1
|
Srinivasan Rajsri K, K Durab S, A Varghese I, Vigneswaran N, T McDevitt J, Kerr AR. A brief review of cytology in dentistry. Br Dent J 2024; 236:329-336. [PMID: 38388613 DOI: 10.1038/s41415-024-7075-7] [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: 10/02/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 02/24/2024]
Abstract
Oral cytology is a non-invasive adjunctive diagnostic tool with a number of potential applications in the practice of dentistry. This brief review begins with a history of cytology in medicine and how cytology was initially applied in oral medicine. A description of the different technical aspects of oral cytology is provided, including the collection and processing of oral cytological samples, and the microscopic interpretation and reporting, along with their advantages and limitations. Applications for oral cytology are listed with a focus on the triage of patients presenting with oral potentially malignant disorders and oral mucosal infections. Furthermore, the utility of oral cytology roles across both expert (for example, secondary oral medicine or tertiary head and neck oncology services) and non-expert (for example, primary care general dental practice) clinical settings is explored. A detailed section covers the evidence-base for oral cytology as a diagnostic adjunctive technique in both the early detection and monitoring of patients with oral cancer and oral epithelial dysplasia. The review concludes with an exploration of future directions, including the integration of artificial intelligence for automated analysis and point of care 'smart diagnostics', thereby offering some insight into future opportunities for a wider application of oral cytology in dentistry.
Collapse
Affiliation(s)
- Kritika Srinivasan Rajsri
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, 10010, USA
| | - Safia K Durab
- Division of Oral and Maxillofacial Pathology, UT Health, The University of Texas Health Science Centre, Houston, Texas, 77054, USA
| | - Ida A Varghese
- Division of Oral and Maxillofacial Pathology, UT Health, The University of Texas Health Science Centre, Houston, Texas, 77054, USA
| | - Nadarajah Vigneswaran
- Division of Oral and Maxillofacial Pathology, UT Health, The University of Texas Health Science Centre, Houston, Texas, 77054, USA
| | - John T McDevitt
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, 10010, USA
| | - A Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York,, 10010, USA.
| |
Collapse
|
2
|
Osorio-Osorno YA, Arboleda Toro D, Arango JC, Parada-Sanchez MT. Optimized liquid-based cytology for the cellular and molecular analysis of oral keratinocytes: A promising diagnostic tool. Diagn Cytopathol 2020; 49:96-104. [PMID: 32877007 DOI: 10.1002/dc.24604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Liquid-based cytology (LBC) has improved exfoliative cytology by facilitating the extraction of more precise information from epithelial cells. The aim of this study was to optimize a protocol using a conventional cytobrush to perform LBC, obtaining oral keratinocytes for their further cellular and molecular analysis. METHODS LBC was performed in 30 healthy donors from buccal mucosa. We evaluated the use of diethyl pyrocarbonate (DEPC)-treated Dulbecco's Modified Eagle Medium (DMEM) medium right after the collection of the cells. Cell morphology and viability were determined by Orcein staining and flow cytometry, respectively. RNA was extracted by the trizol method, and evaluated with spectrometry and electrophoresis. Finally, RNA was copied into cDNA and GAPDH and TLR2 genes were amplified by reverse transcription polymerase chain reaction (RT-PCR) and quantitative reverse transcription polymerase chain reaction (RT-qPCR) using specific primers. RESULTS Only DEPC-treated DMEM preserved the viability of intact intraepithelial keratinocytes. RNA quantity and quality improves in samples treated with DEPC. RNA integrity is comparable with a cell line control. GAPDH gene was successfully amplified by RT-PCR and RT-qPCR. CONCLUSIONS Therefore, LBC performed under these conditions becomes a reproducible technique for the retrieval of intraepithelial oral keratinocytes with good cell viability for cytomorphometric analysis, and extraction of good RNA quality suitable for molecular analyses such as PCR. We propose this LBC protocol as a complementary method to the cellular and molecular study of oral mucosa pathologies; however, it requires further study.
