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Keerthika R, Chandra A, Khairnar M, Jain T, Singh N, Agrawal R. Diagnostic Utility of Cytomorphometric Evaluation of Exfoliated Oral Mucosal Cells in Type II Diabetes Mellitus: A Systematic Review and Meta-analysis. Indian J Otolaryngol Head Neck Surg 2024; 76:2948-2961. [PMID: 39130347 PMCID: PMC11306689 DOI: 10.1007/s12070-024-04601-2] [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: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 08/13/2024] Open
Abstract
Diabetes Mellitus (DM) is the sixth leading cause of mortality and morbidity in the world. Early diagnosis and periodic monitoring are mandatory to prevent complications. The custom of noninvasive exfoliative cytology diagnostic technique is the need of the hour in diabetes, where the invasive methods lose viability. The purpose of this meta-analysis is to analyze the cytomorphometric changes in the exfoliated cells of the oral mucosa, as an adjunct to the diagnosis of type II diabetes. A thorough search was made by using PubMed, Google Scholar, and Cochrane Library databases. Original research articles, that evaluated cytomorphometric parameters (nuclear area, cytoplasmic area, cytoplasmic nuclear ratio) in type II diabetes patients were included in this review. Risk of bias was analysed for each study using Joanna Briggs Institute and Review Manager was used for meta-analysis. All nine subgroups included for qualitative and quantitative data synthesis revealed that there was a significant increase in nuclear area and a decrease in cytoplasmic nuclear ratio in diabetic patients as compared to non-diabetics. Random-effects model also confirmed cytologically altered (nuclear area and cytoplasmic nuclear ratio) parameters to have a significantly increased risk of association with diabetes. Furthermore, these morphometry parameters were also associated with glycemic control and there was no gender disparity among them. Mounting evidence authenticate that cytomorphometric analysis of oral mucosal cells using exfoliative cytology might be aid as an adjunct non-invasive diagnostic tool for type II diabetes.
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Affiliation(s)
- R. Keerthika
- Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Akhilesh Chandra
- Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Mahesh Khairnar
- Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Trupti Jain
- Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Neha Singh
- Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Rahul Agrawal
- Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
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Kannan N, Ramani P. Comparative Analysis of Cytomorphology in Adolescent and Geriatric Patients: A Cross-Sectional Study. Cureus 2023; 15:e44753. [PMID: 37809272 PMCID: PMC10556376 DOI: 10.7759/cureus.44753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Exfoliation of the surface cells of the normal epithelium occurs as a result of physiological turnover. Epithelial cells are constantly renewed, and they are exfoliated or shed as they migrate from the basal layer to the uppermost layer of the epithelium. Oral exfoliative cytology involves the collection and microscopic evaluation of these shed cells or scraped epithelial cells, quantitatively and qualitatively. The objective of the present study was to analyze and compare the cytomorphometric features like cellular area, nuclear area, and nuclear-cytoplasmic ratio from buccal mucosal smears of adolescent and geriatric patients. This study highlights the changes in cell morphology in different age groups (adolescent and pediatric), which could be attributed to hormonal, habitual, and aging factors. Material and methods Buccal smear sample was collected from a total of 60 individuals belonging to the age groups of 11-19 years and above 60 years. The smears were stained with H&E and PAP (Papanicolaou) stain. Photomicrographs were taken in 40x, and measurements were calculated using ImageJ software (National Institutes of Health, Bethesda, Maryland, United States). Cellular size, nuclear size, and nucleo-cytoplasmic ratio were analyzed and compared between the two age groups using independent t-tests using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Results A significant difference was observed in the cellular area and nuclear area between the two age groups with a p-value of 0.00. No significant findings were present in the nucleo-cytoplasmic area of the two age groups. Conclusion Cytomorphometric analysis has shown that there were variations in the cytoplasmic and nuclear areas among different age groups.
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Affiliation(s)
- Neha Kannan
- Oral and Maxillofacial Pathology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, IND
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G P, Ramani P. The Comparative Analysis of Buccal Exfoliated Cells in the Pediatric and Adolescent Age Groups Among the Dravidian Population During the COVID-19 Pandemic: A Cross-Sectional Study. Cureus 2023; 15:e44022. [PMID: 37746403 PMCID: PMC10517427 DOI: 10.7759/cureus.44022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Adolescence is a distinct stage of development marked by a variety of physiological, behavioral, hormonal, and cellular changes. Objective The objective of this study is to assess the cytomorphometry of buccal exfoliated cells in the age groups 1-10 and 11-19 and detect any changes in their buccal exfoliated cells during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods Buccal smears were collected from 60 patients of age groups 1-10 (n=30) and 11-19 (n=30). Cytomorphometric analysis was done using the ImageJ software (National Institutes of Health, Bethesda, MD). Statistical analysis was done using an independent t-test. Results The cytomorphometric analysis of buccal smears between age groups 1-10 and 11-19 showed a statistically significant difference in cell size, cell shape, and nuclear-cytoplasmic (N/C) ratio. Conclusion This study helps to understand the physiological changes in this era and thus will aid to compare the physiological to the pathological changes of exfoliated cells in future studies.
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Affiliation(s)
- Priyadharshini G
- Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Joy S, Abraham S, Madiraju GS, Almugla YM, Aorrju R. Cytomorphometric Analysis of Exfoliated Buccal Mucosal Cells and DNA Repair Proficiency in Peripheral Lymphocytes in Type 1 Diabetes Mellitus. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S529-S534. [PMID: 37654286 PMCID: PMC10466648 DOI: 10.4103/jpbs.jpbs_636_22] [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: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 09/02/2023] Open
Abstract
The aim of this study was to analyze the cytomorphometric changes in the buccal mucosal smears and to correlate the cytomorphometric findings and glycosylated hemoglobin (HbA1c) in type 1 diabetic (T1D) patients. In addition, DNA repair proficiency in peripheral lymphocytes of T1D patients was evaluated. Smears from the clinically normal buccal mucosa of 46 healthy subjects as controls and randomly selected 45 T1D patients, were stained using the Papanicolaou method, and the mean values (μm2) of nuclear area (NA), cytoplasmic area (CA), and cytoplasmic: nucleus ratio (CNR) were obtained for each patient. DNA damage in diabetics and control subjects was tested on peripheral blood samples using an in vitro mutagen sensitivity assay. Statistical analysis included Student's t-test, one-way ANOVA, and Pearson's correlation test to correlate cytomorphometric changes with HbA1c levels in both T1D and healthy control groups. The mean NA and CA values were higher in T1D while the mean CNR was found to be higher in the healthy control group. Statistical significance between the two groups was found only for the mean NA (P < 0.001) and mean CNR values (P < 0.001). A significant correlation was seen between HbA1c and CNR in both the T1D group (P = 0.015) and the healthy control group (P = 0.02). Significant differences were noted between the T1D and control subjects with regard to the frequency of damaged cells and DNA repair proficiency (P < 0.05). Significant cytomorphometric alterations were detected in the buccal mucosal cells of diabetic patients, which may aid in the early detection of diabetes or predict the risk for future disease complications among T1D patients.
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Affiliation(s)
- Sheethal Joy
- Consultant Dentist, Amrita Multi Speciality Dental Clinics, Kerala, India
| | - Sajith Abraham
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| | - Guna Shekhar Madiraju
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| | - Yousef Majed Almugla
- Department of Preventive Dental Sciences, Faculty of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ramakrishna Aorrju
- Registrar, Specialist Endodontist, Dental Centre, Al Ahsa Health Cluster, Ministry of Health, Al Ahsa, Saudi Arabia
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S D, Ramani P, Ramalingam K. Cytomorphometric Analysis of Buccal Exfoliated Cells in Geriatric and Pediatric Age Groups - A Cross-Sectional Study. Cureus 2023; 15:e39082. [PMID: 37332425 PMCID: PMC10269398 DOI: 10.7759/cureus.39082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background We have to establish variations in cellular dimensions in buccal smears with respect to age. It can be used as a reference standard while dealing with age-related pathological abnormalities. Aim The study aims to compare the nuclear area (NA), cellular area (CA), and nucleus-to-cytoplasm ratio (N:C) of pediatric and geriatric age groups in smears obtained from clinically normal buccal mucosa. Materials and methods Buccal smears were collected from 60 subjects with age groups of <10 and >60 years. Cytological smears were prepared and fixed using alcohol. H&E and Papanicolaou's staining was performed as per manufacturer instructions. Cytomorphometric analysis was carried out using Image J software v.1.52 for CA, NA, and N:C. Statistical analysis using Student's t-test was performed using SPSS version 23.0 (IBM Inc, Armonk, New York). Results A significant difference (p<0.001) in NA and CA between the pediatric and geriatric age groups was noted. There was no significant difference in N:C among the study groups. Conclusion The present study provides baseline data of two different age groups that can be used for comparison of abnormal cells in suspicious clinical lesions.
