DNA content as a prognostic marker in patients with oral leukoplakia

DNA aneuploidy combined with radial EBUS in the diagnosis of peripheral lung lesions

OBJECTIVE

To explore the diagnostic value of DNA aneuploidy analysis combined with radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy in peripheral lung lesions.

METHOD

We performed a retrospective analysis of patients who underwent R-EBUS examination. DNA aneuploidy analysis of bronchial washing from the target bronchial segment were performed. The clinical information, R-EBUS data, pathological results and DNA image cytometry (DNA-ICM) results were collected. For patients who did not have a clear diagnosis after bronchoscopy, follow-up data was recorded.

RESULTS

A total of 42 cases were included. Thirty patients had confirmed malignant tumor of the lung, 19 of which were confirmed by pathology after bronchoscopy, and 11 cases were confirmed later by surgery or percutaneous lung puncture. Twelve patients were finally considered to have benign lesions. The sensitivity of R-EBUS is 63.3% and the specificity is 100%. DNA-ICM has a sensitivity of 76.7% and a specificity of 91.7%. When combined, they have a sensitivity of 90%, and specificity 91.7%. As for malignant lesions, we further analyzed smoking, the size and location of lesions on chest CT, the number of aneuploid cells and the maximum value of DNA content. The results indicated that increased number of aneuploid cells or increased max value of DNA content may predict higher probability of malignancy.

CONCLUSION

DNA-ICM combined with R-EBUS can improve the diagnostic sensitivity of malignant peripheral lung lesions. Increased number of aneuploid cells or increased max value of DNA content may indicate that the lesions are more likely to be malignant.

Application of 5-aminolevulinic acid-mediated Waterlase-assisted photodynamic therapy in the treatment of oral leukoplakia

Photodynamic therapy (PDT) is an alternative microinvasive approach with satisfying results in the treatment of oral leukoplakia (OL). PDT combined with laser irradiation shows promise, safety and efficacy in treating OL. The efficacy of waterlase (YSGG) combined with PDT was studied by brush and tissue biopsy. Seventy-one patients with histologically diagnosed OL were enrolled, including patients with mild to moderate dysplasia, severe dysplasia and various dysplastic tissues. Patients were evaluated at baseline (t0), the end of treatment (t1) and 1 year later (t2). At t1, PDT showed a significant therapeutic effect on OL with mild to moderate dysplasia. Clinical and histological examinations revealed 60 cases (84.51%) of complete remission and 11 cases (15.49%) of partial remission. On brush biopsy, all PDT-treated patients showed reduced aneuploidy and normal histological findings. Unfortunately, at t2, 9 patients relapsed with OL, which may be related to continued smoking and betel nut chewing. At t2, 5 patients developed new severe epithelial dysplasia and even carcinoma in situ in other areas, mostly the tongue. ALA-mediated PDT combined with YSGG is effective in treating OL, particularly that with mild to moderate dysplasia. However, severe dysplasia may present undesirable effects, and the mechanism remains to be further investigated. ALA-mediated PDT combined with YSGG provides a new method for OL treatment.

Cytomorphometric Study of Changes in Buccal Mucosal Cells in Alcoholics

Background:

Chronic alcohol consumption carries a high risk for oral and pharyngeal cancers among persons who have never smoked. Excessive alcohol consumption displays cytogenetic changes in oral mucosa cells. Cytomorphometric analysis of oral mucosal cells helps in the early detection of cytomorphological transformations in alcoholics before and after the onset of carcinoma.

Materials and Methods:

A prospective, hospital-based, comparative study was done after written informed consent. Smears were obtained from the clinically normal buccal mucosa of 102 randomly selected alcoholic patients attending the medicine outpatient department aged above 25 years who consumed a minimum of 45 ml alcohol per day for at least 10 years and of 102 nonalcoholics as control. The slides were immediately fixed in absolute methanol and stained by the Papanicolaou (Pap) staining technique. PAP-stained smears were examined under the light microscope. Using the image J 1.47 image analysis software, a morphometric analysis of around 50 cells/case was done.

Results:

A statistically significant increase in mean cytoplasmic area (P < 0.001), mean nuclear area (P < 0.01), and cell-to-nuclear parameter ratio (P < 0.001) was seen in the alcohol group in comparison with the control group.

Conclusion:

Prolonged consumption of alcohol produces cytomorphometric changes in buccal mucosal cells before the onset of premalignant lesions.

Retracted publications and their citation in dental literature: A systematic review

OBJECTIVES

The present systematic review aimed to perform an in-depth analysis of the different features of retracted publications in the dental field.

MATERIAL AND METHODS

This review has been recorded in the PROSPERO database (CRD42017075634). Two independent reviewers performed an electronic search (Pubmed, Retraction Watch) for retracted articles in dental literature up to December 31, 2018.

RESULTS

180 retracted papers were identified, the first published in 2001. Retractions increased by 47% in the last four-year period (2014-2018), when compared with 2009-2013 (94 and 64 retracted publications, respectively). Author misconduct was the most common reason for retraction (65.0%), followed by honest scientific errors (12.2%) and publisher-related issues (10.6%). The majority of retracted research was conducted in Asia (55.6%), with 49 papers written in India (27.2%). 552 researchers (89%) are listed as authors in only one retracted article, while 10 researchers (1.6%) are present in five or more retracted publications. Retracted articles were cited 530 times after retraction: the great majority of these citations (89.6%) did not consider the existence of the retraction notice and treated data from retracted articles as reliable.

