: 35134591 DOI: 10.1016/j.jormas.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Keratinized lesions have been a conceivable false-negative (FN) factor in oral exfoliative cytology (OEC); however, other factors are poorly analyzed. In this study, we aimed to identify the factors influencing the accuracy of OEC and FNs focusing on the lesion characteristics, patient background, and surgeon factors in oral potentially malignant disorders (OPMD). MATERIAL AND METHODS We retrospectively studied 44 patients who underwent both OEC and histopathological diagnosis. Sensitivity, specificity, FN rate, false-positive (FP) rate, and prevalence of both methods were compared. Similarly, accuracy indices were compared among clinical diagnosis groups (leukoplakia vs. other diagnosis). The association between patient and surgeon-related factors influencing FN OEC results were investigated using Fisher's exact test and a multiple logistic regression analysis. RESULTS Overall, the sensitivity; specificity; and FN, FP, and prevalence rates of OEC were 31.8%, 82.1%, and 68.8%, 17.9%, and 36.4%, respectively. Leukoplakia was significantly more common in clinical diagnosis (P = 0.007) with sensitivity, specificity, and FN rates of 20.0%, 95.2%, and 80.0%, respectively. Contrarily, non-keratinized lesions had sensitivity, specificity, and FN of 83.3%, 85.7%, and 16.7%, respectively. In the prevalent group, leukoplakia and anucleate squamous cells were significantly associated with FN cases (P = 0.013, P = 0.050). On multivariate analysis in OEC negative patients, age ≤64 (P = 0.050) and location on the tongue (P = 0.047) was independently associated with FNs. CONCLUSION FN of OEC was conceivable to be due to poor deep-seated cell sampling, which was associated with leukoplakia, age, and location. Therefore, these factors may be considered in the evaluation of OEC results.
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Affiliation(s)
- Shigeru Ishii
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Wakako Sakaguchi
- Department of Environmental Pathology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan.
| | - Masafune Sugai
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Tatsuhito Nagumo
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Satoko Koeda
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Manami Ozawa
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Toru Kitamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Makiko Yamamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Hiroki Akiyama
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Keiichi Tsukinoki
- Department of Environmental Pathology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan.
| | - Atsushi Nakamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
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Linxweiler M, Körner S, Wemmert S, Rimbach H, Helfrich J, Linxweiler B, Takacs ZF, Solomayer EF, Wagner M, Morris LGT, Schick B, Kühn JP. Cytology-based Cancer Surgery of the Head and Neck (CyCaS-HN): a prospective, randomized, controlled clinical trial. Eur Arch Otorhinolaryngol 2022; 279:4505-4514. [PMID: 35305137 PMCID: PMC9363327 DOI: 10.1007/s00405-022-07333-7] [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: 12/10/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
Purpose Liquid-based cytology (LBC) is routinely used in gynecology but is rarely applied in head and neck oncology though many suspicious lesions are easily accessible. While several studies have evaluated the potential use of LBC for early detection and molecular characterization of head and neck squamous cell carcinomas (HNSCCs), no study investigated its potential role in surgical management and therapy planning so far. Methods Twenty-five patients with cT1-2 squamous cell carcinomas of the oral cavity and oropharynx were prospectively enrolled in this study and were randomized to two treatment arms: in the control arm, a diagnostic panendoscopy with incisional biopsy was followed by a second operation with transoral tumor resection ± neck dissection and tracheostomy. In the intervention arm, patients underwent LBC diagnostics and in case of a positive result received one single operation with panendoscopy and incisional biopsy for confirmation of LBC result by rapid section histology followed by transoral tumor resection ± neck dissection and tracheostomy in the same session. Results Time between clinical diagnosis and definitive surgical treatment was significantly shorter in the intervention group compared with the control group (p < 0.0001). Additionally, time of hospitalization (p < 0.0001) and cumulative operation time (p = 0.062) were shorter in the intervention group. No significant differences in overall, progression-free, and disease-specific survival were observed. Conclusion Cytology-based cancer surgery is a promising therapeutic strategy that can potentially be considered for a well-defined group of early-stage HNSCC patients and help to avoid repetitive general anesthesia, shorten the diagnosis-to-treatment interval and spare operation as well as hospitalization time.