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Affiliation(s)
- Dharini S
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Odell EW. Aneuploidy and loss of heterozygosity as risk markers for malignant transformation in oral mucosa. Oral Dis 2021; 27:1993-2007. [PMID: 33577101 DOI: 10.1111/odi.13797] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
The ability to predict malignant transformation in oral potentially malignant disorders would inform targeted treatment, provide prognostic information and allow secondary prevention. DNA ploidy and loss of heterozygosity assays are already in clinical use, and loss of heterozygosity has been used in prospective clinical trials. This review appraises published evidence of predictive ability and explores interpretation of heterogeneous studies, with different diagnostic methods, criteria and intention. Both methods have a sound biological foundation and have predictive value independent of dysplasia grading and clinical parameters. The application of these two techniques cannot be directly compared because of differences in expression of results and application to populations of different risk. Predicting malignant transformation accurately on an individual patient basis is not yet possible with either technique. However, they are valuable applications to stratify patients for inclusion in trials, identify the lowest risk patients and exclude risk when biopsy results are indeterminate for dysplasia.
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Patel U, Shah R, Patel A, Shah S, Patel D, Patel A. Effect of tobacco in human oral leukoplakia: a cytomorphometric analysis. Med Pharm Rep 2020; 93:273-279. [PMID: 32832892 PMCID: PMC7418830 DOI: 10.15386/mpr-1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/05/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Tobacco use is one of the most critical risk factors for different oral diseases. The aim of this study is to demonstrate the effect of tobacco on oral mucosa by cytomorphometric analysis of cells with the help of exfoliative cytology and to find out the improvement in diagnostic sensitivity of exfoliative cytology in the detection of dysplastic changes and early oral malignancy. Methods The nuclear area (NA) and cytoplasmic area (CA) of cells were measured within cytological smear obtained from leukoplakia lesions of buccal mucosa of 90 tobacco users, 30 smokers (TS), 30 chewers (TC) and 30 with combined habit of smoking and chewing (TSC) and from normal buccal mucosa of 30 non users (NU) of tobacco. Each habit group consisted of 30 tobacco users with oral leukoplakia lesion with mild epithelial dysplasia only. The 30 non-users of tobacco served as controls. The mean values of the CA and NA were obtained for each case, and the nuclear/cytoplasmic area (NA/CA) ratio was calculated. Results The results showed a statistically significant increase (P<0.001) in mean NA and a statistically significant decrease (P<0.001) in mean CA values of tobacco users with leukoplakia as compared to non-users, hence NA/CA ratio value was significantly higher in tobacco users with the lesion. Conclusion The changes in cellular morphology caused by tobacco use can be visualized by use of exfoliative cytology with the help of cytomorphometric analysis. The evaluation of parameters (NA, CA and NA/CA ratio) may increase the sensitivity of exfoliative cytology for the early diagnosis of oral premalignant and malignant lesions.
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Affiliation(s)
- Uday Patel
- Department of Oral and Maxillofacial Pathology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
| | - Rina Shah
- Department of Oral and Maxillofacial Pathology, Index College of Dental Science, Indore, Madhya Pradesh, India
| | - Alpesh Patel
- Department of Oral and Maxillofacial Pathology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
| | - Shreyas Shah
- Department of Oral Pathology, K.M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Dhruva Patel
- Department of Oral and Maxillofacial Pathology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
| | - Anil Patel
- Department of Oral and Maxillofacial Pathology, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
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Huang HC, Chiang SJ, Wen SH, Lee PJ, Chen HW, Chen YF, Dong CY. Three-dimensional nucleus-to-cytoplasm ratios provide better discrimination of normal and lung adenocarcinoma cells than in two dimensions. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-4. [PMID: 31432656 PMCID: PMC6983472 DOI: 10.1117/1.jbo.24.8.080502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
We acquired multiphoton images of normal and lung adenocarcinoma cell lines in three dimensions. Image stacks of the cells were then processed to obtain nucleus-to-cytoplasm (N/C) ratios in two and three dimensions. While N/C ratios in three dimensions can be unambiguously determined from the volumetric ratios of the nucleus and cytoplasm, two-dimensional (2-D) N/C can vary depending on the axial plane selected for N/C ratio determination. We determined 2-D N/C ratios from three criteria: (1) axial position at which the nuclear area is the largest; (2) the largest 2-D N/C ratio value; and (3) axial position at the midpoint of nuclear axial position. We found that different definitions of 2-D N/C ratio will significantly affect its value. Furthermore, in general, larger variance was found in 2-D rather than three-dimensional (3-D) N/C ratios. Lack of ambiguity in definition and reduced variance suggest that 3-D N/C ratio is a better parameter for characterizing tumor cells in the clinical setting.
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Affiliation(s)
- Hsu-Cheng Huang
- National Taiwan University, Department of Physics, Taipei, Taiwan
| | - Shu-Jen Chiang
- National Taiwan University, Department of Physics, Taipei, Taiwan
| | - Shu-Han Wen
- National Taiwan University, Department of Physics, Taipei, Taiwan
| | - Pei-Jung Lee
- National Taiwan University, College of Medicine, Graduate Institute of Toxicology, Taipei, Taiwan
| | - Huei-Wen Chen
- National Taiwan University, College of Medicine, Graduate Institute of Toxicology, Taipei, Taiwan
| | - Yang-Fang Chen
- National Taiwan University, Department of Physics, Taipei, Taiwan
| | - Chen-Yuan Dong
- National Taiwan University, Department of Physics, Taipei, Taiwan
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Raman RK, Kamboj M, Narwal A. The Diagnostic Role of Methyl Green-Pyronin Y Staining in Oral Leukoplakia and Oral Squamous Cell Carcinoma: An Exfoliative Cytology-Based Cytomorphometric Analysis. Acta Cytol 2019; 63:401-410. [PMID: 31112943 DOI: 10.1159/000499623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Oral exfoliative cytology is a noninvasive and nonpainful technique for early diagnosis of oral potentially malignant disorders and oral cancer, and the use of cytomorphometry ameliorates its diagnostic reliability. The objective of the present study was to analyze methyl green-pyronin Y (MGP)-stained oral exfoliated cells (OECs) of oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) by cytomorphometry. MATERIALS AND METHOD An observational study was conducted on 150 individuals equally divided into three groups: normal mucosa, OL, and OSCC. Smears were prepared from OECs and stained with MGP. Cytomorphometry was done for 100 cells per subject, and various cell and nuclear parameters were measured and calculated. RESULTS The Kruskal-Wallis test with post hoc correlation showed significant differences in nucleus and cell diameter (ND, CD), nucleus and cell area (NA, CA), nucleus and cell perimeter (NP, CP), and nucleus to cytoplasmic (N:C) ratio for diameter, perimeter, and area. Spearman's ρ correlation of various N:C ratio methods showed good correlation between N:C perimeter and diameter ratio, N:C diameter and ellipse ratio, and N:C area and ellipse ratio. Additional morphological factors showed significant relations for both cell and nuclear regularity factor, shape factor, and nuclear contour index. DISCUSSION MGP-based cytomorphometry showed a significant decrease in CD, CA, and CP and increase in ND, NA, NP, and N:C ratio from normal mucosa to OL and OSCC. MGP proved its worth as an effective stain for OECs, despite its strict standardization.
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Affiliation(s)
- Rahul Kumar Raman
- Post-Graduate Institute of Dental Sciences, Department of Oral Pathology and Microbiology, Pt B.D. Sharma University of Health Sciences, Rohtak, India
| | - Mala Kamboj
- Post-Graduate Institute of Dental Sciences, Department of Oral Pathology and Microbiology, Pt B.D. Sharma University of Health Sciences, Rohtak, India,
| | - Anjali Narwal
- Post-Graduate Institute of Dental Sciences, Department of Oral Pathology and Microbiology, Pt B.D. Sharma University of Health Sciences, Rohtak, India
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Jairajpuri ZS, Rana S, Hajela A, Jetley S. Toward early diagnosis of oral cancer: Diagnostic utility of cytomorphological features, a pilot study. Natl J Maxillofac Surg 2019; 10:20-26. [PMID: 31205384 PMCID: PMC6563646 DOI: 10.4103/njms.njms_12_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Early detection of oral cancer is one of the most efficient ways to reduce the high mortality from this disease because of the ready accessibility of the oral cavity. We need to devise urgent diagnostic tools to detect early oral premalignant and malignant lesions. Aim: The aim of the present study was to grade the oral lesions in an attempt toward developing a novel cytological grading system. Further, morphometric analysis of cellular parameters was also performed to compare their significance in differentiating benign from malignant lesions. Materials and Methods: The present study was conducted at a tertiary care hospital catering to the low socioeconomic population. Patients presenting in the various Out Patient Departments with suspicious oral lesions were evaluated by cytology in the Department of Pathology. Results: A total of 72 patients were evaluated with a mean age of 43.54 ± 10.35 years. The involvement of the buccal mucosa was the most common site of oral lesions. Cytologically, the lesions were graded according to the oral/oro-pharyngeal cytology grading system into grades A to F. Cyto-morphometric analysis showed an increasing trend in mean nuclear diameter from benign to malignant cases while the mean cytoplasmic diameter decreased, value of P < 0.05 was observed indicating a statistically significant difference between the two groups. Conclusions: Cytological features of pleomorphism are a unique feature in oral carcinoma reflecting intracellular alterations in cells. Grading of lesions according to cytological characteristics can be helpful in standardizing the reporting of the oral lesion. However, our study was restricted by limited data; we emphasize more extensive studies to assess the usefulness and applicability of such a grading system. We also conclude that the use of cytomorphometry can improve the diagnostic reliability of exfoliative cytology.