Collapse
Affiliation(s)
- Yuliana Andrea Osorio-Osorno
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - David Arboleda Toro
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Julian Camilo Arango
- Grupo Micología Médica y Experimental, School of Microbiology, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Monica Tatiana Parada-Sanchez
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
| |
Collapse
|
3
|
Noda Y, Kondo Y, Sakai M, Sato S, Kishino M. Galectin-1 is a useful marker for detecting neoplastic squamous cells in oral cytology smears. Hum Pathol 2016; 52:101-9. [DOI: 10.1016/j.humpath.2016.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 01/26/2023]
|
4
|
Braz-Silva PH, Santos RTM, Schussel JL, Gallottini M. Oral hairy leukoplakia diagnosis by Epstein-Barr virusin situhybridization in liquid-based cytology. Cytopathology 2013; 25:21-6. [DOI: 10.1111/cyt.12053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
- P. H. Braz-Silva
- Laboratory of Virology; Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
- Department of Oral Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - R. T. M. Santos
- Division of Pathology; Adolfo Lutz Institute; São Paulo Brazil
| | - J. L. Schussel
- Department of Oral and Maxillofacial Surgery; Erasto Gaertner Hospital; Curitiba Brazil
| | - M. Gallottini
- Department of Oral Pathology; School of Dentistry; University of São Paulo; São Paulo Brazil
| |
Collapse
|
5
|
Mehrotra R. The role of cytology in oral lesions: A review of recent improvements. Diagn Cytopathol 2011; 40:73-83. [PMID: 21442772 DOI: 10.1002/dc.21581] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 09/29/2010] [Indexed: 11/08/2022]
Affiliation(s)
- Ravi Mehrotra
- Department of Pathology, Division of Cytopathology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India. rm8509@rediffmail. com
| |
Collapse
|
6
|
Pérez-Sayáns M, Somoza-Martín JM, Barros-Angueira F, Reboiras-López MD, Gándara-Vila P, Gándara Rey JM, García-García A. Exfoliative cytology for diagnosing oral cancer. Biotech Histochem 2010; 85:177-87. [PMID: 20426699 DOI: 10.3109/10520290903162730] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Exfoliative cytology is a minimally invasive technique for obtaining oral cell specimens from patients for diagnostic purposes. Classical applications of oral cytology studies, such as oral candidiasis, have been extended to include oral precancerous and cancerous lesions. A number of analytical methods are available for studying cytology specimens. The development of molecular analysis techniques, the oral cancer etiopathogenic process, and improvements in liquid-based exfoliative cytology are leading to renewed interest in exfoliative cytology. Results sometimes are disputed, so the aim of our review was to clarify the applicability of exfoliative cytology to the diagnosis of oral precancerous and cancerous lesions.
Collapse
Affiliation(s)
- M Pérez-Sayáns
- School of Dentistry, Entrerríos s/n, Santiago of Compostela C.P. 15782, Spain.
| | | | | | | | | | | | | |
Collapse
|
7
|
Braz-Silva PH, Magalhães MHCG, Hofman V, Ortega KL, Ilie MI, Odin G, Vielh P, Hofman P. Usefulness of oral cytopathology in the diagnosis of infectious diseases. Cytopathology 2010; 21:285-99. [PMID: 20629682 DOI: 10.1111/j.1365-2303.2010.00779.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, the incidence of oral opportunistic infections has increased, partly due to the widespread implementation of organ and bone marrow transplantation and the increase in the prevalence of human immunodeficiency virus (HIV) infection. Cytology can be used as a rapid, inexpensive and simple routine procedure in diagnosing infectious diseases of the mouth. Moreover, ancillary methods can be applied to cytological samples, increasing the specificity and sensitivity for the diagnosis of infectious diseases. This review describes the cytopathological features of the main viral, fungal, bacterial and parasitic infections of the mouth. Cytological techniques of specimen collection, identification of infectious agents by cytomorphological approaches and ancillary methods, and diagnostic pitfalls will be discussed.
Collapse
Affiliation(s)
- P H Braz-Silva
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, University of Nice Sophia Antipolis, Nice, France
| | | | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Abstract
During the last decade, oral cytology has once again become the focus of scientific research. This new interest is due to the introduction of a cytobrush for cell collection as well as a computer-assisted analysis (Oral CDx). Although promising, the sensitivity and specificity of conventional oral brush cytology remains limited. To circumvent the problems and improve the accuracy, various adjunctive analytical methods have been attempted. DNA analysis, immunocytochemical and molecular analysis are suggested methodological cytology approaches to improve the validity of oral brush cytology. An increase in sensitivity (up to 100%) and specificity (up to 100%) of oral brush biopsy has been reported on localized pre-malignant and malignant lesions. Oral brush biopsy probably will not replace histopathology in the definitive diagnosis of oral cancer, but it might be valuable for the prevention of misdiagnosis of clinically doubtful oral lesions and for the monitoring of lesions that might proceed on to oral cancer.