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Affiliation(s)
- Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany.
| | - Sandrina Körner
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Silke Wemmert
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Hugo Rimbach
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Johanna Helfrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Barbara Linxweiler
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Germany
| | - Zoltan Ferenc Takacs
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Germany
| | - Erich Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Germany
| | - Mathias Wagner
- Department of General and Surgical Pathology, Saarland University Medical Center, Homburg, Germany
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.,Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany
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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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Tomić U, Petrović S, Soldatović I, Mihailović Đ, Kuzmanović Č, Jelovac D, Tomanović N, Pucar A. Comparison of transepithelial cytology and histopathology in the diagnosis of potentially malignant and malignant lesions of the oral mucosa. BALKAN JOURNAL OF DENTAL MEDICINE 2022. [DOI: 10.5937/bjdm20220531-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: The objective of the study was to compare cytological diagnoses using transepithelial cytology (oral brush biopsy) with histopathological diagnoses obtained by incisional biopsy in patients with benign lesions, oral potentially malignant disorders and oral squamous cell carcinoma. Material and Methods: The study included 57 patients. Brush biopsy was performed after local anaesthesia administration using the cervical brush. It was immediately followed by an incisional biopsy. Modified Bethesda System was used for cytological analysis and correlated with histopathological diagnoses according to intraepithelial neoplasia. Results: Good agreement was shown between cytological and histopathological diagnosis (kappa = 0.791). The sensitivity of the study was 92.85%, specificity 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) 93.54%. Conclusions: Oral brush biopsy, which allows the collection of epithelial cells of all layers can provide fast, precise and efficient cytological results which are in good agreement with the 'gold standard'-incisional biopsy followed by histopathology.
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11
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Sukegawa S, Ono S, Nakano K, Takabatake K, Kawai H, Nagatsuka H, Furuki Y. Clinical study on primary screening of oral cancer and precancerous lesions by oral cytology. Diagn Pathol 2020; 15:107. [PMID: 32912249 PMCID: PMC7488236 DOI: 10.1186/s13000-020-01027-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background This study was conducted to compare the histological diagnostic accuracy of conventional oral-based cytology and liquid-based cytology (LBC) methods. Methods Histological diagnoses of 251 cases were classified as negative (no malignancy lesion, inflammation, or mild/moderate dysplasia) and positive [severe dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC)]. Cytological diagnoses were classified as negative for intraepithelial lesion or malignancy (NILM), oral low-grade squamous intraepithelial lesion (OLSIL), oral high-grade squamous intraepithelial lesion (OHSIL), or SCC. Cytological diagnostic results were compared with histology results. Results Of NILM cytology cases, the most frequent case was negative [LBC n = 50 (90.9%), conventional n = 22 (95.7%)]. Among OLSIL cytodiagnoses, the most common was negative (LBC n = 34; 75.6%, conventional n = 14; 70.0%). Among OHSIL cytodiagnoses (LBC n = 51, conventional n = 23), SCC was the most frequent (LBC n = 31; 60.8%, conventional n = 7; 30.4%). Negative cases were common (LBC n = 13; 25.5%, conventional n = 14; 60.9%). Among SCC cytodiagnoses SCC was the most common (LBC n = 16; 88.9%, conventional n = 14; 87.5%). Regarding the diagnostic results of cytology, assuming OHSIL and SCC as cytologically positive, the LBC method/conventional method showed a sensitivity of 79.4%/76.7%, specificity of 85.1%/69.2%, false-positive rate of 14.9%/30.7%, and false-negative rate of 20.6%/23.3%. Conclusions LBC method was superior to conventional cytodiagnosis methods. It was especially superior for OLSIL and OHSIL. Because of the false-positive and false-negative cytodiagnoses, it is necessary to make a comprehensive diagnosis considering the clinical findings.
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Affiliation(s)
- Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan. .,Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Sawako Ono
- Department of Pathology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.,Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
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Deuerling L, Gaida K, Neumann H, Remmerbach TW. Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11111813. [PMID: 31752196 PMCID: PMC6896118 DOI: 10.3390/cancers11111813] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from an identical number of oral lesions, then cytological diagnoses were made using liquid-based cytology. The final diagnoses in the study were 105 histologically proven squamous cell carcinomas (SCCs), 744 potentially malignant lesions and 503 cases of traumatic, inflammatory or benign hyperplastic oral lesions. The sensitivity and specificity of the liquid-based brush biopsy were 95.6% (95% CI 94.5–96.7%) and 84.9% (95% CI 83.0–86.8%), respectively. This led to the conclusion that brush biopsy is potentially a highly sensitive and reliable method to make cytological diagnoses of oral neoplasia. The main advantage of a brush biopsy over a scalpel biopsy is that it is less invasive and is more tolerated by the patients. Therefore, more lesions can be screened and more cancers can be detected at an early stage.