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Affiliation(s)
- Zeeba Shamim Jairajpuri
- Departments of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Safia Rana
- Departments of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Apoorva Hajela
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sujata Jetley
- Departments of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Nallamala S, Guttikonda VR, Manchikatla PK, Taneeru S. Age estimation using exfoliative cytology and radiovisiography: A comparative study. J Forensic Dent Sci 2018; 9:144-148. [PMID: 29657491 PMCID: PMC5887637 DOI: 10.4103/jfo.jfds_39_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Age estimation is one of the essential factors in establishing the identity of an individual. Among various methods, exfoliative cytology (EC) is a unique, noninvasive technique, involving simple, and pain-free collection of intact cells from the oral cavity for microscopic examination. Objective: The study was undertaken with an aim to estimate the age of an individual from the average cell size of their buccal smears calculated using image analysis morphometric software and the pulp–tooth area ratio in mandibular canine of the same individual using radiovisiography (RVG). Materials and Methods: Buccal smears were collected from 100 apparently healthy individuals. After fixation in 95% alcohol, the smears were stained using Papanicolaou stain. The average cell size was measured using image analysis software (Image-Pro Insight 8.0). The RVG images of mandibular canines were obtained, pulp and tooth areas were traced using AutoCAD 2010 software, and area ratio was calculated. The estimated age was then calculated using regression analysis. Results: The paired t-test between chronological age and estimated age by cell size and pulp–tooth area ratio was statistically nonsignificant (P > 0.05). Conclusion: In the present study, age estimated by pulp–tooth area ratio and EC yielded good results.
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Affiliation(s)
- Shilpa Nallamala
- Department of Oral Pathology, Mamata Dental College, Khammam, Telangana, India
| | | | | | - Sravya Taneeru
- Department of Oral Pathology, Mamata Dental College, Khammam, Telangana, India
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12
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Cowpe JG, Longmore RB, Green MW. Quantitative Exfoliative Cytology of Abnormal Oral Mucosal Smears. J R Soc Med 2018; 81:509-13. [PMID: 3184106 PMCID: PMC1291758 DOI: 10.1177/014107688808100905] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study quantitative techniques have been applied to smears collected from the buccal mucosa and floor of the mouth. The results display an encouraging success rate for identifying premalignant and malignant lesions. ‘Intrapatient’ normal smears provide a satisfactory control for comparison with pathological smears. Early results indicate that quantitative cytology could be of great value for monitoring and follow-up of suspicious lesions and provide an excellent additional diagnostic test for detecting early oral malignancy.
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Affiliation(s)
- J G Cowpe
- Department of Dental Surgery, University of Dundee
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13
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Ferreira SJ, Machado MÂN, de Lima AAS, Johann ACBR, Grégio AMT, Azevedo-Alanis LR. Identification of AgNORs and cytopathological changes in oral lichen planus lesions. Acta Histochem 2017; 119:32-38. [PMID: 27916273 DOI: 10.1016/j.acthis.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/17/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate cytopathological changes in epithelial cells of the oral mucosa of patients with oral lichen planus (OLP) compared with patients without OLP. SUBJECTS AND METHODS Swabs were collected from the oral mucosa of 20 patients with OLP (case group) and 20 patients without OLP (control group) using liquid-based cytology. After Papanicolaou staining, the smears were characterized based on Papanicolaou classification and degree of maturation. Nuclear area (NA) measurements, cytoplasmic area (CA) measurements, and the NA/CA ratio were determined from 50 epithelial cells per slide. For quantification of argyrophilic nucleolar organizer regions (AgNORs), the smears were stained with silver nitrate, and the number of AgNORs was counted in 100 cells. RESULTS In both groups, there was a predominance of Papanicolaou Class I nucleated cells in the superficial layer. The average values of NA (p>0.05) and CA (p=0.000) were greater in the case group (NA=521.6, CA=22,750.3) compared with the control group (NA=518.9, CA=18,348.0). The NA/CA ratio was 0.025 for the case group and 0.031 for the control group (p=0.004). There was no significant difference between the mean AgNORs values of both groups (p>0.05). CONCLUSION The oral mucosa of patients with OLP exhibited significant cytomorphometric changes. However, there was no evidence of malignancy.
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Affiliation(s)
- Stefânia Jeronimo Ferreira
- Graduate Program in Dentistry, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, Pr 80215-901, Brazil.
| | | | | | - Aline Cristina Batista Rodrigues Johann
- Graduate Program in Dentistry, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, Pr 80215-901, Brazil.
| | - Ana Maria Trindade Grégio
- Graduate Program in Dentistry, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, Pr 80215-901, Brazil.
| | - Luciana Reis Azevedo-Alanis
- Graduate Program in Dentistry, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, Pr 80215-901, Brazil.
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Sahay K, Rehani S, Kardam P, Kumra M, Sharma R, Singh N. Cytomorphometric analysis and morphological assessment of oral exfoliated cells in type 2 diabetes mellitus and healthy individuals: A comparative study. J Cytol 2017; 34:27-33. [PMID: 28182082 PMCID: PMC5259926 DOI: 10.4103/0970-9371.197594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Oral exfoliative cytology is a simple, nonaggressive technique that is well accepted by patients. Therefore, it is an attractive option, which aids in the diagnosis and observation of epithelial atypias associated with oral mucosal diseases. Aims: The aim of this study was to evaluate and compare the quantitative and qualitative alterations in exfoliative smears from type 2 diabetics and healthy individuals. Patients and Methods: The study includes 30 type 2 diabetics and 30 healthy persons of both sexes. PAP and hematoxylin and eosin (H and E) stained smears were prepared from buccal mucosa (BM), tongue (T), floor of the mouth (FOM), and palate (P). Under a light microscope, 50 clearly defined unfolded epithelial cells were quantitatively evaluated for cellular area (CA), nuclear area (NA), and cellular-to-nuclear area ratio (CA:NA) and assessed for morphological features. Statistical Analysis: Collected data was manually entered into the Statistical Package for the Social Sciences version 13.5 for analysis. Student's t-test was used at 95% confidence interval. Results: Quantitative assessment of the overall mean CA was less, mean NA was more, and mean CA:NA was less in diabetics than that in healthy persons at all the four sites. Diabetic oral cells showed qualiative cytoplasmic and nuclear alterations: cytoplasmic vacuoles, karyorrhexis, karyolysis, pyknosis, peri-nuclear halo, binucleation, nuclear vacuoles, inflammation, and microbial colonies. Conclusion: Oral cytology from type 2 diabetics is associated with detectable cytomorphological changes with alteration in size of the cell and nucleus, which is site specific, indicating epithelial cell degeneration in cytoplasm and nucleus.
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Affiliation(s)
- Khushboo Sahay
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
| | - Shweta Rehani
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
| | - Priyanka Kardam
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
| | - Madhumani Kumra
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
| | - Rashi Sharma
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
| | - Nisha Singh
- Department of Oral Pathology and Microbiology, Suddha Rustagi College of Dental Science and Research, Faridabad, Haryana, India
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Nivia M, Sunil SN, Rathy R, Anilkumar TV. Comparative cytomorphometric analysis of oral mucosal cells in normal, tobacco users, oral leukoplakia and oral squamous cell carcinoma. J Cytol 2016; 32:253-60. [PMID: 26811574 PMCID: PMC4707788 DOI: 10.4103/0970-9371.171241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Squamous cell carcinoma (SCC) is the third most common cause of oral morbidity in India despite the numerous advances made in the treatment protocol. Aim: To compare the cytomorphometric changes of oral mucosal cells in normal subjects (Group I) with that of tobacco users without any lesion (Group II), tobacco users with oral leukoplakia (Group III), and tobacco users with oral SCC (Group IV) through a semi-automated image analysis system. Materials and Methods: Oral mucosal cells collected from study subjects (n = 100) stained using rapid Papanicolaou stain. Photomicrograph of 50 nonoverlapping cells captured at 50× magnification with a digital image capture system. Cytomorphometric analysis of cells in the captured images was performed with Image-Pro image analysis software. Image analysis was performed to obtain cell diameter (CD), cytoplasmic area (CyA), nuclear diameter (ND), nuclear area (NA), and nuclear-to-cytoplasmic ratio. These values were statistically compared among the groups using one-way analysis of variance (ANOVA) and Mann-Whitney U test. Results: The ND, NA, and nuclear-to-cytoplasmic ratio values were found to be increased in the samples collected from leukoplakia and oral SCC. The CD and CyA decreased compared to the normal mucosa in oral SCC samples. Conclusion: The cytomorphometric changes observed in samples from oral SCC and oral leukoplakia were consistent with the current diagnostic features. Hence, the semi-automated cytomorphometric analysis of oral mucosal cells can be used as an objective adjunct diagnostic tool in the diagnosis of these lesions.
