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Odell EW. Aneuploidy and loss of heterozygosity as risk markers for malignant transformation in oral mucosa. Oral Dis 2021; 27:1993-2007. [PMID: 33577101 DOI: 10.1111/odi.13797] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
The ability to predict malignant transformation in oral potentially malignant disorders would inform targeted treatment, provide prognostic information and allow secondary prevention. DNA ploidy and loss of heterozygosity assays are already in clinical use, and loss of heterozygosity has been used in prospective clinical trials. This review appraises published evidence of predictive ability and explores interpretation of heterogeneous studies, with different diagnostic methods, criteria and intention. Both methods have a sound biological foundation and have predictive value independent of dysplasia grading and clinical parameters. The application of these two techniques cannot be directly compared because of differences in expression of results and application to populations of different risk. Predicting malignant transformation accurately on an individual patient basis is not yet possible with either technique. However, they are valuable applications to stratify patients for inclusion in trials, identify the lowest risk patients and exclude risk when biopsy results are indeterminate for dysplasia.
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Nikitakis NG, Pentenero M, Georgaki M, Poh CF, Peterson DE, Edwards P, Lingen M, Sauk JJ. Molecular markers associated with development and progression of potentially premalignant oral epithelial lesions: Current knowledge and future implications. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:650-669. [DOI: 10.1016/j.oooo.2018.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022]
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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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Khanna R, Agarwal A, Khanna S, Basu S, Khanna AK. S-phase fraction and DNA ploidy in oral leukoplakia. ANZ J Surg 2010; 80:548-51. [PMID: 20795971 DOI: 10.1111/j.1445-2197.2009.05196.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of malignant conversion in oral leukoplakia is well documented. Histological findings are often unreliable and it is difficult to predict on the basis of clinical and histopathological changes which leukoplakic lesion will turn malignant. METHODS We used the technique of flow cytometry to evaluate the ploidy status, DNA index and S-phase fraction in leukoplakia, oral cancer and normal oral mucosal biopsies and compared it with histological findings. The study was carried out on 30 patients with oral cancer, 60 with leukoplakia and 30 with normal oral mucosal biopsies. RESULTS The aneuploidy rate in oral cancers was 64%, for leukoplakia 20%, while all normal mucosal biopsies were diploid. Aneuploid lesions also had a greater S-phase fraction (SPF). The DNA Index (DI) of aneuploid oral cancers was 1.72 and aneuploid leukoplakias was 1.24. Leukoplakia specimens which showed histological evidence of dysplasia had aneuploidy rate of 38%, DI of 1.19 and SPF of 6.2%. The corresponding values for leukoplakia specimens without dysplasia were 14%, 1.09 and 4.1%, respectively. CONCLUSION The method of flow cytometry can be used to identify the subset of leukoplakia patients who are at a higher risk of malignant conversion. These patients could undergo more rigid surveillance or undergo excision biopsy of their lesions.
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Affiliation(s)
- Rahul Khanna
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, India.
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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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Gandolfo S, Pentenero M, Demurtas A, Navone R. Comment on "the flow cytometric analysis of premalignant and malignant lesions in head and neck squamous cell carcinoma" [Kamal-Eldin Ahmed Abou-Elhamd and Tito Naeem Habib. Oral Oncol 2007;43(4):366-72]. Oral Oncol 2007; 44:100-1; author reply 102. [PMID: 17714978 DOI: 10.1016/j.oraloncology.2007.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 05/15/2007] [Accepted: 05/17/2007] [Indexed: 10/22/2022]
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Vargas PA, Torres-Rendon A, Speight PM. DNA ploidy analysis in salivary gland tumours by image cytometry. J Oral Pathol Med 2007; 36:371-6. [PMID: 17559500 DOI: 10.1111/j.1600-0714.2007.00551.x] [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] [Indexed: 11/29/2022]
Abstract
AIM To determine whether DNA ploidy by image cytometry is a good diagnostic tool to distinguish benign and malignant salivary gland tumours. METHODS A total of 62 salivary gland tumours were studied. Cases were histologically diagnosed [haematoxylin and eosin (H&E)]. According to the World Health Organization (WHO) classification, there were 14 mucoepidermoid carcinomas (MEC), 11 adenoid cystic carcinomas (ACC), 10 pleomorphic adenomas (PA), 10 carcinoma ex PA (CEPA), 9 acinic cell carcinomas (ACCa), 3 polymorphous low-grade adenocarcinomas (PLGA), 2 papillary cystadenocarcinomas (PC), 1 myoepithelial carcinoma (MC), 1 undifferentiated carcinoma (UC) and 1 mucinous adenocarcinoma (MA). Paraffin sections (40 microm) were micro-dissected to isolate tumour areas; cell nuclei were extracted and Feulgen-stained cytospin monolayers were analysed using a DNA image cytometry system. For each case, DNA index (DI) was calculated relative to internal controls (lymphocytes; DI=1.0). Cases were categorized as diploid or aneuploid and the proportion of cells over 5c was also calculated. RESULTS Fifty-three of 62 salivary gland tumours were uniformly diploid. Only nine cases were aneuploid: five CEPA, one low-grade MEC, one PC, one UC and one MA. CONCLUSIONS The vast majority of salivary gland tumours were diploid. High-grade malignancies may be aneuploid, and ploidy may be useful to identify malignant change in atypical PA. Further, larger studies are needed to confirm our results and to further evaluate the usefulness of the technique in high-grade lesions.
