Liquid-based cytology in oral cavity squamous cell cancer

Advances in Oral Exfoliative Cytology: From Cancer Diagnosis to Systemic Disease Detection

Oral exfoliative cytology has emerged as a valuable tool in the early detection of oral cancer and other systemic diseases. This review comprehensively examines the current applications and recent advancements in oral exfoliative cytology techniques. We analyzed published literature from the past decade, focusing on methodological improvements, diagnostic accuracy, and emerging applications. Key findings include: (1) Enhanced cell collection and preparation methods have significantly improved sample quality and diagnostic reliability. (2) Integration of molecular markers and DNA analysis with traditional cytomorphological assessment has increased diagnostic sensitivity and specificity for oral cancer detection. (3) Novel applications in systemic disease detection, including diabetes and iron overload disorders, demonstrate the expanding utility of this technique. (4) Computer-assisted analysis and deep learning algorithms show promise in improving diagnostic accuracy and efficiency. Despite these advancements, challenges remain in standardization and widespread clinical implementation. This review provides a critical evaluation of oral exfoliative cytology's current status and future potential in oral and systemic disease diagnosis.

Assessment of Cytological Changes in the Oral Mucosa in Young Hematological Patients Treated with Systemic Chemotherapy

Background and Objectives: The primary objective of the undertaken study was to determine the morphological changes that occur within the oral epithelium in children undergoing chemotherapy following a diagnosis of hematological malignancies. Materials and Methods: The study group consisted of 18 patients diagnosed with leukemia or lymphoma undergoing treatment with chemotherapy. Swabs (liquid-based cytology) were collected from the oral cavity for microscopic evaluation at baseline, during the chemotherapy cycle with oral mucositis symptoms present, and upon completion of the cycle. Both the neutrophil count and oral mucositis (OM) were registered using the WHO (World Health Organization) scale. The control group included 41 children who were generally healthy. All samples underwent microscopical analyses at the Department of Pathology, Medical University of Gdansk, Poland. Results: A total of 190 cytological preparations were evaluated. The baseline preparations revealed similar cytological images, and the superficial cells of the epithelial layers were seen. A significant (p < 0.01) increase in the number of cells in the intermediate layer of the oral epithelium, as well as a decrease (p < 0.01) in the volume of cells in the superficial layers, was observed in further stages of cytostatic treatment. Conclusions: A decrease in the percentage of superficial epithelial cells with a corresponding increase in the number of intermediate epithelial cells is considered to be a result of toxic damage to the oral mucosa during chemotherapy.

Evaluation of oral brush liquid-based cytology for oral squamous cell carcinoma: a comparative study of cytological and histological diagnoses at a single center

PURPOSE

Liquid-based cytology is highly useful in oral cytology. However, there are only few reports on the accuracy of this method. The current study aimed to compare oral liquid-based cytological and histological diagnoses and to evaluate items that should be considered in oral cytological diagnosis for oral squamous cell carcinoma.

METHODS

We included 653 patients who underwent both oral cytological and histological examinations. Data on sex, specimen collection region, cytological and histological diagnoses, and histological images were reviewed.

RESULTS

The overall male-to-female ratio was 1:1.18. The tongue was the most common specimen collection region, followed by the gingiva and buccal mucosa. The most common cytological examination result was negative (66.8%), followed by doubtful (22.7%) and positive (10.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis were 69%, 75%, 38%, and 92%, respectively. Approximately 8.3% of patients with a negative cytological diagnosis had a histological diagnosis of oral squamous cell carcinoma. Furthermore, 86.1% of histopathologic images of cytology-negative squamous cell carcinomas exhibited well-differentiated keratinocytes lacking atypia on the surface. The remaining patients developed recurrence, or they had low cell counts.

CONCLUSION

Liquid-based cytology is useful in screening oral cancer. However, a cytological diagnosis of superficial-differentiated oral squamous cell carcinoma is occasionally inconsistent with the histological diagnosis. Therefore, histological and cytological examinations should be performed if tumor-like lesions are suspected clinically.

Cytology-based Cancer Surgery of the Head and Neck (CyCaS-HN): a prospective, randomized, controlled clinical trial

Purpose

Liquid-based cytology (LBC) is routinely used in gynecology but is rarely applied in head and neck oncology though many suspicious lesions are easily accessible. While several studies have evaluated the potential use of LBC for early detection and molecular characterization of head and neck squamous cell carcinomas (HNSCCs), no study investigated its potential role in surgical management and therapy planning so far.