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Affiliation(s)
- Mahadoon Nivia
- Department of Oral and Maxillofacial Pathology, Azeezia College of Dental Sciences and Research, Trivandrum, Kerala, India
| | - Sukumaran Nair Sunil
- Department of Oral and Maxillofacial Pathology, Pushpagiri College of Dental Sciences, Trivandrum, Kerala, India
| | - Ravindran Rathy
- Department of Oral and Maxillofacial Pathology, Azeezia College of Dental Sciences and Research, Trivandrum, Kerala, India
| | - Thapasimuthu Vijayamma Anilkumar
- Department of Veterinary Pathology, Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Keratinized strap cells: a rare cytological atypia resembles Anitschkow cells, in human oral neoplasm. Int J Clin Oncol 2015; 21:59-67. [DOI: 10.1007/s10147-015-0865-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
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Sharma D, Sandhu SV, Bansal H, Gupta S. Distinct perturbations of oral squamous cell carcinoma patients: A quantitative cytomorphometric analysis. Int J Health Sci (Qassim) 2015; 9:283-91. [PMID: 26609293 PMCID: PMC4633192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE Oral cancer constitutes a major health issue in developing countries, representing the leading cause of death. Quantitative assessment by sophisticated diagnostic techniques is becoming increasingly important. Hence, a histochemical staining procedure and morphometric evaluation are used to obtain optimal information on the cellular events. The objective of present study is to assess the variation in cellular area, nuclear area, cellular diameter, nuclear diameter and nuclear/cytoplasmic ratio respectively in normal subjects, smokeless tobacco users, (smokers, combination and oral squamous cell carcinoma patients. METHODS Total 125 number of subjects were divided into five groups, each comprising 25 subjects of more than 40 years of age. These groups were: a. Normal, b. smokeless tobacco users, c. smokers d. combination and e. oral squamous cell carcinoma. Oral smears were obtained, stained with Feulgen stain and the cells were measured cytomorphometrically using Nikon imaging software. RESULTS Our study showed a significant reduction in the cellular diameter, cellular area and increase in the nuclear diameter, nuclear area and nuclear/cytoplasmic ratio in oral squamous cell carcinoma patients as compared to tobacco users and normal patients. Significant changes were found in group I, II, III and IV when compared with group V but as such no significant intergroup variation was found in cellular and nuclear dimensions in smokers, smokeless tobacco users, combination and control group. CONCLUSION Quantitative parameters could be assessed by cytomorphometry. Cytomorphological changes in exfoliated squames could serve as a useful adjunct in the early diagnosis of oral squamous cell carcinomas.
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Affiliation(s)
- Deepti Sharma
- Senior Lecturer, Christian Dental College (CMCH), Ludhiana, Punjab, India
| | - Simarpreet V Sandhu
- Professor and Head, Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Himanta Bansal
- Professor and Head, Department of Oral and Maxillofacial Pathology, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
| | - Shruti Gupta
- Senior Lecturer, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India
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Karthik KR, Malathi N, Poornima K, Prakash S, Kadhiresan R, Arunmozhi U. Evaluation of Glycemic Control in Type 2 Diabetes Mellitus using Cytomorphometry of Buccal Cells and Correlation with Glycosylated Hemoglobin. J Int Oral Health 2015; 7:20-4. [PMID: 25859101 PMCID: PMC4377144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/15/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To study cytological alterations in the exfoliated buccal cells of diabetic patients. To analyze the cytomorphometric findings in the smears of uncontrolled and controlled diabetic patients and compare it with that of normal healthy controls. To establish a correlation between cytomorphometric changes and glycosylated hemoglobin (HbA1c) in diabetics and normal controls, for evaluation of glycemic control. MATERIALS AND METHODS The study was carried out in 40 confirmed diabetic patients from a hospital out-patient diabetic ward and 20 healthy individuals as controls (Group A: n = 20), in Chennai. Specific exclusion criteria were used to select the study group from a larger group of subjects. Based on HbA1c values, the diabetic patients were categorized into Group B = Controlled diabetics (n = 20) (HbA1c <7%) and Group C = Uncontrolled diabetics (n = 20) (HbA1c >9%). After informed consent, buccal smear was collected from clinically normal appearing mucosa and stained with papanicoloau (PAP) stain. Cytomorphometric analysis of selective PAP stained cells was done using image analysis software, Image Pro Plus 5.5 (Olympus) and parameters determined were average cytoplasmic area (CA), average nuclear area (NA) and cytoplasmic:nuclear (C: N) ratio for an average of 50 cells/patient. RESULTS Comparing the average NA among three groups, an increase through Group A, B, C, with a maximum significance between Group C and A was seen. The average C: N ratio showed a statistically significant difference between all three groups. Significant correlation existed between the HbA1c values and both the C: N ratio and average NA in all the three groups. CONCLUSIONS Cytomorphometric analysis of buccal smears using the C: N ratio alteration as a reliable criteria, may serve as yet another non-invasive tool for screening programs for diabetic detection. And the technique may possibly be used also for evaluation of glycemic control in known diabetics.
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Affiliation(s)
- K Raghavendhar Karthik
- Reader, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India,Correspondence: Dr. Karthik KR. SRM Dental College, Ramapuram, Bharathi Salai, Ramapuram, Chennai - 600 089, Tamil Nadu, India.
| | - N Malathi
- Professor and Head, Department of Oral Pathology, Sri Ramachandra Dental College, Chennai, Tamil Nadu, India
| | - K Poornima
- Oral Physician and Radiologist, Radiant Smile Care, Chennai, Tamil Nadu, India
| | - Sunil Prakash
- Post-graduate Student, Department of Oral Pathology, SRM Dental College, Chennai, Tamil Nadu, India
| | - R Kadhiresan
- Senior Lecturer, Department of Periodontics, Sri Venkateshwara Dental College, Chennai, Tamil Nadu, India
| | - U Arunmozhi
- Professor, Department of Periodontics, Sri Venkateswara Dental College, Chennai, Tamil Nadu, India
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Singh M, Sircar K, Tandon A, Chowdhry A, Popli DB. The role of tobacco as an etiological agent for oral cancer: Cytomorphometrical analysis of the buccal mucosa in tobacco users. Dent Res J (Isfahan) 2014; 11:649-55. [PMID: 25540659 PMCID: PMC4275633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Histopathological diagnosis of lesions arising from the intake of tobacco is based on subjective evaluation of morphological alterations within the lesional tissue. Oral exfoliative cytology is a non-invasive diagnostic technique for early detection of oral premalignant and malignant lesions. Morphometric techniques have been advocated as objective and reproducible methods of detecting changes before they are visible by routine microscopy and can facilitate differentiation of normal and abnormal epithelium. This study was conducted to assess the morphometric parameters (cell diameter, nuclear diameter and nuclear cytoplasmic ratio [N:C ratio]) in tobacco smokers and chewers and to evaluate the variations, if any. MATERIALS AND METHODS The study was conducted on cytological smears obtained from oral lesions of patients with habit of tobacco smoking (Group B) and tobacco chewing (Group C). Group A comprised of subjects free from oral lesions and not using tobacco in any form. Patients with both the habits were excluded. The smears were stained using Papanicoloaou staining method. For morphometric analysis, Microimage 3.0 image analysis software was employed. The statistical test employed was an analysis of variance and P < 0.05 was considered as significant. RESULTS The results of this study showed that the cellular diameter was progressively reduced and nuclear diameter progressively increased from Group A to Group B to Group C. The N:C ratio also showed a progressive increase from Group A to Group C. CONCLUSION The results confirmed that tobacco chewing and smoking influenced the cytomorphology of normal appearing buccal mucosa and the degree of these changes were found to be greater in chewers as compared to smokers.
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Affiliation(s)
- Megha Singh
- Department of Oral Pathology and Microbiology, Harsaran Dass Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Keya Sircar
- Department of Oral Pathology and Microbiology, School of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Ankita Tandon
- Department of Oral Pathology and Microbiology, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India,Address for correspondence: Dr. Ankita Tandon, Department of Oral Pathology and Microbiology, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India. E-mail:
| | - Aman Chowdhry
- Department of Oral Pathology and Microbiology, School of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Deepika Bablani Popli
- Department of Oral Pathology and Microbiology, School of Dentistry, Jamia Millia Islamia, New Delhi, India
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Rivera C, Núñez-de-Mendoza C. Exfoliative cytology of oral epithelial cells from patients with type 2 diabetes: cytomorphometric analysis. Int J Clin Exp Med 2013; 6:667-676. [PMID: 24040475 PMCID: PMC3762622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
This research objective is to identify cytomorphometrical changes using exfoliative cytology (EC) and later Papanicolaou (Pap) staining, for oral epithelial cells of patients with type 2 diabetes (DM2) (n = 30), while being compared to patients without the disease (n = 30). Additionally, we investigated an association between cellular changes and salivary flow levels; relationship that until now has not been reported. Results show that the cell diameter and the nuclear-cytoplasmic ratio was significantly higher compared to those patients without the disease (p ≤ 0.001 Student and Welch test). Decreased salivary flow was significantly associated with increased cell diameter and nuclear-cytoplasmic ratio (p ≤ 0.001 ANOVA with Tukey test). Evidence and clinical observations show that DM2 and decreased salivary flow are related to detectable cytomorphometrical changes in exfoliated cells, which may extend the horizon of this cytological technique.