CONCLUSIONS

Retractions in dental literature have constantly increased in recent years, with the majority of them due to misconduct and fraud. The publication of unreliable research has many negative consequences. Studies derived from such material are designed on potentially incorrect bases, waste funds and resources, and most importantly, increase risk of incorrect treatment for patients. Citation of retracted papers represents a major issue for the scientific community.

DNA aneuploidy with image cytometry for detecting dysplasia and carcinoma in oral potentially malignant disorders: A prospective diagnostic study

BACKGROUND

Current evidence on diagnostic value of aneuploidy with DNA image cytometry (ICM) using brushings for oral potentially malignant disorders (OPMD) is limited by sample size and inconsistent classification criteria of aneuploidy. This study aimed to explore the optimal cut-off values of DNA content and evaluate the diagnostic accuracy of DNA-ICM for detecting dysplasia and/or carcinoma in OPMD.

MATERIALS AND METHODS

A total of 401 consecutive patients with OPMD were enrolled in this prospective diagnostic study. Brushing and biopsy sample form each patient was processed by DNA-ICM and histological examination respectively.

RESULTS

When the optimal cut-off of at least one aneuploid cell with DNA index (DI) ≥2.3, the area under the curves (AUC) was 0.735 and positive predictive value was 92.7% for detecting dysplasia within OPMD. When the optimal cut-off of at least one aneuploid cell with DI ≥ 3.5, the AUC was 0.851 and negative predictive values was 96.8% for detecting carcinoma within OPMD. Importantly, multivariate analysis revealed that aneuploidy with DI ≥ 2.3 in OPMD was significantly associated with dysplasia risk (adjusted OR, 5.52; 95%CI, 2.90-10.51; P < .001), and aneuploidy with DI ≥ 3.5 in OPMD was strongly associated with malignant risk (adjusted OR, 21.05; 95%CI, 9.34-47.41; P < .001).

CONCLUSIONS

This largest-scale diagnostic study optimized the criteria of aneuploidy cytology for noninvasive detection of oral dysplasia and carcinoma within OPMD. DNA aneuploidy in OPMD was an independent marker that strongly associated with oral dysplasia/carcinoma. Our findings suggest that DNA-ICM may serve as a useful noninvasive adjunctive tool for oral cancer and OPMD screening.

Diagnostic Utility of Cytology in Assessment of Ploidy Status in Potentially Malignant Oral Disorders

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.

Toward the use of precision medicine for the treatment of head and neck squamous cell carcinoma

Precision medicine is a new strategy that aims at preventing and treating human diseases by focusing on individual variations in people's genes, environment and lifestyle. Precision medicine has been used for cancer diagnosis and treatment and shows evident clinical efficacy. Rapid developments in molecular biology, genetics and sequencing technologies, as well as computational technology, has enabled the establishment of "big data", such as the Human Genome Project, which provides a basis for precision medicine. Head and neck squamous cell carcinoma (HNSCC) is an aggressive cancer with a high incidence rate and low survival rate. Current therapies are often aggressive and carry considerable side effects. Much research now indicates that precision medicine can be used for HNSCC and may achieve improved results. From this perspective, we present an overview of the current status, potential strategies, and challenges of precision medicine in HNSCC. We focus on targeted therapy based on cell the surface signaling receptors epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and human epidermal growth factor receptor-2 (HER2), and on the PI3K/AKT/mTOR, JAK/STAT3 and RAS/RAF/MEK/ERK cellular signaling pathways. Gene therapy for the treatment of HNSCC is also discussed.

Repression of GPRC5A is associated with activated STAT3, which contributes to tumor progression of head and neck squamous cell carcinoma

Background

G protein–coupled receptor family C group 5 member A (GPRC5A), a retinoic acid-inducible gene, is a lung tumor suppressor. Previously, we showed that repression of GPRC5A expression was associated with pathologic differentiation grade of oral squamous cell carcinomas (OSCC) and overexpression of GPRC5A gene inhibited the malignant phenotype in OSCC cells, suggesting that GPRC5A also functions as a tumor suppressor in oral cancer. However, the molecular mechanisms underlying GPRC5A deficiency in head and neck squamous cell carcinoma (HNSCC) are still unclear.

Methods

In this study, we used Western blot analysis and immunohistochemical (IHC) staining to investigate the expression of GPRC5A in both HNSCC cell lines and clinical samples. GPRC5A stable transfectants and their parental HNSCC cells were characterized for their biological activities in anchorage-independent growth.

Results

IHC analysis showed that, GPRC5A expression was high in normal tissue, but gradually decreased in oral leukoplakia, a precancerous stage, and greatly suppressed in primary cancer. Repression of GPRC5A was correlated with activated STAT3, which associates with aggressive clinicopathological features in HNSCC patients. Moreover, overexpression of GPRC5A suppressed IL-6-induced-STAT3 activation and inhibited anchorage-independent growth in HNSCC cells.

Conclusions

Repressed GPRC5A associates with increased tumor grade and activated STAT3, which may be used as a prognostic marker for tumor progression of HNSCC.

Incidence of Data Duplications in a Randomly Selected Pool of Life Science Publications

Since the solution to many public health problems depends on research, it is critical for the progress and well-being for the patients that we can trust the scientific literature. Misconduct and poor laboratory practice in science threatens the scientific progress, leads to loss of productivity and increased healthcare costs, and endangers lives of patients. Data duplication may represent one of challenges related to these problems. In order to estimate the frequency of data duplication in life science literature, a systematic screen through 120 original scientific articles published in three different cancer related journals [journal impact factor (IF) <5, 5-10 and >20] was completed. The study revealed a surprisingly high proportion of articles containing data duplication. For the IF < 5 and IF > 20 journals, 25% of the articles were found to contain data duplications. The IF 5-10 journal showed a comparable proportion (22.5%). The proportion of articles containing duplicated data was comparable between the three journals and no significant correlation to journal IF was found. The editorial offices representing the journals included in this study and the individual authors of the detected articles were contacted to clarify the individual cases. The editorial offices did not reply and only 1 out of 29 cases were apparently clarified by the authors, although no supporting data was supplied. This study questions the reliability of life science literature, it illustrates that data duplications are widespread and independent of journal impact factor and call for a reform of the current peer review and retraction process of scientific publishing.

