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Dineshkumar T, Srikanth P, Nagarathinam AE, Rajkumar K, Priyadharini S, Shruthi TA. Diagnostic Utility of Cytology in Assessment of Ploidy Status in Potentially Malignant Oral Disorders. Asian Pac J Cancer Prev 2019; 20:3145-3151. [PMID: 31653166 PMCID: PMC6982665 DOI: 10.31557/apjcp.2019.20.10.3145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Oral leukoplakia, the most common potentially malignant oral disorder (PMOD) may progress to oral squamous cell carcinoma (OSCC). Although, the current standard of care for assessing its malignant potential remains histological examination and assessing the severity of dysplasia, DNA ploidy analysis has been suggested as a surrogate marker to predict the behaviour of PMODs. OBJECTIVES To detect aneuploidy and to correlate ploidy status with different grades of dysplasia in both tissue and cytology samples to predict the behaviour of these potentially malignant disorders and to assess the diagnostic utility of cytology samples for ploidy analysis. METHODOLOGY After obtaining ethical clearance and consent, tissue and cytology samples of leukoplakia were collected and grouped based on the dysplastic findings into low-risk (n=20) and high-risk (n=20). DNA ploidy analysis was done using high resolution flow cytometry and its diagnostic utility was assessed. RESULTS Diagnostic utility was expressed in terms of sensitivity, specificity, PPV and NPV. On comparing the ploidy status of individual cases between tissue and cytology samples, cytology was able to accurately determine the ploidy status in majority of the cases. In the low-risk group, cytology had a sensitivity and specificity of 100% and a PPV and NPV of 100% with an overall diagnostic accuracy of 100%. Among the high-risk group, cytology had a sensitivity of 80% and specificity of 100% with a PPV of 100% and NPV of 83.33% and had an overall diagnostic accuracy of 90%. Combining both groups together, it had a sensitivity of 85.71% and specificity of 100% with a PPV of 100% and NPV of 92.31% and had an overall diagnostic accuracy of 94.74%. CONCLUSION Overall, this study showed a positive correlation between cytology and tissue samples and ploidy and grade of dysplasia and cytology proved to be a simple and efficient with a reasonable diagnostic value.
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Affiliation(s)
- Thayalan Dineshkumar
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
| | - Prabakar Srikanth
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
| | - A E Nagarathinam
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
| | - Krishnan Rajkumar
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
| | - Shankaran Priyadharini
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
| | - T A Shruthi
- Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India
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Castagnola P, Zoppoli G, Gandolfo S, Monticone M, Malacarne D, Cirmena G, Brown D, Aiello C, Maffei M, Marino R, Giaretti W, Pentenero M. Genomic DNA Copy Number Aberrations, Histological Diagnosis, Oral Subsite and Aneuploidy in OPMDs/OSCCs. PLoS One 2015; 10:e0142294. [PMID: 26540282 PMCID: PMC4634987 DOI: 10.1371/journal.pone.0142294] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022] Open
Abstract
Oral potentially malignant disorders (OPMDs) characterized by the presence of dysplasia and DNA copy number aberrations (CNAs), may reflect chromosomal instability (CIN) and predispose to oral squamous cell carcinoma (OSCC). Early detection of OPMDs with such characteristics may play a crucial role in OSCC prevention. The aim of this study was to explore the relationship between CNAs, histological diagnosis, oral subsite and aneuploidy in OPMDs/OSCCs. Samples from OPMDs and OSCCs were processed by high-resolution DNA flow cytometry (hr DNA-FCM) to determine the relative nuclear DNA content. Additionally, CNAs were obtained for a subset of these samples by genome-wide array comparative genomic hybridization (aCGH) using DNA extracted from either diploid or aneuploid nuclei suspension sorted by FCM. Our study shows that: i) aneuploidy, global genomic imbalance (measured as the total number of CNAs) and specific focal CNAs occur early in the development of oral cancer and become more frequent at later stages; ii) OPMDs limited to tongue (TNG) mucosa display a higher frequency of aneuploidy compared to OPMDs confined to buccal mucosa (BM) as measured by DNA-FCM; iii) TNG OPMDs/OSCCs show peculiar features of CIN compared to BM OPMDs/OSCCs given the preferential association with total broad and specific focal CNA gains. Follow-up studies are warranted to establish whether the presence of DNA aneuploidy and specific focal or broad CNAs may predict cancer development in non-dysplastic OPMDs.