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Affiliation(s)
- César Rivera
- Unit of Histology and Embryology, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of TalcaTalca, Chile
- Biomedical Sciences Master Program, Oral Pathology mention, University of TalcaTalca, Chile
| | - Camila Núñez-de-Mendoza
- Unit of Histology and Embryology, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of TalcaTalca, Chile
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Abu Eid R, Sawair F, Landini G, Saku T. Age and the architecture of oral mucosa. AGE (DORDRECHT, NETHERLANDS) 2012; 34:651-658. [PMID: 21559867 PMCID: PMC3337934 DOI: 10.1007/s11357-011-9261-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
Age changes affect the oral mucosa (the protective lining of the oral cavity), but few of these have been studied objectively. The aim of this study was to quantitatively analyse a number of morphometric parameters of the ageing oral mucosa. The fractal dimension of the epithelial connective tissue interface (ECTI) was estimated in 42 samples of normal buccal mucosa to correlate any changes in their irregularity to the age of the individuals. Morphometric parameters extracted from theoretical cell areas computed programatically were also analysed. Results showed no significant change in ECTI complexity associated with age; however, there was indication that epithelial cells tended to become larger and flatter with age. Interestingly, while some parameters did not show significant differences case wise, cluster analysis showed that the data clustered the cases into three main age groups: one representing the first two decades of life, another group represents adult life (21-50 years) and the last group representing the ageing population (50-90 years).
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Affiliation(s)
- Rasha Abu Eid
- Dental School, The University of Aberdeen, Scotland, UK.
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Preclinical alterations of oral epithelial cells in contact with orthodontic appliances. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 155:299-303. [PMID: 22286817 DOI: 10.5507/bp.2011.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study evaluated the behavior of oral epithelial cells in contact with orthodontic appliances. METHODS Oral epithelial cells of clinically normal buccal mucosa were obtained by liquid-based exfoliative cytology from 22 orthodontic patients. The following regions were evaluated: a) oral mucosa exposed to friction from orthodontic brackets; b) oral mucosa exposed to friction from the tube on the orthodontic band, and c) oral mucosa not exposed to friction (control area). Nuclear (NA) and cytoplasmic (CA) areas and NA/CA ratio were assessed by an image analysis system. Cell morphology and cellularity were also analyzed by Papanicolaou technique. RESULTS The NA of the cells in contact with orthodontic brackets and bands were smaller than the control area. Cells in contact with the brackets showed the greatest reduction in CA in comparison with the cells subjected to friction from the tube, and the control group. Smears classified as type I predominated in all regions analyzed, although type II were predominant, together with superficial epithelial cells, mainly in the oral mucosa in contact with the band tube. CONCLUSION Preclinical alterations in the epithelial cells of oral mucosa, caused by orthodontic appliances, are reduction in NA, increase in cell keratinization and inflammatory features, especially in the band tube area.
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Rajput DV, Tupkari JV. Early detection of oral cancer: PAP and AgNOR staining in brush biopsies. J Oral Maxillofac Pathol 2011; 14:52-8. [PMID: 21731263 PMCID: PMC3125060 DOI: 10.4103/0973-029x.72501] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this study was to determine the diagnostic accuracy of routine Papanicolaou stain (PAP) and Silver stained Nucleolar Organizer Regions (AgNOR) staining in brush biopsies taken from suspected oral lesions for early detection of oral cancer. Materials and Methods: Brush biopsies were collected from macroscopically suspicious lesions of the oral cavity of 34 patients and 10 normal-aged and sex-matched controls. The numbers of AgNORs were counted in 100 squamous epithelial cell nuclei per slide after silver staining of the smears (Ploton’s one-step method). Results: Sensitivity and specificity of PAP analysis in the oral smears for detection of oral cancer and normal cells was 91.176% and 100%. The positive and negative prediction values were 100% and 76.92%, respectively. Sensitivity and specificity of AgNOR analysis in the oral smears for detection of oral cancer and normal cells was 100%. The positive and negative prediction values were 100% each. Conclusion: Based on the above facts, we conclude that brush biopsy in conjunction with AgNOR staining is an easily practicable, non-invasive, safe and accurate screening method for the detection of macroscopically suspicious oral cancerous lesions. Because of its simple technique and high reliability for cellular proliferation, AgNOR staining in brush smears can be used as an adjunct to other routine cytological diagnoses for the early detection of oral cancer. However, further investigations with more number of study samples will be needed to establish this correlation beyond doubt.
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Affiliation(s)
- Dinesh V Rajput
- Department of Oral Pathology and Microbiology, YCMM and RDF's Dental College and Hospital, Wadgaon Gupta MIDC, Ahmednagar - 414001, India
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Patel PV, Kumar S, Kumar V, Vidya G. Quantitative cytomorphometric analysis of exfoliated normal gingival cells. J Cytol 2011; 28:66-72. [PMID: 21713150 PMCID: PMC3111711 DOI: 10.4103/0970-9371.80745] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The use of oral exfoliative cytology as a diagnostic aid accentuates the need for establishing an accurate baseline, thereby enabling the comparison of abnormal oral tissue with established baseline. Aims and Objective: To detect any changes in the nuclear area (NA), cytoplasmic area (CA), and nuclear:cytoplasmic ratio (N:C ratio) values for clinically normal gingival smears in relation to age and sex of apparently healthy subjects. Materials and Methods: Gingival smears were collected from 80 (40 male, 40 female) apparently healthy subjects belonging to the age group of 0–20, 21–40, 41–60, and more than 60 years. Smear slides were fixed by using spray fixative. The smears were stained using Papanicolaou procedure. The cytoplasmic and NAs were measured using image analysis software. Statistical analysis of the data was done using one-way ANOVA with Tukey–HSD procedure and Student's t test. Results: The result showed that there was a significant difference (P<0.001) in NA, CA, and N:C in males of different age groups. There was a significant difference (P<0.001) in NA, CA, and N:C in females of different age groups. The difference in N:C between males and females was significant (P<0.001) in all the groups. The difference in NA, CA, and N:C with age irrespective of gender was significant (P<0.05). There was a significant difference (P<0.05) between males and females with respect to NA, CA, and N:C irrespective of age. Conclusion: Age-and sex-related alterations were observed in gingival smears, which could be a baseline for these variables to compare identical measurements, made on pathologic smears of oral premalignant and malignant lesions.
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Affiliation(s)
- Punit Vaibhav Patel
- Department of Periodontology, JSS Dental College and Hospital, Contituent College of JSS University, Mysore - 15, Karnataka, India
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Smitha T, Sharada P, Girish H. Morphometry of the basal cell layer of oral leukoplakia and oral squamous cell carcinoma using computer-aided image analysis. J Oral Maxillofac Pathol 2011; 15:26-33. [PMID: 21731274 PMCID: PMC3125652 DOI: 10.4103/0973-029x.80034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives: To study and compare the changes in nuclear and cellular size, shape and nuclear–cytoplasmic ratio of the cells in the basal layer of oral leukoplakia and well-differentiated oral squamous cell carcinoma (SCC) with normal buccal mucosa, using computer-aided image analysis in tissue sections. Study design: This was a retrospective study conducted on tissue sections on a total number of 70 cases to determine the various morphometric parameters. The data collected in this study were analyzed statistically by computing descriptive statistics, viz., percentage, mean, standard deviation, standard error of mean, 95% confidence interval for mean. The difference in the control and study groups for various diagnostic variables was compared by means of analysis of variance (ANOVA), Student’s t-test for independent samples, wherever applicable. Mann–Whitney U-test and Kruskal–Wallis test were used where the data were found to be asymmetrical and the standard deviations were also different. The results were considered statistically significant whenever P ≤ 0.05. Results: Our results were significant for the morphometric parameter, size. The values of nuclear perimeter and area, cellular perimeter and area increased gradually from the normal buccal mucosa to leukoplakia, reaching the highest value in SCC. There was statistically significant difference in the nuclear and cellular areas to differentiate between leukoplakia and squamous cell carcinoma. Two variables which were used to study the shape, “form perimeter (PE)” and “contour index (CI)”, showed significant difference between normal buccal mucosa and leukoplakia and between normal buccal mucosa and SCC. The morphometric parameter, nuclear–cytoplasmic ratio, in our results showed an increase in leukoplakia and SCC compared to normal buccal mucosa, but the difference was not significant between leukoplakia and SCC. Conclusion: The morphometric parameter, size, was useful to differentiate between normal, potentially malignant leukoplakia and SCC.
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Affiliation(s)
- T Smitha
- Department of Oral and Maxillofacial Pathology, V. S. Dental College and Hospital, K. R. Road, VV Puram, Bangalore, India
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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.
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Affiliation(s)
- M Pérez-Sayáns
- School of Dentistry, Entrerríos s/n, Santiago of Compostela C.P. 15782, Spain.