Meta-analysis of two computer-assisted screening methods for diagnosing oral precancer and cancer

The early diagnosis of oral precancer and cancer is crucial and could have the highest impact on improving survival rates. A meta-analysis was conducted to compare the accuracy between the OralCDx brush biopsy and DNA-image cytometry in diagnosing both conditions. Bibliographic databases were systematically searched for original relevant studies on the early diagnosis of oral precancer and oral cancer. Study characteristics were evaluated to determine the accuracy of the two screening strategies. Thirteen studies (eight of OralCDx brush biopsy and five of DNA-image cytometry) were identified as having reported on 1981 oral mucosa lesions. The meta-analysis found that the area under the summary receiver operating characteristic curves of the OralCDx brush biopsy and DNA-image cytometry were 0.8879 and 0.9885, respectively. The pooled sensitivity, specificity, and diagnostic odds ratio of the OralCDx brush biopsy were 86% (95% CI 81-90), 81% (95% CI 78-85), and 20.36 (95% CI 2.72-152.67), respectively, while these modalities of DNA-image cytometry were 89% (95% CI 83-94), 99% (95% CI 97-100), and 446.08 (95% CI 73.36-2712.43), respectively. Results of a pairwise comparison between each modality demonstrated that specificity, area under the curve (AUC), and Q(∗) index of DNA-image cytometry was significantly higher than that of the OralCDx brush biopsy (Z=2.821, p<0.05; Z=1.711, p<0.05; Z=1.727, p<0.05), but no significant difference in sensitivity was found (Z=1.520, p>0.05). In conclusion, the meta-analysis of the published studies indicated that DNA-image cytometry is more accurate than the OralCDx brush biopsy in diagnosing oral precancer and oral cancer.

Detection of cell carcinogenic transformation by a quadruplex DNA binding fluorescent probe

Cancer can be easily treated when found early. A probe capable of detecting cell transformation may increase the success rate of early diagnosis of cancer. In this report we have tested the ability of a fluorescent, quadruplex DNA binding probe, 3,6-bis(1-methyl-4- vinylpyridinium) carbazole diiodide (BMVC), to detect cell transformation in vitro. BMVC was applied to living cells in several different models of cell transformation, and the fluorescence signals of BMVC were measured. The degrees of cell transformation in these models were characterized by alterations in cellular morphological phenotype and subcellular organization. When BMVC probes were applied, the number of BMVC-positive cells increased in accordance with the degree of transformation. BMVC was capable of significantly detecting formation of foci, increased cellular motility, cell proliferation, cell apoptosis, anchorage-independent growth, and increased invasiveness of transformed cells. These results demonstrate the ability of BMVC probes to detect cell transformation and indicate that BMVC is of promise for use as a probe in early cancer detection.

The expression of E-cadherin and cathepsin-D in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma: A comparative analysis between immunohistochemistry and routine histopathology

Background:

E-cadherin is known to be an invasion suppressor gene and cathepsin-D, a protease, which is an invasion promoter and plays a central role in solid tumors including oral cancer.

Aims:

To look for the expression pattern in normal buccal mucosa, dysplastic oral epithelium and oral squamous cell carcinoma (SCC) along with their correlation to individual atypical features, thereby providing an objective to the grading system in predicting the fate of affected epithelium.

Materials and Methods:

To elucidate the expression patterns of these markers, we examined immunohistochemically on formalin fixed, paraffin embedded sections 22 dysplastic epithelia, eight SCC and ten normal buccal mucosa.

Results:

In dysplastic epithelium slight loss of expression of E-cadherin was noted as grade of dysplasia increased. Two cases of carcinoma clearance showed only basal and suprabasal staining. The staining varied in SCC with patchy to complete absence of expression. With cathepsin-D fine to moderate granular cytoplasmic staining was noted in most of the dysplastic epithelium. Similar staining was noted in SCC. The atypical features which strongly correlated to loss of expression of E-cadherin and intense cathepsin-D expression are basilar hyperplasia, loss of cohesion, mitosis, loss of polarity and drop shaped rete ridges.

Conclusions:

The result of the study shows that the above atypical features should be given more weightage in addition to traditional grading system, in predicting the fate of affected epithelium. Additional studies with larger sample size and using monoclonal antibody against cathepsin-D may further strengthen our findings.

Molecular changes in the multistage pathogenesis of head and neck cancer

Head and neck squamous cell carcinomas (SCCHN) arise in the mucosa of the upper aerodigestive tract at multiple anatomic sites. While tobacco and alcohol exposure remain the primary risk factors for this malignancy, infection with the human papilloma virus is emerging as a major contributing factor to cancers that arise primarily in the oropharynx. Despite therapeutic advances, survival has remained relatively unchanged over the past few decades. Increased understand of the cellular and molecular biology of these cancers will improve our understanding of this malignancy and facilitate the development of more effective therapeutic strategies. Alterations that have been studied to date include genetic and epigenetic changes. While the epidermal growth factor receptor (EGFR) is the only established molecular therapeutic target, other proteins and pathways are under active investigation to determine their contribution to SCCHN carcinogenesis and progression.