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Affiliation(s)
- Lena Deuerling
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Kristin Gaida
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Heinrich Neumann
- Medical Care Center for Histology, Cytology and Molecular Diagnostics, 52351 Düren, Germany;
| | - Torsten W. Remmerbach
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
- German Association of Oral Diagnostics (DGOD mbH), Wettiner Str. 10, 04105 Leipzig, Germany
- Correspondence:
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Kondo Y, Oya K, Sakai M, Fujiwara C, Tojo F, Usami Y, Fukuda Y, Kogo M, Kishino M. Accuracy of liquid‐based cytology (LBC) in the oral mucosa according to novel diagnostic guidelines in Japan: Classification of cytology for oral mucosal disease (JSCC, 2015). ACTA ACUST UNITED AC 2019. [DOI: 10.1002/osi2.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yuko Kondo
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Kaori Oya
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Manabu Sakai
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Chisato Fujiwara
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Fumiaki Tojo
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Yu Usami
- Department of Oral pathology Osaka University Graduate School Dentistry Osaka Japan
| | - Yasuo Fukuda
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
| | - Mikihiko Kogo
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
- First Department of Oral and Maxillofacial Surgery Osaka University Graduate School Dentistry Osaka Japan
| | - Mitsunobu Kishino
- Department of Clinical Laboratory Osaka University Dental Hospital Osaka Japan
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Chan CH, Huang TT, Chen CY, Lee CC, Chan MY, Chung PC. Texture-Map-Based Branch-Collaborative Network for Oral Cancer Detection. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:766-780. [PMID: 31135368 DOI: 10.1109/tbcas.2019.2918244] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The paper proposes an innovative deep convolutional neural network (DCNN) combined with texture map for detecting cancerous regions and marking the ROI in a single model automatically. The proposed DCNN model contains two collaborative branches, namely an upper branch to perform oral cancer detection, and a lower branch to perform semantic segmentation and ROI marking. With the upper branch the network model extracts the cancerous regions, and the lower branch makes the cancerous regions more precision. To make the features in the cancerous more regular, the network model extracts the texture images from the input image. A sliding window is then applied to compute the standard deviation values of the texture image. Finally, the standard deviation values are used to construct a texture map, which is partitioned into multiple patches and used as the input data to the deep convolutional network model. The method proposed by this paper is called texture-map-based branch-collaborative network. In the experimental result, the average sensitivity and specificity of detection are up to 0.9687 and 0.7129, respectively based on wavelet transform. And the average sensitivity and specificity of detection are up to 0.9314 and 0.9475, respectively based on Gabor filter.
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15
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Alsarraf A, Kujan O, Farah CS. Liquid‐based oral brush cytology in the diagnosis of oral leukoplakia using a modified Bethesda Cytology system. J Oral Pathol Med 2018; 47:887-894. [DOI: 10.1111/jop.12759] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 12/25/2022]
Affiliation(s)
| | - Omar Kujan
- UWA Dental School University of Western Australia Nedlands WA Australia
| | - Camile S. Farah
- UWA Dental School University of Western Australia Nedlands WA Australia
- Australian Centre for Oral Oncology Research & Education UWA Dental School University of Western Australia Nedlands WA Australia
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16
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Bacterial Colonization and Tissue Compatibility of Denture Base Resins. Dent J (Basel) 2018; 6:dj6020020. [PMID: 29914101 PMCID: PMC6023505 DOI: 10.3390/dj6020020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022] Open
Abstract
Currently, there is minimal clinical data regarding biofilm composition on the surface of denture bases and the clinical tissue compatibility. Therefore, the aim of this experimental study was to compare the bacterial colonization and the tissue compatibility of a hypoallergenic polyamide with a frequently used PMMA resin tested intraorally in a randomized split-mouth design. Test specimens made of polyamide (n = 10) and PMMA (n = 10) were attached over a molar band appliance in oral cavity of 10 subjects. A cytological smear test was done from palatal mucosa at baseline and after four weeks. The monolayers were inspected for micronuclei. After four weeks in situ, the appliance was removed. The test specimens were immediately cultivated on non-selective and selective nutrient media. All growing colonies were identified using VITEK-MS. The anonymized results were analyzed descriptively. A total of 110 different bacterial species could be isolated, including putative pathogens. An average of 17.8 different bacterial species grew on the PMMA specimens, and 17.3 on the polyamide specimens. The highest number of different bacterial species was n = 24, found on a PMMA specimen. On the two specimens, a similar bacterial distribution was observed. Micronuclei, as a marker for genotoxic potential of dental materials, were not detected. This study indicates that the composition of bacterial biofilm developed on these resins after four weeks is not influenced by the type of resin itself. The two materials showed no cytological differences. This investigation suggests that polyamide and PMMA are suitable for clinical use as denture base material.
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17
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H. Alsarraf A, Kujan O, Farah CS. The utility of oral brush cytology in the early detection of oral cancer and oral potentially malignant disorders: A systematic review. J Oral Pathol Med 2017; 47:104-116. [DOI: 10.1111/jop.12660] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | - Omar Kujan
- UWA Dental School; University of Western Australia; Nedlands WA Australia
| | - Camile S. Farah
- UWA Dental School; University of Western Australia; Nedlands WA Australia
- Australian Centre for Oral Oncology Research & Education; UWA Dental School; University of Western Australia; Nedlands WA Australia
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