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Affiliation(s)
| | - Gabriele Zoppoli
- IRCCS AOU - San Martino -IST, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sergio Gandolfo
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
| | | | | | | | - David Brown
- J.-C. Heuson Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Massimo Maffei
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Marino
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
| | | | - Monica Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
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Monti-Hughes A, Aromando RF, Pérez MA, Schwint AE, Itoiz ME. The hamster cheek pouch model for field cancerization studies. Periodontol 2000 2014; 67:292-311. [DOI: 10.1111/prd.12066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 12/13/2022]
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Sperandio M, Brown AL, Lock C, Morgan PR, Coupland VH, Madden PB, Warnakulasuriya S, Møller H, Odell EW. Predictive Value of Dysplasia Grading and DNA Ploidy in Malignant Transformation of Oral Potentially Malignant Disorders. Cancer Prev Res (Phila) 2013; 6:822-31. [DOI: 10.1158/1940-6207.capr-13-0001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Giaretti W, Pentenero M, Gandolfo S, Castagnola P. Chromosomal instability, aneuploidy and routine high-resolution DNA content analysis in oral cancer risk evaluation. Future Oncol 2013; 8:1257-71. [PMID: 23130927 DOI: 10.2217/fon.12.116] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Carcinogen exposure of the oral cavity is thought to create an extensive 'field cancerization'. According to this model, a very early precursor of oral cancer is a patch of normal-appearing mucosa in which stem cells share genetic/genomic aberrations. These precancerous fields then become clinically visible as white and red lesions (leuko- and erythro-plakias), which represent the vast majority of the oral potentially malignant disorders. This review focuses on aneuploidy (where it is from) and on biomarkers associated with DNA aneuploidy in oral mucosa and oral potentially malignant disorders, as detected by DNA image and flow cytometry. Data from the literature strongly support the association of DNA ploidy with dysplasia. However, work is still needed to prove the clinical value of DNA ploidy in large-scale prospective studies. Using high-resolution DNA flow cytometry with fresh/frozen material and the degree of DNA aneuploidy (DNA Index) might improve the prediction of risk of oral cancer development.
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Affiliation(s)
- Walter Giaretti
- Department of Diagnostic Oncology, Biophysics & Cytometry Section, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi n.10, 16132, Genoa, Italy.
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DNA ploidy measurement in oral leukoplakia: Different results between flow and image cytometry. Oral Oncol 2012; 48:636-40. [DOI: 10.1016/j.oraloncology.2012.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/16/2012] [Accepted: 01/26/2012] [Indexed: 11/24/2022]
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Pentenero M, Giaretti W, Navone R, Demurtas A, Rostan I, Bertolusso G, Broccoletti R, Arduino PG, Malacarne D, Gandolfo S. DNA aneuploidy and dysplasia in oral potentially malignant disorders: association with cigarette smoking and site. Oral Oncol 2009; 45:887-90. [PMID: 19457703 DOI: 10.1016/j.oraloncology.2009.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 11/30/2022]
Abstract
To date there are still no reliable biomarkers for oral potentially malignant disorders (PMDs) to predict the risk of progression to squamous cell carcinoma (SCC). Within a prospective clinical trial of patients with PMDs, DNA content flow cytometry (DNA FCM) was evaluated for 60 PMDs using fresh samples obtained by a dermatological curette. There were 6/42 PMDs without dysplasia, but with DNA aneuploidy, versus 8/18 with both dysplasia and aneuploidy (p=0.02). When the tongue and the buccal mucosa, the two most common sites in the present series of cases were compared, dysplastic PMDs were mainly located on the tongue (p=0.01). Tobacco smokers, who preferentially developed PMDs in the buccal mucosa at a younger age than non-smokers (p=0.002), had fewer dysplastic PMDs than did non-smokers (p=0.01). Dysplasia was significantly linked to DNA aneuploidy (p=0.03) in smokers. The present data suggest that aneuploidy is an early event in oral carcinogenesis and that the influence of tobacco varies according to subsite and patient age. When DNA FCM of PMD samples are obtained by curette scraping, extensive areas can be covered with a minimally invasive, rapid, inexpensive procedure. Moreover DNA FCM of these samples appears easy amenable to routine analysis. Further research on larger numbers of PMDs should be carried out to determine whether DNA FCM plays a role in the prediction of risk of PMD transformation.
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Affiliation(s)
- Monica Pentenero
- Department of Clinical and Biological Sciences, Oral Medicine and Oral Oncology Section, University of Turin, Regione Gonzole 10, 10043 Orbassano (TO), Italy.