Oral Leukoplakia as It Relates to HPV Infection: A Review

Leukoplakia is the most common potentially malignant lesion of the oral cavity and can be categorised according to its clinical appearance as homogeneous or nonhomogenous. Tobacco and areca nut use, either alone or in combination are the most common risk factors for oral leukoplakia, but some oral leukoplakias are idiopathic. Some leukoplakias arise within fields of precancerized oral epithelium in which the keratinocytes may be at different stages of cytogenetic transformation. Leukoplakias may unpredictably regress, may remain stable, or may progress to carcinoma. There is a greater risk of carcinomatous transformation of idiopathic leukoplakia, of non-homogenous leukoplakia, of leukoplakia affecting the floor of the mouth; the ventrolateral surface of the tongue and the maxillary retromolar and adjoining soft palate (collectively called high-risk sites), of leukoplakia with high-grade epithelial dysplasia, and of leukoplakia in which the keratinocytes carry cytogenetic alterations associated with carcinomatous transformation. Although there appears to be some link between human papillomavirus (HPV) and oral leukoplakia, there is little evidence to support a causal relationship either between HPV infection and oral leukoplakia or between HPV-infected leukoplakic keratinocytes and their carcinomatous transformation.

Cell transformation and the evolution of a field of precancerization as it relates to oral leukoplakia

Potentially malignant oral leukoplakias arise within precancerized epithelial fields consisting of cytogenetically altered keratinocytes at various stages of transformation. The evolution of a clone of keratinocytes culminating in a precancerous phenotype is a function of the number of mutagenic events, rather than the sequential order in which they occur. The altered molecular configurations of the transformed precancerous keratinocytes may confer upon them a growth advantage in relation to the unaltered neighbouring keratinocytes. Replicative clonal expansion of these keratinocytes results in the progressive replacement of the surrounding normal keratinocytes by the fitter clone or clones of altered cells. The precancerized oral epithelial field may have a clinically normal appearance and microscopically may be normal or may show dysplasia. Oral leukoplakias arising within a precancerized epithelial field in which the keratinocytes show DNA aneuploidy or loss of heterozygosity at certain specific chromosomal loci have the potential to progress to carcinoma. The pathogenic mechanisms that drive the carcinomatous transformation of oral leukoplakias, in which cytogenetic alterations in the keratinocytes cannot be detected, are unknown.

Chemopreventive potential of natural compounds in head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) is one of the most fatal cancers worldwide. Despite advances in the management of HNSCC, the overall survival for patients has not improved significantly due to advanced stages at diagnosis, high recurrence rate after surgical removal, and second primary tumor development, which underscore the importance of novel strategies for cancer prevention. Cancer chemoprevention, the use of natural or synthetic compounds to prevent, arrest, or reverse the process of carcinogenesis at its earliest stages, aims to reverse premalignancies and prevent second primary tumors. Genomics and proteomics information including initial mutation, cancer promotion, progression, and susceptibility has brought molecularly targeted therapies for drug development. The development of preventive approaches using specific natural or synthetic compounds, or both, requires a depth of understanding of the cross-talk between cancer signaling pathways and networks to retain or enhance chemopreventive activity while reducing known toxic effects. Many natural dietary compounds have been identified with multiple molecular targets, effective in the prevention and treatment of cancer. This review describes recent advances in the understanding of the complex signaling networks driving cancer progression and of molecularly targeted natural compounds under preclinical and clinical investigation.

Oral squamous cell cancer: early detection and the role of alcohol and smoking

Objective

Oral squamous cell carcinoma has a remarkable incidence worldwide and a fairly onerous prognosis, encouraging further research on factors that might modify disease outcome.

Data sources

A web-based search for all types of articles published was initiated using Medline/Pub Med, with the key words such as oral cancer, alcohol consumption, genetic polymorphisms, tobacco smoking and prevention. The search was restricted to articles published in English, with no publication date restriction (last update 2010).

Review Methods

In this review article, we approach the factors for a cytologic diagnosis during OSCC development and the markers used in modern diagnostic technologies as well. We also reviewed available studies of the combined effects of alcohol drinking and genetic polymorphisms on alcohol-related cancer risk.

Results

The interaction of smoking and alcohol significantly increases the risk for aero-digestive cancers. The interaction between smoking and alcohol consumption seems to be responsible for a significant amount of disease.

Conclusion

Published scientific data show promising pathways for the future development of more effective prognosis. There is a clear need for new prognostic indicators, which could be used in diagnostics and, therefore a better selection of the most effective treatment can be achieved.

Nipple aspirate fluid and ductoscopy to detect breast cancer

We prospectively performed cytologic assessment and image analysis (IA) on matched nipple aspirate fluid (NAF) and mammary ductoscopy (MD) specimens to determine (1) the accuracy of these methods in cancer detection and (2) whether the two collection methods provide complementary information.NAF and MD specimens were collected from 84 breasts from 75 women (nine bilateral samples) who underwent breast surgery. Cytologic evaluation was performed on all samples. IA was performed on slides with sufficient epithelial cells.Cytologic evaluation proved more accurate in patients without pathologic spontaneous nipple discharge (PND) than those with PND, mainly because of the potential false positive diagnosis in the latter. While the sensitivity of NAF and MD cytology was low (10% and 14%, respectively), both were 100% specific in cancer detection in the non-PND cohort. Combining NAF and MD cytology information improved sensitivity (24%) without sacrificing specificity. Similar to cytology, IA was more accurate in patients without PND having high specificity (100% for aneuploid IA), but relatively low sensitivity (36%). Combining NAF and MD cytology with aneuploid IA improved the sensitivity (45%) while maintaining high specificity (100%). The best predictive model was positive NAF cytology and/or MD cytology combined with IA aneuploidy, which resulted in 55% sensitivity and 100% specificity in breast cancer detection.Cytologic evaluation and IA of NAF and MD specimens are complementary. The presence of atypical cells arising from an intraductal papilloma in ductoscopic specimens is a potential source of false positive diagnosis in patients with nipple discharge.