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Souto GR, Caliari MV, Lins CEC, De Aguiar MCF, De Abreu MHNG, Mesquita RA. Tobacco use increase the number of aneuploid nuclei in the clinically healthy oral epithelium. J Oral Pathol Med 2010; 39:605-10. [DOI: 10.1111/j.1600-0714.2010.00907.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Loss R, Sandrin R, França BHS, de Azevedo-Alanis LR, Grégio AMT, Machado MÂN, de Lima AAS. Cytological analysis of the epithelial cells in patients with oral candidiasis. Mycoses 2010; 54:e130-5. [PMID: 20202111 DOI: 10.1111/j.1439-0507.2009.01857.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rafael Loss
- Department of Oral Pathology, School of Dentistry, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Pereira BR, Tanaka OM, Lima AAS, Guariza-Filho O, Maruo H, Camargo ES. Metal and Ceramic Bracket Effects on Human Buccal Mucosa Epithelial Cells. Angle Orthod 2009; 79:373-9. [PMID: 19216594 DOI: 10.2319/021508-92.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/01/2008] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objective: To test the null hypothesis that metal and ceramic brackets have no effect on the epithelial cells of the buccal mucosa.
Materials and Methods: Two metal and two ceramic brackets were bonded in 21 individuals of both sexes. With the use of liquid-based exfoliative cytology, morphometric and morphologic changes in buccal mucosa cells adjacent to these brackets were determined and were compared at three time points: baseline (T0), 60 days after placement (T1), and 30 days after removal of the brackets (T2).
Results: A decrease in nuclear area and an increase in cytoplasmic area occurred in the buccal mucosa cells adjacent to the brackets at T1 (P < .01). At T2, this altered morphometry persisted only in cells adjacent to the metal brackets, although to a lesser degree than at T1 (P < .01). A greater decrease in nuclear area was noted in cells adjacent to the metal brackets than in those next to the ceramic brackets (P < .01). At T0, the proportions of surface and subsurface cells were similar, but at T1, a predominance of surface cells was observed (P < .05). At all time points, smears of cells appeared normal or normal with some inflammatory changes.
Conclusion: The hypothesis is rejected. Placement of metal and ceramic brackets in the buccal cavity induces cellular alterations. These alterations do not suggest malignancy.
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Affiliation(s)
- Betina R. Pereira
- a Graduate MS Program Orthodontics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Orlando M. Tanaka
- b Senior Professor, Graduate Dentistry Program, Orthodontics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Antônio A. S. Lima
- c Senior Professor, Graduate Dentistry Program, Stomatology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Odilon Guariza-Filho
- d Associate Professor, Graduate Dentistry Program, Orthodontics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Hiroshi Maruo
- b Senior Professor, Graduate Dentistry Program, Orthodontics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Elisa S. Camargo
- d Associate Professor, Graduate Dentistry Program, Orthodontics, Pontifical Catholic University of Paraná, Curitiba, Brazil
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30
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Pektas ZO, Keskin A, Günhan O, Karslioğlu Y. Evaluation of nuclear morphometry and DNA ploidy status for detection of malignant and premalignant oral lesions: quantitative cytologic assessment and review of methods for cytomorphometric measurements. J Oral Maxillofac Surg 2006; 64:628-35. [PMID: 16546642 DOI: 10.1016/j.joms.2005.12.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Indexed: 10/24/2022]
Abstract
PURPOSE Detection of a precancerous or cancerous lesion when small is one of the most important factors to improve 5-year survival rates of oral cancer. Although surgical biopsy is the most definitive method for diagnosing oral lesions, it is impractical to routinely subject large numbers of patients to biopsy. Recently, cytomorphometric assessments improved by advanced computer-assisted image analysis systems have gained importance. This study was established to evaluate the efficacy of nuclear cytomorphometric analysis and DNA ploidy status for the detection of oral malignancies. Methods used for cytomorphometric analysis were also reviewed. PATIENTS AND METHODS Oral mucosal smears (n = 44) were obtained from patients (n = 22) presenting with various oral lesions using a cytobrush immediately before biopsy. Cytomorphometric measurements and nuclear Feulgen DNA content analysis were carried out after the Feulgen staining procedure. Smears from the lesion site constituted the study group whereas contralateral healthy mucosal sites served as control. RESULTS DNA ploidy analysis revealed 20 diploid (90.9%) and 2 aneuploid DNA patterns (9.1%) sampled from the lateral margin of the tongue and floor of the mouth. When only malignant lesions were considered, aneuploidy rate was 16.7% whereas a diploid pattern was indicated for 83.3% of the sample. With cytomorphometric measurements, a statistically significant difference was shown for nuclear perimeter, area, diameter equivalent to circle, minimum and maximum Feret, intensity, DNA content (c) and DNA index values. CONCLUSIONS Cytomorphometric analysis via oral brush biopsy is a valuable adjunct to biopsy for identification of premalignant and early stage cancerous oral lesions as a rapid and minimally invasive procedure with high specificity and sensitivity rates, requiring no topical or local anesthetic.
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Affiliation(s)
- Zafer Ozgür Pektas
- Department of Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey.
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31
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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.
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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
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32
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Cançado RP, Yurgel LS, Filho MS. Comparative analyses between the smoking habit frequency and the nucleolar organizer region associated proteins in exfoliative cytology of smokers' normal buccal mucosa. Tob Induc Dis 2004; 2:43-9. [PMID: 19570270 PMCID: PMC2671520 DOI: 10.1186/1617-9625-2-1-43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An evaluation of the cellular alterations in the smoker's oral mucosal cells was performed. Exfoliative Citology technique were applied and the cytologic smears stained with silver for quantitative analyses of Argyrophilic nucleolar organizer regions. (AgNORs). Cytologic smears were collected from two anatomic sites, mouth floor and tongue border with the purpose of relating the frequency of smoking with the quantitative analyses of the AgNORs. This study showed that the average number of AgNORs/nucleus is related with the number of cigarettes per day in the mouth floor of smoker's. These results suggest a possible relation between the number of cigarettes per day and an increase rate of cellular proliferation in the oral mucosal cells.
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Affiliation(s)
- Renata Pittella Cançado
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontificia Universidade Católica do rio Grande do Sul, Brazil.
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33
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Mollaoglu N, Wilson MJ, Cowpe JG. Extraction of DNA from oral cytological samples by scraping and smear method suitable for restriction site mutation analysis: a pilot study. Diagn Cytopathol 2001; 25:83-5. [PMID: 11477709 DOI: 10.1002/dc.2009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The restriction site mutation assay (RSM) can be used to measure base changes which occur in the DNA coding for bacterial restriction enzymes. The aim of this study was to investigate whether DNA, of sufficient quantity and quality for analysis by RSM, could be extracted from cells collected from precancerous lesions using a cytological smear technique. Six smears were collected from each of five lesions of leukoplakia displaying a variety of clinical appearances. Three methods for the extraction of DNA were compared. The commercial extraction method was shown to be most convenient and reproducible, routinely providing 1-5 microg of DNA per sample. Cell populations collected by a cytological smear technique can provide DNA of sufficient quantity and quality for analysis of RSM.
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Affiliation(s)
- N Mollaoglu
- Department of Oral and Maxillofacial Surgery, University of Gazi, Dental Faculty, Ankara, Turkey.
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34
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Cançado RP, Yurgel LS, Filho MS. Evaluation of the nucleolar organizer region associated proteins in exfoliative cytology of normal buccal mucosa. Effect of smoking. Oral Oncol 2001; 37:446-54. [PMID: 11377233 DOI: 10.1016/s1368-8375(00)00110-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An evaluation of cellular alterations in the smoker's oral mucosal cells was performed. The Exfoliative Cytology technique was applied and the cytological smears stained with silver for the enumeration of Argyrophilic nucleolar organizer regions (AgNORs). Cytological smears were collected from two anatomic sites: floor of the mouth and tongue border, in both groups, smokers and non smokers, with a purpose of correlating the smoking habit to possible cellular alterations. The enumeration of the AgNORs showed that the average number of AgNORs is higher in smokers. There is a significant difference (P=0.0001) between smears from the floor of the mouth and from tongue border in the smoking group. In this study, no correlation between number of cigarettes, age and gender was found, but the results suggest that there might be a correlation between the smoking habit and an increased rate of cellular proliferation in the oral mucosal cells.
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Affiliation(s)
- R P Cançado
- Departament of Oral and Maxillofacial Surgery, School of Dentistry, Av. Ipiranga, 1600 Prédio 06, sala, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil.
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35
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Ramaesh T, Mendis BR, Ratnatunga N, Thattil RO. The effect of tobacco smoking and of betel chewing with tobacco on the buccal mucosa: a cytomorphometric analysis. J Oral Pathol Med 1999; 28:385-8. [PMID: 10535360 DOI: 10.1111/j.1600-0714.1999.tb02108.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of tobacco use on the buccal mucosa has been assessed by cytomorphometry. Cell and nuclear diameters (CD, ND) of exfoliated oral squames were measured in tobacco smokers (S), betel chewers with tobacco (C) and those with a combined habit (S+C). Non-users (NU) served as controls. The mean CD values in S, C, S+C and NU were: 50.8 (+/-0.47), 49.39 (+/-0.48), 49.12 (+/-0.47) and 51.87 (+/-0.76) microm, and the mean ND values were: 8.83 (+/-0.07), 8.61 (+/-0.08), 8.72 (+/-0.10) and 8.33 (-/+ 0.09) microm, respectively. The least significant difference procedure (LSD at P=0.05) showed a significant reduction for CD in C and S+C and an increase for ND in all three habit groups, compared to the controls. This study shows that the use of tobacco influences the cytomorphology of the normal buccal mucosa. Betel chewing with tobacco influences the ND and CD, while smoking influences only the ND.