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Hirshberg A, Yarom N, Amariglio N, Yahalom R, Adam I, Stanchescu R, Ben-Dov I, Taicher S, Rechavi G, Trakhtenbrot L. Detection of non-diploid cells in premalignant and malignant oral lesions using combined morphological and FISH analysis - a new method for early detection of suspicious oral lesions. Cancer Lett 2007; 253:282-90. [PMID: 17386971 DOI: 10.1016/j.canlet.2007.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 11/15/2022]
Abstract
Alteration in DNA content is an early event in oral carcinogenesis. We have examined oral brush samples to detect non-diploid cells (NDC) using simultaneous morphological and cytogenetic analysis. The study included 8 oral squamous cell carcinomas (OSCC), 22 premalignant lesions (OPLs), and 25 control individuals. Slides stained with Giemsa followed by FISH using chromosome 2 centromeric DNA probe, were scanned and fluorescent signals were simultaneously analyzed in parallel with the morphology. The proportion of NDC increased with the severity of the diagnosis. In two control subjects, 1-1.5% of the examined cells were NDC. Over 2% NDC were present in all OSCC cases and in 11 of the OPLs, of which, in 8 the histologic diagnosis was either epithelial hyperplasia or mild dysplasia. A significant number of NDC had normal morphology when cytomorphology and FISH were compared. Two patients with OPLs developed OSCC these patients had a significant proportion of NDC. We suggest that the combined morphological and cytogenetic analysis of cells collected by a non-invasive brush sampling can enhance early detection of potentially malignant cells.
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Affiliation(s)
- Abraham Hirshberg
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Raimondi A, Cabrini R, Itoiz ME. Ploidy analysis of field cancerization and cancer development in the hamster cheek pouch carcinogenesis model. J Oral Pathol Med 2005; 34:227-31. [PMID: 15752258 DOI: 10.1111/j.1600-0714.2004.00256.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The hamster cheek-pouch carcinogenesis model is a well-known animal system that closely mimics the development of premalignant and malignant lesions in human oral cancer. Our aim was to numerically characterize the premalignant and malignant lesions and expressions of field cancerization in this model using ploidy as the end-point. METHODS To study the DNA content and proliferation status of the cells in this model we assessed the Feulgen reaction and the immunohistochemical reaction for 5-bromo-2-deoxiuridine (BrdU) in different histological areas of serial tissue sections of the cheek pouches of animals injected with BrdU. RESULTS Ploidy values were higher in cancerized epithelia with no unusual microscopic features (NUMF), in preneoplastic and tumor areas than in control epithelia. The aneuploidy index was higher in NUMF areas than in control and differed significantly from control in preneoplastic areas and carcinoma. CONCLUSIONS The unexpected alteration in DNA content observed in NUMF epithelia is of great relevance as a biomarker of field cancerized areas.
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Affiliation(s)
- A Raimondi
- Oral Pathology Department, Faculty of Dentistry, University of Buenos Aires, 1122 Buenos Aires, Argentina
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Saito T, Mizuno S, Notani K, Fukuda H, Kobayashi I, Shindoh M, Kohgo T. Flow cytometric analysis of cell cycle fractions in oral leukoplakia. Int J Oral Maxillofac Surg 1998; 27:217-21. [PMID: 9662018 DOI: 10.1016/s0901-5027(98)80015-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Flow cytometric analysis of cell cycle fractions and DNA ploidy was performed on 39 biopsy specimens of oral leukoplakia. The aneuploidy rate of these leukoplakias was 9/39 (23.1%) and the mean DNA index of the aneuploid lesions was 1.34. The aneuploidy rate was significantly higher in severely dysplastic lesions (8/17) than in mildly dysplastic (1/15, P<0.02) and nondysplastic (0/7, P<0.05) lesions. No significant differences in the percentages of each cell cycle fraction were seen between the diploid and the aneuploid leukoplakias. However, the S-phase fraction of the severely dysplastic lesions (23.0%) among the diploid leukoplakias was higher than those of the mildly dysplastic (12.4%) and nondysplastic (15.5%) lesions, and the difference between the severely dysplastic and the mildly dysplastic lesions was statistically significant (P<0.001). These results suggest that flow cytometric analysis of cell cycle fractions and DNA ploidy might offer additional information for assessing the malignant potential of oral leukoplakias.