Cytometric analysis of oral scrapings of patients with oral lichen planus

OBJECTIVE

Aneuploidy has been associated with malignant and premalignant oral lesions. In the past few years, its application in oral precancerous lesions and its prognostic meaning have been controversial issues. The aim of our study was to characterize alterations in DNA content by automated DNA image cytometry in oral scrapings of patients with oral lichen planus.

METHODS

Cytological samples from 40 patients clinicopathologically diagnosed with oral lichen planus were analysed by DNA image cytometry.

RESULTS

All the cases were classified as diploid, showing a predominant population of cells with normal DNA content (DNA index, 0.85-1.15). Atrophic/erosive lesions showed a higher percentage of tetraploid cells when compared with reticular/papular lesions but this was not statistically significant (P = 0.09).

CONCLUSIONS

Aneuploidy does not seem a common event in oral lichen planus lesions. However, we consider that the use of DNA image cytometry of oral scrapings may be an easy and helpful methodology in the follow-up of patients with these lesions.

[Diagnosis of laryngeal carcinoma]

DIAGNOSTICAL PROBLEMS OF LARYNGEAL CARCINOMA: Carcinoma of the larynx is still a prognostic serious disease associated with high mortality. Survival rates for these tumors vary and depend on the presence of early symptoms, anatomic accessibility and lymphatic supply. Despite advances in therapy and novel surgical and non-surgical approaches, early diagnosis remains the best predictor of survival.

STRATEGY AND NOVEL DIAGNOSTICAL PROCEDURES

This article reviews the diagnosis for laryngeal carcinoma in an effort to heighten the clinical and endoscopic recognition of these lesions, providing also global overview of clinical conventional and recent endoscopic diagnostic tools for squamous cell type of carcinoma of the larynx. Screening of asymptomatic individuals would detect tumors at an early enough stage to patients' benefit.

CONCLUSION

The progress in the elucidation of the molecular genetic changes in these tumors should soon bring novel diagnostic procedures into the clinical practise. The review higlights the important advances of endoscopic, radilogical and molecular methods in detection of the tumor which may help clinicians to diagnose tumors as early as possible. TNM staging, biopsy and histopathological grading remain the gold standard for diagnosis of laryngeal carcinoma. A great number of novel endoscopical methods are only supplementary tools to microlaryngoscopy. Some of the most significant biological markers might be integrated with the evaluation of behavioural factors, clinical and histopathological examinations for a new clinicomolecular approach to laryngeal cancer.

DNA ploidy analysis by image cytometry helps to identify oral epithelial dysplasias with a high risk of malignant progression

Abnormal DNA content (aneuploidy) has been associated with malignant and premalignant epithelial lesions. The presence of aneuploidy in tumours at an early stage and in dysplastic lesions suggests that analysis of DNA content may be a useful marker for determination of prognosis in these lesions. The aim of this study was to use DNA image cytometry to evaluate aneuploidy in oral dysplastic lesions and to determine whether aneuploidy is associated with malignant progression. Forty-two lesions of oral epithelial dysplasias (OED) that had progressed to oral squamous cell carcinoma (OSCC) and 44 lesions that did not progress were analysed for DNA ploidy using image cytometry of nuclear monolayers prepared from paraffin-embedded tissue. Forty-two OSCC that had arisen from the OED cases and five samples of normal oral mucosa samples (NOM) were also examined. Aneuploidy was found in 14/42 (33.3%) of the OED that progressed, but in only 5/44 (11.3%) of OED that did not progress (p=0.01). A total of 19 OED were aneuploid of which 74% showed malignant progression compared to only 42% of the diploid lesions. The sensitivity and specificity of DNA image cytometry to detect cases with high risk of malignant progression was 0.33 and 0.88, respectively. The PPV and NPV were 0.74 and 0.58. We conclude that aneuploid oral dysplastic lesions have a high risk of malignant progression and that DNA image cytometry might help to identify those lesions most at risk.

Assessment of chromosomal gains as compared to DNA content changes is more useful to detect dysplasia in Barrett's esophagus brush cytology specimens

Abnormal DNA ploidy status has been suggested as a prognostic factor for Barrett's esophagus progression into esophageal adenocarcinoma (EAC). The aim of the study was to compare image cytometry DNA analysis (ICDA) and fluorescent in situ hybridization (FISH) in the assessment of DNA ploidy status in Barrett's esophagus (BE), and to determine the value of these abnormalities as an adjunct to conventional cytology in detection of dysplasia and EAC. Brush cytology specimens of 90 BE patients were examined using ICDA and FISH with peri-centromeric probes for chromosomes 7 and 17. The results of ICDA and FISH were compared with each other, and with dysplasia grade or EAC as determined by histology and cytology. FISH and ICDA detected abnormalities in 41% (37/90) and 22% (19/90) of the BE cases, respectively. Gains of chromosome 7 and/or 17 were present in 13% of nondysplasia cases, which further increased with dysplasia stage, while overall DNA content aneuploidy was detected predominantly in high grade dysplasia (HGD) and EAC. Using FISH results combined with cytology, we were able to identify IND/LGD (indefinite/ low grade dysplasia) with a sensitivity and specificity of 75 and 76%, respectively. FISH alone detected HGD/EAC with a high sensitivity and specificity of 85 and 84%, which was superior to that of cytology alone. Thus, FISH is more sensitive than ICDA to detect chromosomal abnormalities in BE brush cytology specimens. FISH detects chromosomal gains in early stages of BE and represents a valuable adjunct to conventional cytology to detect dysplasia or EAC.