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Affiliation(s)
- T Ramaesh
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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36
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Ogden GR, Wight AJ, Rice P. Effect of alcohol on the oral mucosa assessed by quantitative cytomorphometry. J Oral Pathol Med 1999; 28:216-20. [PMID: 10226944 DOI: 10.1111/j.1600-0714.1999.tb02027.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of alcohol on the oral mucosa was assessed using quantitative cytomorphology applied to smears taken from clinically normal oral mucosa of patients attending an alcohol problem unit and results were compared to a control group (consisting of social and non-drinkers) attending a hospital for routine dental care. Smears were stained using the Papanicolaou method and the nuclear and cell boundaries of 50 randomly selected cells traced and mean areas (NA and CA, respectively) calculated. The average number of units of alcohol consumed were recorded for each group together with relevant blood tests. The alcohol group was further subdivided into "binge" and "regular" drinkers. No significant differences were found between mean NA and mean CA values for these two types of alcohol drinkers, despite a marked difference in weekly units consumed. However, a statistically significant reduction in mean cytoplasmic area (P < 0.001) and mean nuclear area (P < 0.01) was found for the alcohol group when compared to controls. In conclusion, excess alcohol intake may influence results for quantitative oral cytomorphology. Further research is indicated on the relative effects of alcohol (both topical and systemic).
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Affiliation(s)
- G R Ogden
- Unit of Oral Surgery & Medicine, Dundee Dental Hospital & School, University of Dundee, Scotland
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37
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Axford SE, Ogden GR, Stewart AM, Saleh HA, Ross PE, Hopwood D. Fluid phase endocytosis within buccal mucosal cells of alcohol misusers. Oral Oncol 1999; 35:86-92. [PMID: 10211315 DOI: 10.1016/s1368-8375(98)00086-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The structure of the oral mucosa is now well characterised, although studies on oral epithelial cell function have received less attention. The aims of this study were to see whether endocytosis could be demonstrated in cells from oral smears and if so, to assess the effect of chronic high alcohol intake on such uptake. Buccal mucosal smears were collected from 135 patients (91 non- or social drinkers, and 44 patients with harmful alcohol use). Name, age, sex, and alcohol history (for alcohol problem patients) were recorded. Cell suspensions were incubated in a solution of bovine serum albumin (BSA)-coated fluorescently labelled latex microspheres (0.02 micron diameter) in Ham's F-10 culture medium for 1 h at 37 degrees C as a marker of fluid phase endocytosis. Uptake of microspheres was confirmed by confocal microscopy, and mean endocytosed fluorescence levels determined by flow cytometry. A repeat smear from 11 of the alcohol patients was taken 9-14 days later. Endocytosis was significantly reduced in both male (P < 0.01) and female (P < 0.01) alcohol problem patients compared to controls. Units of alcohol consumed and cigarettes smoked per day did not show a dose-response correlation with endocytosis in the alcohol problem patients. Apparent abstinence from alcohol had no further effect on endocytic uptake at days 9-14. This study shows that normal oral squamous cells removed as buccal smears readily endocytose fluorescent microspheres and that this capacity can be affected by alcohol. Chronic high alcohol intake would appear to down regulate endocytosis in buccal cells even up to 14 days of abstinence. This may have implications for the pathogenesis of oral mucosal disorders in long-term users.
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Affiliation(s)
- S E Axford
- Department of Molecular and Cellular Pathology, University of Dundee, Ninewells Hospital and Medical School, Scotland, UK
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38
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Ramaesh T, Mendis BR, Ratnatunga N, Thattil RO. Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma. J Oral Pathol Med 1998; 27:83-6. [PMID: 9526735 DOI: 10.1111/j.1600-0714.1998.tb02099.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa (n = 40); Group 2: lesions with no epithelial dysplasia (n = 58); Group 3: lesions with epithelial dysplasia (n = 27); and Group 4: SCC lesions (n = 51). The mean CD and ND values were: Group 1: 51.78 (+/- 0.11) and 8.36 (+/- 0.49); Group 2: 45.73 (+/- 0.16) and 8.31 (+/- 0.68); Group 3: 41.32 (+/- 0.13) and 9.04 (+/- 0.46); Group 4: 38.58 (+/- 0.11) and 10.10 (+/- 0.56) microns, respectively. Correlation between the ND and CD was positive for Group 1 (r = 0.78, P < 0.05) and Group 2 (r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences (P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different (P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.
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Affiliation(s)
- T Ramaesh
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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39
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Kobayashi TK, Ueda M, Nishino T, Terasaki S, Kameyama T. Brush cytology of herpes simplex virus infection in oral mucosa: use of the ThinPrep processor. Diagn Cytopathol 1998; 18:71-5. [PMID: 9451562 DOI: 10.1002/(sici)1097-0339(199801)18:1<71::aid-dc12>3.0.co;2-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evaluation was made of oral scraping specimen using Cytobrush from 11 patients with clinical suspicious lesions for herpes simplex virus (HSV) infection. In this study, oral brush cytology prepared using an automated smear apparatus (ThinPrep method) has been applied. The smears prepared by ThinPrep are equally well suited for screening purposes, producing highly cellular specimens with well-preserved cytoplasm and nuclei. The results obtained on the 11 patients, four cytologic specimens, showed pathognomonic viral cellular changes of HSV infection. Viral isolation studies were performed on 10 of the 11 patients and ten specimens tested positive for HSV by culture. Of the ten HSV positive isolates, six were positive by either cytology or immunocytochemical staining. Of the two smears showing HSV positive cells, both smears were also confirmed by in situ hybridization (ISH) with a biotinylated clone DNA probe. Using the ICC technique, detection of HSV antigen in oral scraping smears was of great value in the diagnosis of oral HSV infection, especially in cases of equivocal lesions. Oral cytology by means of ThinPrep method obviously deserves additional trials as an adjunct in the cytology of HSV-suspected lesions.
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Affiliation(s)
- T K Kobayashi
- Department of Cytopathology, Saiseikai Shiga Hospital, Imperial Gift Foundation, Inc., Japan
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40
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Abstract
The use of oral exfoliative cytology in clinical practice declined due to the subjective nature of its interpretation and because there may be only a small number of abnormal cells identifiable in a smear. The more recent application of quantitative techniques, together with advances in immunocytochemistry, have refined the potential role of cytology, stimulating a reappraisal of its value in the diagnosis of oral cancer. This review considers the influence of the quantitative analysis of cytomorphology, DNA analysis and other tumour markers applied to oral exfoliative cytological samples. These studies indicate that oral cytology may provide an important adjunct in the assessment of the patient with a potentially cancerous oral lesion.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery & Periodontology, Dental Hospital, University of Dundee, UK
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41
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Brickley MR, Cowpe JG, Shepherd JP. Performance of a computer simulated neural network trained to categorise normal, premalignant and malignant oral smears. J Oral Pathol Med 1996; 25:424-8. [PMID: 8930820 DOI: 10.1111/j.1600-0714.1996.tb00291.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The accurate detection of malignant neoplasms whilst they are still small is recognised as one of the main factors increasing chances of survival. Neural networks have many biomedical applications and they have been applied to neoplasia but their use in oral pathology has only recently been documented. The objectives of this study were to train networks to discriminate between normal and dysplastic mucosa. Each network was trained by back propagation, internal cross validation and tested on additional data. The data were derived by analysing 348 intra-oral smears and included mean nuclear and mean cytoplasmic areas of the smears measured by image analysis. A neural network differentiated between normal/non-dysplastic mucosa and dysplastic/malignant mucosa (specificity 0.82, sensitivity 0.76). These early results suggest that integrating neural networks and image analysis, as well as investigating additional criteria, could enhance automation and accuracy of smear techniques in diagnosing oral malignancy.
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Affiliation(s)
- M R Brickley
- Department of Oral Surgery, Medicine & Pathology, University of Wales College of Medicine, Heath Park, Cardiff, Wales, UK
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42
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Rich AM, Reade PC. Nuclear morphometry in experimental oral mucosal carcinogenesis. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:169-75. [PMID: 8762874 DOI: 10.1016/0964-1955(95)00086-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The area, perimeter and diameter of basal cell nuclei of rat palatal epithelium were measured and the deviation of the basal cell nuclear profile from the form of a sphere was assessed after the application of the carcinogen 4-nitroquinoline-1-oxide (4NQO). After a 24-week treatment-free period, designed to eliminate the irritant effect of the carcinogen, the rats were killed, the palatal mucosa was recovered and processed and the nuclear histometry was assessed with image analysis techniques. The basal cell nuclear area increased as the epithelium became dysplastic and then decreased as carcinoma developed, but there were significant variations in this parameter in the control groups. Basal cell nuclei from moderately or severely dysplastic epithelium, and from epithelium adjacent to areas of invasive carcinoma, were significantly less regular in profile by comparison with control nuclei. Variations in nuclear profile, but not nuclear area, perimeter or diameter, might reflect fundamental nuclear alterations of significance during the process of carcinogenesis.