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Affiliation(s)
- T Saito
- First Department of Oral Surgery, Hokkaido University School of Dentistry, Sapporo, Japan
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Warnakulasuriya KA, Johnson NW. Importance of proliferation markers in oral pathology. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1996; 90:147-77. [PMID: 8791751 DOI: 10.1007/978-3-642-80169-3_5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K A Warnakulasuriya
- Royal College of Surgeons, Department of Dental Sciences/Department of Oral Medicine and Pathology, King's College, School of Medicine and Dentistry, London, England
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12
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Soames JV, Macleod RI, Kelly PJ. Feulgen hydrolysis profiles and acid-labile DNA in oral squamous cell carcinoma. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1995; 31B:222-6. [PMID: 7492916 DOI: 10.1016/0964-1955(95)00025-d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The full Feulgen hydrolysis profiles of healthy and malignant oral epithelial cells were compared by measuring the staining density of nuclei using microdensitometry after varying hydrolysis times. Malignant nuclei contained significantly increased levels of acid-labile DNA. The relative amounts of the rapidly hydrolysable fraction were compared after 5 min hydrolysis for exfoliating epithelial cells from healthy oral mucosa, healing chronic ulcers and squamous cell carcinomas. Although the latter exhibited a wide range of values, analysis of variance showed significant differences (P < 0.05) between healthy control and ulcer groups compared to oral carcinoma. The relative proportion of highly acid-labile DNA in malignant nuclei showed a significant positive correlation with mitotic score (P < 0.01) but no significant correlation with nuclear area. It was concluded that since the susceptibility of DNA to acid hydrolysis probably reflects functional differences in nuclear activity between cells, estimation of the highly acid-labile fraction may have diagnostic and/or prognostic value.
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Affiliation(s)
- J V Soames
- Department of Oral Pathology, Dental School, University of Newcastle upon Tyne, U.K
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Saito T, Yamashita T, Notani K, Fukuda H, Mizuno S, Shindoh M, Amemiya A. Flow cytometric analysis of nuclear DNA content in oral leukoplakia: relation to clinicopathologic findings. Int J Oral Maxillofac Surg 1995; 24:44-7. [PMID: 7782640 DOI: 10.1016/s0901-5027(05)80855-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
DNA ploidy of 50 biopsy specimens of oral leukoplakia was investigated by flow cytometry, and the results were compared with the clinicopathologic appearances. The aneuploidy rate of the leukoplakias was 17/50 (34%), and the mean DNA index (DI) of the aneuploid lesions was 1.22, with a range from 0.70 to 1.84. The incidence of the aneuploidy was significantly (P < 0.01) higher in nonhomogeneous leukoplakias (11/18) than in homogeneous lesions (6/32). The aneuploidy rate of the severely dysplastic leukoplakias (11/17) was significantly higher than those of the mildly dysplastic (4/22; P < 0.01) and the nondysplastic (2/11; P < 0.02) lesions. A significant (P < 0.01) difference in the aneuploidy rate was also observed between tongue (12/23) and gingival (2/18) leukoplakias.
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Affiliation(s)
- T Saito
- First Department of Oral Surgery, Hokkaido University School of Dentistry, Sapporo, Japan
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Saito T, Sato J, Satoh A, Notani K, Fukuda H, Mizuno S, Shindoh M, Amemiya A. Flow cytometric analysis of nuclear DNA content in tongue squamous cell carcinoma: relation to cervical lymph node metastasis. Int J Oral Maxillofac Surg 1994; 23:28-31. [PMID: 8163856 DOI: 10.1016/s0901-5027(05)80322-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The relationship between DNA ploidy and the incidence of cervical lymph node metastasis in 36 patients with tongue squamous cell carcinoma (SCC) was investigated. The aneuploidy rate of tongue carcinomas was 15/36 (42%), and the mean DNA index (DI) was 1.23, with a range from 0.87 to 3.54. Histologically identified cervical lymph node metastasis was observed in 11 cases, and the incidence of the cervical lymph node metastasis was significantly (P < 0.02) higher in the aneuploid cases (8/15) than in the diploid cases (3/21). Recurrence of the primary lesions was seen in nine cases 0.3-2.5 years after the initial treatment. No obvious difference in the incidence of the recurrence was noted, however, between the diploid (5/21) and the aneuploid (4/15) cases. These results indicate a significant relationship between aneuploidy and incidence of the regional lymph node metastasis, in contrast to the absence of a positive relationship between aneuploidy and recurrence of tongue SCC.
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Affiliation(s)
- T Saito
- First Department of Oral Surgery, Hokkaido University School of Dentistry, Sapporo, Japan
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Abstract
Tissue markers of potential malignancy have been sought for many years. Cell surface markers, particularly blood group and histocompatibility antigens, have shown great promise and several squamous carcinoma antigens have been identified--but not fully studied in potentially malignant lesions. Growth factors and receptors also need further study. Cytoplasmic markers of potential malignancy have been examined and, of these, keratins, filaggrin, and some carcinoma antigens show most promise. Nuclear analyses have promise but are time-consuming and expensive. Image cytometric analyses appear to be sensitive and predictive: oncogene and tumour suppressor analyses remain to be fully evaluated. New investigative techniques at the cellular and molecular level show increasing promise at defining potentially malignant oral epithelial lesions but more prospective studies are required.
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Affiliation(s)
- C Scully
- Department of Oral Medicine, Pathology and Microbiology, Bristol Dental Hospital and School, England
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