Correlation of DNA ploidy with progression of cervical cancer

The majority of squamous cell carcinomas of cervix are preceded by visible changes in the cervix, most often detected by cervical smear. As cervical cancer is preceded by long precancerous stages, identification of the high-risk population through detection of DNA ploidy may be of importance in effective management of this disease. Here we attempted to correlate aneuploid DNA patterns and their influence on biological behavior of flow-cytometry analysis of DNA ploidy which was carried out in cytologically diagnosed cases of mild (79), moderate (36), and severe (12) dysplasia, as well as “atypical squamous cells of unknown significance (ASCUS)” (57) along with controls (69), in order to understand its importance in malignant progression of disease. Cytologically diagnosed dysplasias, which were employed for DNA ploidy studies, 39 mild, 28 moderate, and 11 severe dysplasia cases were found to be aneuploid. Out of the 69 control subjects, 6 cases showed aneuploidy pattern and the rest 63 subjects were diploid. An aneuploidy pattern was observed in 8 out of 57 cases of cytologically evaluated ASCUS. The results of the followup studies showed that aberrant DNA content reliably predicts the occurrence of squamous cell carcinoma in cervical smear. Flow cytometric analysis of DNA ploidy may provide a strategic diagnostic tool for early detection of carcinoma cervix. Therefore, it is a concept of an HPV screening with reflex cytology in combination with DNA flow cytometry to detect progressive lesions with the greatest possible sensitivity and specificity.

A metabonomic approach to the diagnosis of oral squamous cell carcinoma, oral lichen planus and oral leukoplakia

Early diagnosis of oral squamous cell carcinoma (OSCC) and precursor lesions is an attractive strategy to decrease patient morbidity and mortality, but presently there are no satisfied diagnostic approaches. This study proposed a metabonomics-based diagnostic approach for OSCC and its precancerous lesions, including oral lichen planus (OLP) and oral leukoplakia (OLK). Saliva samples were collected from patients and healthy donors, and HPLC/MS analysis was performed to acquire metabolic profiles. Diagnostic model was then constructed with hierarchical principal component analysis (HPCA) and discriminate analysis algorithms. The results indicate that metabolic profiling can properly describe the pathologic characteristics of OSCC, OLP and OLK. HPCA combined with kernel fisher discriminant analysis achieved 100% accuracy in diagnosis of test samples, which is superior to direct principal component analysis and other modeling algorithms. The metabonomic approach based on the integral investigation of oral metabolites enables the detection of OSCC and precancerous lesions on noninvasive saliva samples. The proposed approach is noninvasive, efficient and low-cost, and it can be developed as a promising method for population-based screening of cancers and precancers in the oral cavity.

The possible premalignant character of oral lichen planus and oral lichenoid lesions: A prospective five-year follow-up study of 192 patients

Recently, we reported the preliminary results of a prospective study on the possible premalignant character of oral lichen planus (OLP) and oral lichenoid lesions (OLL). Based on these data it was concluded that there was some but no convincing support for the hypothesis that patients with OLL have an increased risk of development of oral cancer, but not so in patients with OLP. In the present treatise the results of prolonged follow-up of this cohort of patients have been described. A study group of 192 patients, 67 patients diagnosed with OLP and 125 patients with OLL, according to revised World Health Organization diagnostic criteria, was followed for periods ranging from 7.6 to 96.9 months (mean, 55.9 months). The expected number of patients with oral cancer in the group of patients with OLP and in the group of patients with OLL was estimated by comparing the number of patients, their ages, sex, and the length of follow-up to annual incidence rates of oral cancer for the general population in The Netherlands. The binomial test was used to determine whether the observed number of cases of cancer in the OLP group and the OLL group exceeded the expected numbers. Four out of 192 patients, two men and two women, developed a squamous cell carcinoma of the oral mucosa during follow-up. All malignant transformations occurred in the OLL group. The malignant transformation of the OLL group, based on a mean follow-up of 53.8 months, was calculated at 0.71% per year. A comparison of the expected against actual figures for the development of carcinomas revealed no increase in patients with OLP and a 142-fold increase in patients with OLL, the latter being statistically significant, with a p-value of 0.044. The present data give support to the hypothesis that patients with OLL have an increased risk of development of oral cancer. There seems to be no increased risk in patients with OLP. In view of our results we advise to monitor only the subgroup of OLL patients twice a year for early detection of possible malignant transformation.

Allelic imbalance on chromosomes 3p, 9p and 17p in malignant progression of laryngeal mucosa

Objectives/hypothesis:

To evaluate the character and significance of microsatellite deoxyribonucleic acid allelic imbalance in laryngeal squamous cell carcinogenesis.

Methods:

We investigated the frequency of expression and clinical relationships of loss of heterozygosity and microsatellite instability in 49 laryngeal premalignant and malignant lesions. Allelic imbalance was analysed using six polymorphic markers (D3S1234, D9S171, D9S1748, D9S162, D9SINFA and D17S796), via polymerase chain reaction – single sequence length polymorphism – silver staining.