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Affiliation(s)
- A M Rich
- School of Dental Science, University of Melbourne, Australia
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43
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Sugerman PB, Savage NW, Williams SL, Joynson OB, Daley TJ, Cowpe JG. A quantitative cytological study of lesional and non-lesional mucosa in oral lichen planus. Arch Oral Biol 1996; 41:117-20. [PMID: 8833600 DOI: 10.1016/0003-9969(95)00106-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Smears of buccal mucosa, dorsal surface of the tongue and floor of mouth were taken from 10 patients with histologically confirmed oral lichen planus and 12 healthy age- and sex-matched controls. In buccal smears, no significant differences in cytoplasmic and nuclear areas were observed between lesional, adjacent non-lesional and control tissues. However, the cytoplasmic area in smears from lichen planus lesions on the dorsum of the tongue and adjacent clinically normal mucosa was reduced compared with healthy controls. The cytoplasmic: nuclear ratio in smears from clinically normal floor of mouth in oral lichen planus was similarly reduced. Papanicolaou-stained smears from buccal lichen planus showed increased keratinization compared with normal buccal mucosa. These findings demonstrate that quantitative cytology can detect both cytoplasmic and nuclear changes in oral lichen planus.
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Affiliation(s)
- P B Sugerman
- Oral Biology and Pathology, The University of Queensland, St Lucia, Australia
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44
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Macleod RI, Soames JV. Morphological and morphometric studies of exfoliated oral squames from chronic inflammatory oral ulcers using light and scanning electron microscopy. Br J Oral Maxillofac Surg 1995; 33:86-9. [PMID: 7772592 DOI: 10.1016/0266-4356(95)90205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The morphological and morphometric features of exfoliated squames from the margins of chronic oral ulcers were studied by light and scanning electron microscopy. A variety of features consistent with a mixture of degenerative changes and regenerative activity were observed. None was sufficiently reliable to distinguish chronic inflammatory from malignant ulcers.
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Affiliation(s)
- R I Macleod
- Department of Oral Pathology, Dental School, Newcastle upon Tyne, UK
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45
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Ogden GR, Cowpe JG, Chisholm DM, Lane EB. DNA and keratin analysis of oral exfoliative cytology in the detection of oral cancer. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1994; 30B:405-8. [PMID: 7536508 DOI: 10.1016/0964-1955(94)90020-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Refinements in oral exfoliative cytology may make it a suitable screening technique for the early diagnosis of oral cancer. In this study DNA range profiles were combined with keratin expression in an attempt to improve the diagnostic accuracy of oral exfoliative cytology. Smears were taken from 33 biopsy-proven oral cancers and the contralateral normal site. For DNA range profiles the smears underwent Feulgen hydrolysis, with DNA distribution being assessed using the Vickers M85 microdensitometer. For keratin expression a panel of antikeratin antibodies were applied. The smears for keratin expression were then graded on a three-point scale. Abnormal DNA range profiles were observed in 23 of 33 smears taken from oral cancers and in two smears from normal oral mucosa (sensitivity 70%, specificity 90%, positive predictive value 90%). The simple epithelial keratins 8 and 19 were identified in the majority of oral cancer smears. The sensitivity of keratin 19 was greater (90%). However, keratin 8 was the most useful keratin marker associated with malignancy (sensitivity 62%, specificity 100%, positive predictive value 100%). The combination of simple keratin expression and DNA content improved the cancer detection rate beyond that obtainable with DNA range profile alone.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery and Periodontology, Dental Hospital and School, University of Dundee, U.K
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46
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Ogden GR, Cowpe JG, Chisholm DM, Lane DP. p53 immunostaining as a marker for oral cancer in diagnostic cytopathology--preliminary report. Cytopathology 1994; 5:47-53. [PMID: 8173031 DOI: 10.1111/j.1365-2303.1994.tb00127.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The expression of p53 in oral mucosal disorders is strongly associated with malignant disease. Smears from normal and malignant oral mucosa were investigated for the presence of p53 using CM1 polyclonal antibody against p53 protein. The expression of p53 in smears was compared with the expression of the marker in biopsies from these oral carcinomas. p53 was identified in eight smears from 12 biopsy positive oral cancers. It was not seen in smears from eight p53-negative oral cancers and 40 smears from normal oral mucosa. It is suggested that expression of p53 in smears from a clinically suspicious lesion may be of value in the diagnosis of oral carcinoma.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery and Periodontology, University of Dundee, UK
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47
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Ogden GR, McQueen S, Chisholm DM, Lane EB. Keratin profiles of normal and malignant oral mucosa using exfoliative cytology. J Clin Pathol 1993; 46:352-6. [PMID: 7684404 PMCID: PMC501219 DOI: 10.1136/jcp.46.4.352] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS To assess keratin profiles from smears of malignant and contralateral normal oral mucosa as part of the development of a screening procedure for oral cancer based on exfoliative cytology. METHODS Smears were taken from oral cancers (confirmed by biopsy) and from the contralateral site of 20 patients. Using a panel of antikeratin antibodies, the keratins expressed by these cells were identified using a standard immunocytochemical technique (Vectastain) and assessed on a 3 point scale. RESULTS Using chi 2 analysis, noticeable differences between the keratin profiles for malignant mucosal smears compared with the contralateral mucosal smears were found. This was particularly evident for the simple epithelial keratins. CONCLUSION Individual keratins can be identified in smears from oral cancers. The identification of simple epithelial keratins seem to be the best keratin markers associated with malignancy. Their detection within smears from oral lesions could be valuable in the early diagnosis of oral cancer.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery, University of Dundee
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Cowpe JG, Ogden GR, Green MW. Comparison of planimetry and image analysis for the discrimination between normal and abnormal cells in cytological smears of suspicious lesions of the oral cavity. Cytopathology 1993; 4:27-35. [PMID: 8453015 DOI: 10.1111/j.1365-2303.1993.tb00070.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Light microscope analysis of cytological smears of suspicious lesions of the oral cavity is used as a method for detecting early cancer in the oral cavity. The sensitivity of this approach can be improved by quantitative analysis of the cells in the cytological smears. We have compared the efficiency of planimetry and the Vids V system of image analysis, as quantitative methods for discriminating between normal and abnormal cells in cytological smears of suspicious lesions in the oral cavity. Both methods detected an increase in nuclear area and a decrease in cytoplasmic area in abnormal epithelial cells from dysplastic lesions of increasing severity. However, image analysis was better able to discriminate between benign and malignant cells on the basis of nuclear size. Thus the Vids V system of image analysis is more appropriate than planimetry for quantitative analysis of cytological smears from the oral cavity.
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Affiliation(s)
- J G Cowpe
- Department of Dental Surgery, University of Dundee, UK
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Ogden GR, McQueen S, Lane EB, Green MW, Hopwood D, Chisholm DM. Cytokeratin expression in oral exfoliative cytology: effect of temperature and fixation. THE HISTOCHEMICAL JOURNAL 1992; 24:176-9. [PMID: 1374749 DOI: 10.1007/bf01047468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The identification of keratin expression within oral cytology may be useful in the diagnosis of clinically suspicious oral mucosal lesions. There may be wide variation in the temperature at which such smears are stored, prior to processing. Conventionally, rapid fixation or storage at low temperatures is recommended to preserve kertin expression within tissue biopsies. No previous study has assessed whether this is true for oral cytology. Smears were taken from clinically normal buccal mucosa. For each temperature assessed (-70, -40, -22, +5, +20 and +26 degrees C), one smear was spray-fixed (Vale Smear Fix) and one air-dried, prior to storage for 4 days, and then staining with the pan-epithelial antikeratin antibody, LP34. Preservation of keratin expression was assessed as either weak (zero to few positive cells) or strong (most cells positive). The results were analysed using logistic regression with the statistical modelling package, GLIM. Over the range of temperatures studied, spray fixation did not appear to improve the identification of keratin expression. Although the best preservation was obtained at lower temperatures, keratin expression was still adequate after 4 days at 20 degrees C. Hence, a delay in processing of 4 days would still allow detectable expression in oral exfoliative cytology even at room temperature.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery, Dental Hospital and School, Ninewells Hospital & Medical School, University of Dundee, UK
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Abstract
Four smears were taken from the normal buccal mucosa of 55 oral cancer patients and 76 cancer-free patients. In each case, two were stained by the Papanicolaou method and two underwent Feulgen hydrolysis. Quantitative assessment of nuclear area (NA) and cytoplasmic area (CA) of the Papanicolaou smears was undertaken using a semiautomatic image analysis system. DNA profiles were assessed from the Feulgen smears using a Vickers M85 microdensitometer (Vickers Instruments, York, England) and were found to be diploid for all patients. Results were then analyzed with respect to those patients who took alcohol, tobacco, combination of alcohol and tobacco, and those who took neither. A significant reduction in CA for the oral cancer group (P equals 0.001) but no change in NA (P equals 0.74) was observed. A detailed analysis of alcohol and tobacco habits could identify no significant role for these two factors, in the reduction in cytoplasmic area. Such field change may prove to be of value in predicting the development of second malignant tumors.
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Affiliation(s)
- G R Ogden
- Department of Dental Surgery, Dundee University, Scotland
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