Methods

Twenty-five patients with cT1-2 squamous cell carcinomas of the oral cavity and oropharynx were prospectively enrolled in this study and were randomized to two treatment arms: in the control arm, a diagnostic panendoscopy with incisional biopsy was followed by a second operation with transoral tumor resection ± neck dissection and tracheostomy. In the intervention arm, patients underwent LBC diagnostics and in case of a positive result received one single operation with panendoscopy and incisional biopsy for confirmation of LBC result by rapid section histology followed by transoral tumor resection ± neck dissection and tracheostomy in the same session.

Results

Time between clinical diagnosis and definitive surgical treatment was significantly shorter in the intervention group compared with the control group (p < 0.0001). Additionally, time of hospitalization (p < 0.0001) and cumulative operation time (p = 0.062) were shorter in the intervention group. No significant differences in overall, progression-free, and disease-specific survival were observed.

Conclusion

Cytology-based cancer surgery is a promising therapeutic strategy that can potentially be considered for a well-defined group of early-stage HNSCC patients and help to avoid repetitive general anesthesia, shorten the diagnosis-to-treatment interval and spare operation as well as hospitalization time.

Non-Invasive Early Detection of Oral Cancers Using Fluorescence Visualization with Optical Instruments

Simple Summary

Oral cancer has a high mortality rate. Then, oral cancer screening is needed for early detection and treatment. Fluorescence visualization is non-invasive, convenient, and in real-time, and examinations can be repeated. Our study aimed to show the usefulness of oral cancer screening with fluorescence visualization. A total of 502 patients were performed using fluorescence visualization that was analyzed using subjective and objective evaluation. Results of this study, subjective evaluation for detection oral cancer was high sensitivity and low specificity, while objective evaluation using imaging processing analysis was high sensitivity and high specificity. Therefore, oral cancer screening using fluorescence visualization is useful for the detection of oral cancer. The widespread use of this screening can reduce the mortality rate of oral cancer.

Abstract

Background: Oral cancer screening is important for early detection and early treatment, which help improve survival rates. Biopsy is the gold standard for a definitive diagnosis but is invasive and painful, while fluorescence visualization is non-invasive, convenient, and real-time, and examinations can be repeated using optical instruments. The purpose of this study was to clarify the usefulness of fluorescence visualization in oral cancer screening. Methods: A total of 502 patients, who were examined using fluorescence visualization with optical instruments in our hospitals between 2014 and 2019, were enrolled in this study. The final diagnosis was performed by pathological examination. Fluorescence visualization was analyzed using subjective and objective evaluations. Results: Subjective evaluations for detecting oral cancer offered 96.8% sensitivity and 48.4% specificity. Regarding the objective evaluations, sensitivity and specificity were 43.7% and 84.6% for mean green value, 55.2% and 67.0% for median green value, 82.0% and 44.2% for coefficient of variation of value, 59.6% and 45.3% for skewness, and 85.1% and 75.8% for value ratio. For the sub-analysis of oral cancer, all factors on objective and subjective evaluation showed no significant difference. Conclusions: Fluorescence visualization with subjective and objective evaluation is useful for oral cancer screening.

Evaluation of Liquid Based Cytology for Tongue Squamous Cell Carcinoma: Comparison with Conventional Cytology

Oral exfoliative cytology is now used by general practitioners in Japan to screen for oral cancer. With conventional cytology, however, the number of cells that can be sampled is small. Moreover, cell deformation and piling of cells when preparing specimens has been reported. The purpose of this study was to compare conventional and liquid based cytology (LBC), which has been employed with increasing frequency in recent years. We believe that identifying potential pitfalls in oral exfoliative cytology will help improve diagnostic accuracy. A total of 153 patients with tongue squamous cell carcinoma who were diagnosed and treated initially at our hospital between January 2000 and December 2010 were included. Of these, 124 underwent conventional cytology, while the remaining 29 underwent LBC. Histopathological and clinical findings were used as criteria. Conventional cytology yielded a positive rate of 54.8% and LBC 79.3%, while values of 28.2% and 13.8% were obtained for a suspected positive rate, respectively. Liquid based cytology yielded a significantly higher percentage of accurate diagnoses and fewer suspected positives (p<0.05) in cases clinically classified as endophytic and those classified as ulcerative in terms of clinical growth pattern. No significant difference was observed between conventional cytology and LBC in cases of an infiltrative growth pattern, however.The present results suggest that LBC is superior to conventional cytology in achieving an accurate diagnosis based on oral exfoliative cytology. The present findings also suggest that exophytic type, and especially leukoderma type clinical growth patterns constitute pitfall cases in oral exfoliative cytology.