Results:

Allelic loss was seen in 3.7 per cent of the six markers in hyperplastic lesions, 10.81 per cent in mild dysplasia, 26.03 per cent in moderate to severe dysplasia, and 38.67 per cent in laryngeal squamous cell carcinoma. Significant associations were found between allelic loss and clinical pathological grades (χ2 = 17.686, p = 0.000). No statistically significant difference was found in the frequency of microsatellite instability (χ2 = 0.314, p > 0.05). In the early stages of neoplastic change, the incidence of microsatellite instability was higher than that of loss of heterozygosity.

Conclusions:

Allelic imbalance was associated with the carcinogenesis and progression of laryngeal squamous cell carcinoma. Microsatellite analysis might provide new approaches to early genetic detection for patients with premalignant laryngeal lesions.

Proliferative verrucous leukoplakia and its progression to oral carcinoma: a review of the literature

BACKGROUND

Proliferative verrucous leukoplakia (PVL) is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathological features, and potential to develop into cancer. PVL behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can resemble clinically.

METHODS

A PubMed search was conducted which identified studies that examined patients with PVL and reported data meeting inclusion criteria.

RESULTS

PVL is seen much more frequently in females and most often diagnosed after the sixth decade of life. Tobacco use is not strongly linked to the presence of PVL (63% of patients did not use tobacco products). Most (74%) of the patients with PVL progressed to oral carcinoma.

CONCLUSION

PVL is a persistent and progressive oral lesion that requires very close follow-up along with early and aggressive treatment to increase the chances of a favorable outcome.

Biologic markers of breast cancer in nipple aspirate fluid and nipple discharge are associated with clinical findings

BACKGROUND

The aim of this prospective study was to assess predictive markers in nipple aspirate fluid (NAF) and pathologic nipple discharge (PND) collected prior to excisional breast biopsy, as well as clinical factors available prior to biopsy, with histopathologic results in women with a radiographically suspicious and/or palpable breast lesion.

METHODS

208 NAF samples from 191 women were evaluated for the following candidate predictive proteins and cellular markers: prostate-specific antigen (PSA), human glandular kallikrein 2 (hK2), basic fibroblast growth factor (bFGF), S phase fraction (SPF), DNA index, and cytology. Clinical factors included whether or not the lesion was palpable, menopausal status, history of pregnancy, history of birth control or hormone replacement use, and PND.

RESULTS

Considering all women, bFGF (p=0.005) and SPF (0.031) were associated, and abnormal cytology approached an association (p=0.056) with the presence of breast cancer. Women with PND were less likely to have breast cancer (4 vs. 37%, p<0.001) or palpable lesions (10 vs.43%, p<0.001), were younger, had lower PSA levels (p=0.046), and were more likely to have atypical NAF cytology (p=0.002). Excluding PND, increased age, postmenopause (both p<0.01), high bFGF (p=0.004) and low PSA (p=0.05) were associated with cancer. The best breast cancer predictive model included cytology, bFGF, and age (88% sensitive and 57% specific). When the data were divided by menopausal status, the optimal models to predict breast cancer, which included NAF hK2 or PSA and age, were 100% sensitive and 41% specific in pre- vs. 93% sensitive and 12% specific in postmenopausal women.

CONCLUSION

NAF and clinical biomarkers are sensitive predictors of whether a breast contains cancer, and may ultimately help guide treatment. Future studies to determine the optimal combination of predictive markers are warranted.

DNA study of bladder papillary tumours chemically induced by N-butyl-N-(4-hydroxybutyl) nitrosamine in Fisher rats

To examine DNA abnormalities in bladder papillary tumours induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in female rats, using image cytometric DNA analysis and cytogenetics. Thirty female rats were exposed to BBN in their drinking water for 20 weeks. One group of 10 animals served as controls. The animals exposed to BBN were killed at a rate of two per week, with the bladder being collected under aseptic conditions and those tumours with exophytic growth removed. The nuclear DNA content of the tumours was evaluated using image cytometric analysis. In two rats part of the tumour pieces was stipulated for culturing. Cytogenetic analysis was performed on at least 30 cells from each cell population and on both tumours. Papillary carcinomas were classified as low grade and high grade. DNA ploidy studies were carried out on 28 low-grade and 21 high-grade papillary carcinomas. Histograms obtained by image analysis showed that a normal urothelium was diploid; 28.6% and 100% of low-and high-grade papillary carcinomas were aneuploid respectively. Both tumours used for cell culture showed multiple numerical and structural chromosome alterations and several marker chromosomes. Image cytometric DNA analysis proved to be a good and reliable method for examining DNA alterations in papillary bladder carcinomas. The present findings establish that the DNA content is statistically different between low-grade and high-grade papillary carcinomas and that deviation from the diploid number is markedly higher in the high-grade ones. In addition, the occurrence of marker chromosomes seems to be related to the aggressiveness of the tumour.

Field cancerization in oral lichen planus

BACKGROUND

The concept of field cancerization describes the tendency of patients with premalignant and malignant lesions of head and neck mucosal sites to develop multiple carcinomas of the upper aerodigestive tract. Here we address whether this concept should be extended also to patients affected by oral lichen planus (OLP), an inflammatory disorder associated with an increased risk of cancer development.

METHODS

Data from a cohort of 45 patients with OLP who subsequently developed severe dysplastic changes and/or oral squamous cell carcinoma were retrospectively reviewed. Patients who presented more than one oral neoplastic event were considered for further data analysis as regards incidence, localization, management and prognosis.

RESULTS

Twenty (44.4%) patients were affected by one single neoplastic event while 25 (55.6%) developed multiple and often multifocal oral dysplastic and/or malignant events. In most cases, a careful surveillance programme led to diagnosis and effective treatment of oral neoplasias at an early intraepithelial and microinvasive stage, leading to long-term survival. In some patients, however, additional primary tumours occurred suddenly with rapid invasion, leading to advanced stage diagnosis and poor prognosis. Overall, three patients (12%) died due to malignant oral disease.