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Affiliation(s)
- P A Vargas
- Department of Oral Diagnosis, Oral Pathology Section, Dental School of Piracicaba, University of Campinas (UNICAMP), Piracicaba-SP, Brazil
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Brennan M, Migliorati CA, Lockhart PB, Wray D, Al-Hashimi I, Axéll T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB, Holmstrup P, Jontell M, Nair R, Sasser H, Schifter M, Silverman B, Thongprasom K, Thornhill M, Warnakulasuriya S, van der Waal I. Management of oral epithelial dysplasia: a review. ACTA ACUST UNITED AC 2007; 103 Suppl:S19.e1-12. [PMID: 17257863 DOI: 10.1016/j.tripleo.2006.10.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
One of the goals of the fourth meeting of The World Workshop on Oral Medicine (WWOM IV) included a review of the pathophysiology and future directions for the clinical management of patients with oral epithelial dysplasia, excluding the lips and oropharynx. In the pathophysiology review of dysplasia since WWOM III (1998-2006), a wide range of molecular changes associated with progression of dysplasia to squamous cell carcinoma were found. These include loss of heterozygosity, dysregulation of apoptosis, aberrant DNA expression, and altered expression of numerous tissue markers. Based on the literature search, no single molecular pathway has been identified as the primary factor in progression of dysplasia to squamous cell carcinoma. A systematic review of medical (i.e., nonsurgical) management strategies for the treatment of dysplastic lesions has shown promising results in short-term resolution of dysplasia in the small number of studies that met eligibility criteria for review. However, because of the limited periods of follow-up reported in these studies, it remains unclear as whether resolution of dysplasia would actually be a long-term benefit of these interventions. This question is particularly germane when it is considered in the context of prevention of future development of squamous cell carcinoma. Because of the lack of randomized controlled trials that have shown effectiveness in the prevention of malignant transformation, no recommendations can be provided for specific surgical interventions of dysplastic oral lesions either.
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Schwartz JL, Muscat JE, Baker V, Larios E, Stephenson GD, Guo W, Xie T, Gu X, Chung FL. Oral cytology assessment by flow cytometry of DNA adducts, aneuploidy, proliferation and apoptosis shows differences between smokers and non-smokers. Oral Oncol 2003; 39:842-54. [PMID: 13679208 DOI: 10.1016/s1368-8375(03)00107-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oral cytology and morphometric staining is used to identify malignant keratinocytes in oral premalignant or malignant lesions. To detect and to begin to assess changes in oral keratinocytes exposed to tobacco-derived carcinogens, which are at risk for malignant transformation, a novel method is required. The approach uses oral cytology harvested oral keratinocytes analyzed using flow cytometry (FC) for changes in DNA content, damage, cell cycle and apoptosis. Six smoker and six non-smoker oral keratinocytes were evaluated using flow cytometry in the form of laser scanning cytometry (LSC) and laser microdissection (LMD). Among smokers compared to non-smokers, the method detected and assessed DNA damage from tobacco smoke exposure quantifying an enhanced formation of DNA adducts, such as, 8-hydroxy-2'-deoxyguanine (8-OHdG) which creates oxidation lesions and benzo[a]pyrene(B[a]P), which produces a B[a]P)-N2-dG bulky adduct. Increased DNA content, aneuploidy, percentage of cells in synthesis (S) and G(2)+Mitosis (M), and apoptosis were recorded. Tissue and cell controls were used to verify these relationships. Data suggested healthy smokers were at increased risk for malignant transformation of oral keratinocytes because of the changes stated above. Using identical methods, keratinocytes exposed to the tobacco derived carcinogen, B[a]P parallel results obtained from smoke exposure indicating a direct link. Flow cytometric evaluation of oral cytology harvested keratinocytes can be used to measure exposure to tobacco carcinogens, and possibly establish a link to premalignant and malignant transformation before a lesion is noted.
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Affiliation(s)
- Joel L Schwartz
- Institute for Cancer Prevention, One Dana Road, Valhalla, NY 10595, USA.
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Eversole LR, Eversole GM, Kopcik J. Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:455-64. [PMID: 10760727 DOI: 10.1016/s1079-2104(00)70125-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to compare and contrast biomarkers and ploidy data from maxillary gingiva leukoplakias associated with dentifrices and mouthrinses containing the herbal compound sanguinaria with other forms of oral benign and premalignant mucosal keratosis. STUDY DESIGN Representative archived specimens of benign keratosis, sanguinaria-associated keratosis, and keratosis with dysplasia were used for computerized image analysis and biomarker immunohistochemical assays to assess ploidy, DNA content, and p53 and proliferating cell nuclear antigen immunoreactivity of nuclei. RESULTS DNA content was significantly higher and higher numbers of cell populations with hyperploid nuclei were encountered in the dysplastic group than in the other two groups (P <.001). Sanguinaria-associated keratosis did not harbor significant numbers of p53-expressing nuclei, yet it showed a significant elevation in proliferating cell nuclear antigen-labeled nuclei in total, in the basal layer, and in the spinous layer in comparison with benign keratoses (P <.001). In addition, 1.5% of the sanguinaria-associated leukoplakia epithelial cell population was characterized by nuclei with a greater than 4-fold increase in DNA content. CONCLUSIONS Sanguinaria-associated keratoses show some marker and image analysis profiles similar to those of non-sanguinaria dysplastic lesions of the lip and mucosa. Preparations containing sanguinaria should be avoided until the risk for malignant transformation is determined.
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Affiliation(s)
- L R Eversole
- University of the Pacific and Pathology Consultants of New Mexico, Department of Pathology and Medicine, University of the Pacific School of Dentistry, San Francisco, CA 94115, USA
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