Collapse
Affiliation(s)
- R Mehrotra
- Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India.
| | | | | | | | | |
Collapse
|
10
|
Mehrotra R, Singh MK, Pandya S, Singh M. The use of an oral brush biopsy without computer-assisted analysis in the evaluation of oral lesions: a study of 94 patients. ACTA ACUST UNITED AC 2008; 106:246-53. [PMID: 18644521 DOI: 10.1016/j.tripleo.2008.02.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 02/22/2008] [Accepted: 02/26/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the sensitivity and specificity of modified brush biopsy without computer-assisted analysis in the detection of oral premalignant and malignant lesions. STUDY DESIGN Ninety-four patients attending outpatient clinics who exhibited oral lesions suspicious of premalignancy or malignancy were enrolled. All patients underwent an oral brush biopsy using a baby toothbrush followed by a scalpel biopsy. The specimens were analyzed manually in a double-blinded fashion. Sensitivity and specificity were used for the statistical analysis of the samples. Statistical significance was determined using the normal approximation to the binomial distribution of matched results, approximated by the Student t distribution mean test (paired t test). RESULTS Seventy-nine patients with adequate transepithelial brush biopsy samples were included in the study group. When compared to scalpel biopsy, the statistical sensitivity of the brush biopsy was greater than 76.8% (P < .05) while the statistical specificity was greater than 93.3% (P < .05). There were 4 false negative brush biopsy cases. The 4 false negative patients turned out to be dysplasia/ malignancy on histopathology. All 4 were patients with clinical oral submucous fibrosis. CONCLUSION The oral brush biopsy without computer-assisted analysis was found to be a painless, noninvasive test for evaluating oral lesions. The toothbrush brush biopsy with manual analysis had much [corrected] lower sensitivity and specificity than the commercially available oral brush biopsy with computer-assisted analysis. The results demonstrate that by using a toothbrush to obtain an oral brush biopsy sample, oral lesions can be easily evaluated in a resource challenged settings to rule out dysplasia and carcinoma.
Collapse
Affiliation(s)
- Ravi Mehrotra
- Department of Pathology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, India.
| | | | | | | |
Collapse
|
11
|
Braz-Silva PH, de Rezende NPM, Ortega KL, de Macedo Santos RT, de Magalhães MHCG. Detection of the Epstein-Barr virus (EBV) by in situ hybridization as definitive diagnosis of hairy leukoplakia. Head Neck Pathol 2008; 2:19-24. [PMID: 20614337 PMCID: PMC2807608 DOI: 10.1007/s12105-007-0039-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Accepted: 12/14/2007] [Indexed: 11/29/2022]
Abstract
Histopathological findings in cases of hairy leukoplakia (HL) are not exclusive to this lesion. A total of 36 tissue samples from patients previously diagnosed with HL based solely on morphological aspects were used in this study. Our purpose was to confirm the presence of Epstein-Barr virus (EBV) in these tissue samples by in situ hybridization (ISH), and to compare the detection of EBV with specific histopathological findings observed in each case. Among the 36 specimens, 80.55% were EBV positive, confirming the previous clinical and histhophatological diagnosis. None of the histopathological findings analyzed correlated with the presence or absence of EBV. This shows that a definitive diagnosis of HL cannot be established based on histopathological findings alone. Because there are many important implications on the establishment of definitive diagnosis of HL, the detection of EBV by ISH is obligatory.