CONCLUSIONS

Patients with OLP and subsequent development of dysplasia/ oral squamous cell carcinoma are at risk of having multiple and multifocal neoplastic events of the oral cavity, a phenomenon which parallels the concept of field cancerization of traditional head and neck cancers. If detected at an early stage, these neoplasias can be managed with superficial and complete resection. However a small number of patients have loco-regional tumour spread despite a standard surveillance protocol.

Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation

The aim of this paper is to assess the reproducibility of a novel binary grading system (high/low risk) of oral epithelial dysplasia and to compare it with the WHO classification 2005. The accuracy of the new system for predicting malignant transformation was also assessed. Ninety-six consecutive oral epithelial dysplasia biopsies with known clinical outcomes were retrieved from the Oral Pathology archives. A pilot study was conducted on 28 cases to determine the process of classification. Four observers then reviewed the same set of H&E stained slides of 68 oral dysplastic lesions using the two grading systems blinded to the clinical outcomes. The overall inter-observer unweighted and weighted kappa agreements for the WHO grading system were Ks = 0.22 (95% CI: 0.11-0.35), Kw = 0.63 (95% CI: 0.42-0.78), respectively, versus K = 0.50 (95% CI: 0.35-0.67) for the new binary system. Interestingly, all pathologists showed satisfactory agreement on the distinction of mild dysplasia from severe dysplasia and from carcinoma in situ using the new WHO classification. However, assessment of moderate dysplasia remains problematic. The sensitivity and specificity of the new binary grading system for predicting malignant transformation in oral epithelial dysplasia were 85% and 80%, respectively and the accuracy was 82%. The new binary grading system complemented the WHO Classification 2005 and may have merit in helping clinicians to make critical clinical decisions particularly for the cases of moderate dysplasia. Histological grading of dysplasia using established criteria is a reproducible prognosticator in oral epithelial dysplasia. Furthermore, the present study showed that more consensus scoring on either the degree of dysplasia, assessment of risk or the presence of each morphological characteristic by a panel should be encouraged.

Array-comparative genomic hybridization to detect genomewide changes in microdissected primary and metastatic oral squamous cell carcinomas

Oral squamous cell carcinoma (OSCC) is a common worldwide malignancy. However, it is unclear what, if any, genomic alterations occur as the disease progresses to invasive and metastatic OSCC. This study used genomewide array-CGH in microdissected specimens to map genetic alterations found in primary OSCC and neck lymph node metastases. We used array-based comparative genomic hybridization (array-CGH) to screen genomewide alterations in eight pairs of microdissected tissue samples from primary and metastatic OSCC. In addition, 25 primary and metastatic OSCC tissue pairs were examined with immunohistochemistry for protein expression of the most frequently altered genes. The highest frequencies of gains were detected in LMYC, REL, TERC, PIK3CA, MYB, MDR1, HRAS, GARP, CCND2, FES, HER2, SIS, and SRY. The highest frequencies of losses were detected in p44S10, TIF1, LPL, MTAP, BMI1, EGR2, and MAP2K5. Genomic alterations in TGFbeta2, cellular retinoid-binding protein 1 gene (CRBP1), PIK3CA, HTR1B, HRAS, ERBB3, and STK6 differed significantly between primary OSCC and their metastatic counterparts. Genomic alterations in PRKCZ, ABL1, and FGF4 were significantly different in patients who died compared with those who survived. Immunohistochemistry confirmed high PIK3CA immunoreactivity in primary and metastatic OSCC. Higher FGF4 immunoreactivity in primary OSCC is associated with a worse prognosis. Loss of CRBP1 immunoreactivity is evident in primary and metastatic OSCC. Our study suggests that precise genomic profiling can be useful in determining gene number changes in OSCC. As our understanding of these changes grow, this profiling may become a practical tool for clinical evaluation.

Dysplasia/neoplasia surveillance in oral lichen planus patients: A description of clinical criteria adopted at a single centre and their impact on prognosis

The concept of dysplasia/neoplasia surveillance has been applied to long-standing conditions associated with an increased risk of cancer. Although still controversial, periodic direct clinical examination as well as endoscopic techniques are currently performed in patients with inflammatory bowel diseases, Barrett's esophagus, and melanocytic skin lesions in order to detect and treat dysplastic or early malignant changes and therefore improve the patients' prognosis. It is not known if patients with oral lichen planus (OLP), a chronic inflammatory condition associated with an increased risk of cancer development, might benefit from such surveillance as well, nor how this should be performed. Here we present the clinical criteria we have adopted over a 12-year period to detect early malignant transformation of OLP, and report on their impact on the management and prognosis of patients. Overall data from 45 patients affected by 117 neoplastic events arising from OLP have been evaluated. Our dysplasia/neoplasia surveillance has led us to diagnose most episodes (94.9%; n.: 111) of OLP malignant transformation in early intraepithelial and microinvasive phases, namely stage 0 and I oral cancers (T(is) N0M0 or T1N0M0). The 5-year survival rate, where applicable, has been 96.7%. Advanced stage oral cancers have been diagnosed in six patients, three of whom have died. We suggest that the application of strict and rigorous clinical criteria in dysplasia/neoplasia surveillance could help clinicians to detect and treat early OLP malignant transformation and therefore improve long-term survival rates. Nevertheless, a small subgroup of patients has been shown not to benefit from such surveillance and to be characterized by a rapid development of advanced-stage oral carcinomas, with consequent poor prognosis.