Evaluation of an innovative oral brush for potential applications using liquid based cytology

The present study was conducted to assess the applicability of liquid-based cytology (LBC) using an innovative oral brush, Orcellex. Fifty healthy volunteers were recruited. From each subject, four samples were collected using "Orcellex" from apparently normal oral mucosal sites. A plastic spatula was also used to obtain an additional sample. Data on the tolerability and acceptability of the Orcellex were collected from the subjects, together with assessments of the adequacy of LBC slide preparations for cellularity, preparation quality, and the types of cells observed. The Orcellex brush was well accepted by the volunteers, who reported relatively little pain. Orcellex brush LBC preparations were of good quality in terms of cell morphology and staining, with a clean background. Only two smears (2/200; 1%) were found to be inadequate due to low cellularity. All of the plastic spatula LBC preparations were inadequate. Representative cells from all layers of the different oral epithelia examined were documented. Oral liquid-based cytology using the Orcellex brush may have considerable potential for early detection of oral cancer and precancer.

Comparison of specimen adequacy and smear quality in oral smears prepared by manual liquid-based cytology and conventional methods

BACKGROUND

Liquid-based cytology (LBC), recommended in the mass screening of potentially malignant cervical and oral lesions, suffers from high cost owing to the use of expensive automated devices and materials. Considering the need for cost-effective LBC techniques, we evaluated the efficacy of an inexpensive manual LBC (MLBC) technique against conventional cytological technique in terms of specimen adequacy and smear quality of oral smears.

MATERIALS AND METHODS

Cytological samples were collected from 21 patients using a cytobrush device. After preparation of a conventional smear, the brush containing the remaining sample was immersed in the preservative vial. The preserved material was processed by an MLBC technique and subsequently, direct smears were made from the prepared cell button. Both conventional and MLBC smears were stained by routine Papanicolaou technique and evaluated by an independent observer for the thickness of the smear, cellular distribution, resolution/clarity of cells, cellular staining characteristics and the presence of unsatisfactory background/artifacts. Each parameter was graded as satisfactory; or satisfactory, but limited; or unsatisfactory. Chi-square test was used to compare the values obtained (significance set at P ≤ 0.05).

RESULTS

MLBC technique produced a significant number of satisfactory smears with regard to cell distribution, clarity/resolution, staining characteristics and background/artifacts compared to conventional methods.

CONCLUSIONS

MLBC is a cost-effective cytological technique that may produce oral smears with excellent cytomorphology and longer storage life.

Introducing Cytology-Based Theranostics in Oral Squamous Cell Carcinoma: A Pilot Program

We aimed to evaluate the feasibility and reliability of brush cytology in the biomarker expression profiling of oral squamous cell carcinomas within the concept of theranostics, and to correlate this biomarker profile with patient measurable outcomes. Markers representative of prognostic gene expression changes in oral squamous cell carcinoma was selected. These markers were also selected to involve pathways for which commercially available or investigational agents exist for clinical application. A set of 7 markers were analysed by immunocytochemistry on the archival primary tumour material of 99 oral squamous cell carcinoma patients. We confirmed the feasibility of the technique for the expression profiling of oral squamous cell carcinomas. Furthermore, our results affirm the prognostic significance of the epidermal growth factor receptor (EGFR) family and the angiogenic pathway in oral squamous cell carcinoma, confirming their interest for targeted therapy. Brush cytology appears feasible and applicable for the expression profiling of oral squamous cell carcinoma within the concept of theranostics, according to sample availability.

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.

Concordance between cytopathology and incisional biopsy in the diagnosis of oral squamous cell carcinoma

Oral cytopathology is a simple, non-invasive technique that could be used for early detection of oral premalignant and malignant lesions, but the effectiveness of this diagnostic approach remains controversial. The aim of this study was to evaluate the sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology for diagnosing oral squamous cell carcinoma (OSCC) and the diagnostic concordance between cytopathological and histopathological diagnoses. The study enrolled 172 patients at outpatient clinics who presented with oral lesions suspicious of malignancy. All patients underwent oral cytological scrapes followed by an incisional biopsy. Of 148 cases that were histopathologically diagnosed with OSCC, the cytopathological method diagnosed 123 positive cases and resulted in a suspicion of OSCC in 16 patients. Based on these data, the sensitivity was 83.1%, the specificity was 100.0%, the positive predictive value was 100.0%, the negative predictive value was 49.0%, and the accuracy was 85.5%. The diagnostic concordance between histopathological and cytopathological examinations was 83.1% for OSCC and 85.7% for non-neoplastic lesions. The results indicate that cytopathological diagnosis had good concordance with histopathological diagnosis and showed high sensitivity, specificity, positive predictive value, and accuracy. We conclude that the sensitivity of oral cytopathology is sufficient to justify its use as a diagnostic screening test and to confirm the malignant nature of epithelial cells, mainly for the classification of OSCC. Therefore, cytopathology may be a reliable method for referring patients who require diagnosis of suspected oral cancer for starting treatment.