Collapse
Affiliation(s)
- Paulo Henrique Braz-Silva
- Department of Oral Pathology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, Sao Paulo, 05508-000 Brazil
| | - Nathalie Pepe Medeiros de Rezende
- Department of Oral Pathology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, Sao Paulo, 05508-000 Brazil
| | - Karem Lopez Ortega
- Department of Oral Pathology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, Sao Paulo, 05508-000 Brazil
| | | | | |
Collapse
|
12
|
Walling DM, Ray AJ, Nichols JE, Flaitz CM, Nichols CM. Epstein-Barr virus infection of Langerhans cell precursors as a mechanism of oral epithelial entry, persistence, and reactivation. J Virol 2007; 81:7249-68. [PMID: 17376908 PMCID: PMC1933305 DOI: 10.1128/jvi.02754-06] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus associated with many malignant and nonmalignant human diseases. Life-long latent EBV persistence occurs in blood-borne B lymphocytes, while EBV intermittently productively replicates in mucosal epithelia. Although several models have previously been proposed, the mechanism of EBV transition between these two reservoirs of infection has not been determined. In this study, we present the first evidence demonstrating that EBV latently infects a unique subset of blood-borne mononuclear cells that are direct precursors to Langerhans cells and that EBV both latently and productively infects oral epithelium-resident cells that are likely Langerhans cells. These data form the basis of a proposed new model of EBV transition from blood to oral epithelium in which EBV-infected Langerhans cell precursors serve to transport EBV to the oral epithelium as they migrate and differentiate into oral Langerhans cells. This new model contributes fresh insight into the natural history of EBV infection and the pathogenesis of EBV-associated epithelial disease.
Collapse
Affiliation(s)
- Dennis M Walling
- Division of Infectious Diseases, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0435, USA.
| | | | | | | | | |
Collapse
|
13
|
Mehrotra R, Gupta A, Singh M, Ibrahim R. Application of cytology and molecular biology in diagnosing premalignant or malignant oral lesions. Mol Cancer 2006; 5:11. [PMID: 16556320 PMCID: PMC1448188 DOI: 10.1186/1476-4598-5-11] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Accepted: 03/23/2006] [Indexed: 11/29/2022] Open
Abstract
Early detection of a premalignant or cancerous oral lesion promises to improve the survival and the morbidity of patients suffering from these conditions. Cytological study of oral cells is a non-aggressive technique that is well accepted by the patient, and is therefore an attractive option for the early diagnosis of oral cancer, including epithelial atypia and squamous cell carcinoma. However its usage has been limited so far due to poor sensitivity and specificity in diagnosing oral malignancies. Lately it has re-emerged due to improved methods and it's application in oral precancer and cancer as a diagnostic and predictive method as well as for monitoring patients. Newer diagnostic techniques such as "brush biopsy" and molecular studies have been developed. Recent advances in cytological techniques and novel aspects of applications of scraped or exfoliative cytology for detecting these lesions and predicting their progression or recurrence are reviewed here.
Collapse
Affiliation(s)
- Ravi Mehrotra
- Associate Professor Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India
| | - Anurag Gupta
- Postgraduate Student Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India
| | - Mamta Singh
- Professor and Head Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India
| | - Rahela Ibrahim
- Research Fellow Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India
| |
Collapse
|
14
|
Braz-Silva PH, Ortega KL, Rezende NP, Nunes FD, Magalhães MHCG. Detection of Epstein-Barr virus (EBV) in the oral mucosa of renal transplant patients. Diagn Cytopathol 2005; 34:24-8. [PMID: 16355381 DOI: 10.1002/dc.20380] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to determine the prevalence of Epstein-Barr virus (EBV)-DNA in the oral mucosa of renal transplant patients and observe the efficacy of mouth rinses with phosphate-buffered saline (PBS) to eliminate EBV present in the saliva. Lingual, gingival, and buccal cytobrushings were obtained from normal oral mucosa of 10 renal transplant patients and 10 normal subjects, and were examined through polymerase chain reaction (PCR), before and after rinses with PBS. EBV-DNA was detected in 86.6% of renal transplant recipients and in 46.6% of healthy subjects. No significant difference was observed between oral scrapes obtained before and after rinses with PBS with regard to detection of EBV-DNA. Our results suggest that the use of PCR to detect the presence of EBV-DNA in oral mucosa in the absence of specific lesions gives rise to the problem of identifying the viral replication sites. In addition, PBS was not effective at minimizing contamination by saliva.
Collapse
Affiliation(s)
- Paulo H Braz-Silva
- Department of Oral Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | | | | |
Collapse
|