Application of cytology and molecular biology in diagnosing premalignant or malignant oral lesions

Biphasic co-detection of melanoma aneuploid tumor cells and tumor endothelial cells in guidance of specifying the field cancerized surgical excision margin and administering immunotherapy

An optimum safety excision margin (EM) delineated by precise demarcation of field cancerization along with reliable biomarkers that enable predicting and timely evaluating patients' response to immunotherapy significantly impact effective management of melanoma. In this study, optimized biphasic "immunofluorescence staining integrated with fluorescence insitu hybridization" (iFISH) was conducted along the diagnosis-metastasis-treatment-cellular MRD axis to longitudinally co-detect a full spectrum of intact CD31- aneuploid tumor cells (TCs), CD31+ aneuploid tumor endothelial cells (TECs), viable and necrotic circulating TCs (CTCs) and circulating TECs (CTECs) expressing PD-L1, Ki67, p16 and Vimentin in unsliced specimens of the resected primary tumor, EM, dissected sentinel lymph nodes (SLNs) and peripheral blood in an early-stage melanoma patient. Numerous PD-L1+ aneuploid TCs and TECs were detected at the conventional safety EM (2 cm), quantitatively indicating the existence of a field cancerized EM for the first time. Contrary to highly heterogeneous PD-L1 expression and degrees of Chr8 aneuploidy in TCs and TECs in the primary lesions as well as CTCs and CTECs in peripheral blood, almost all TCs and TECs in SLNs and EM were homogeneously PD-L1+ haploid cells. Dynamic monitoring and cellular MRD assessment revealed that, in contrast to PD-L1+ CTCs being responsive to the immune checkpoint inhibitor (ICI-anti-PD-1), multiploid (≥pentasomy 8) PD-L1+ and Ki67+ CTECs were respectively resistant to ICI-sensitized T cells. In therapeutically stressed lymphatic and hematogenous metastatic cascades, stratified phenotypic and karyotypic profiling of iFISH tissue and liquid biopsied TCs, TECs, CTCs and CTECs in future large-cohort studies will enable appropriate re-specification of the optimal safety EM and distribution mapping of in-depth characterized, subcategorized target cells to help illustrate their metastatic relevance, ultimately improving risk stratification and clinical intervention of tumor progression, metastases, therapy resistance and cancer relapse.

Screening of Oral Squamous Cell Carcinoma Through Color Intensity-Based Textural Features

Background Early screening and diagnosis of oral squamous cell carcinoma (OSCC) has always been a major challenge for pathologists. Artificial intelligence (AI)-assisted screening tools can serve as an adjunct for the objective interpretation of Papanicolaou (PAP)-stained oral smears. Aim This study aimed to develop a handy and sensitive computer-assisted AI tool based on color-intensity textural features to be applied to cytologic images for screening and diagnosis of OSCC. Methodology The study included two groups consisting of 80 OSCC subjects and 80 control groups. PAP-stained smears were collected from both groups. The smears were analyzed in Matlab software computed data and color intensity-based textural features such as entropy, contrast, energy, homogeneity, and correlation, were quantitatively extracted. Results In this study, a statistically significant difference was noted for entropy, energy, correlation, contrast, and homogeneity. It was found that entropy and contrast were found to be higher with a decrease in homogeneity, correlation, and energy in OSCC when compared to the control group. Receiver operating characteristic curve analysis was done and accuracy, sensitivity, and specificity were found to be 88%, 91%, and 81%, respectively. Conclusion The gray-level co-occurrence matrix (GLCM) color intensity-based textural features play a significant role in differentiating dysplastic and normal cells in the diagnosis of OSCC. Computer-aided textural analysis has the potential to aid in the early detection of oral cancer, which can lead to improved clinical outcomes.

OralImmunoAnalyser: a software tool for immunohistochemical assessment of oral leukoplakia using image segmentation and classification models

Oral cancer ranks sixteenth amongst types of cancer by number of deaths. Many oral cancers are developed from potentially malignant disorders such as oral leukoplakia, whose most frequent predictor is the presence of epithelial dysplasia. Immunohistochemical staining using cell proliferation biomarkers such as ki67 is a complementary technique to improve the diagnosis and prognosis of oral leukoplakia. The cell counting of these images was traditionally done manually, which is time-consuming and not very reproducible due to intra- and inter-observer variability. The software presently available is not suitable for this task. This article presents the OralImmunoAnalyser software (registered by the University of Santiago de Compostela-USC), which combines automatic image processing with a friendly graphical user interface that allows investigators to oversee and easily correct the automatically recognized cells before quantification. OralImmunoAnalyser is able to count the number of cells in three staining levels and each epithelial layer. Operating in the daily work of the Odontology Faculty, it registered a sensitivity of 64.4% and specificity of 93% for automatic cell detection, with an accuracy of 79.8% for cell classification. Although expert supervision is needed before quantification, OIA reduces the expert analysis time by 56.5% compared to manual counting, avoiding mistakes because the user can check the cells counted. Hence, the SUS questionnaire reported a mean score of 80.9, which means that the system was perceived from good to excellent. OralImmunoAnalyser is accurate, trustworthy, and easy to use in daily practice in biomedical labs. The software, for Windows and Linux, with the images used in this study, can be downloaded from https://citius.usc.es/transferencia/software/oralimmunoanalyser for research purposes upon acceptance.

A novel regulatory sex-skewing method that inhibits testicular DPY30 expression to increase female rate of dairy goat offspring

The demand for goat milk products has increased exponentially with the growth of the global population. The shortage of dairy products will be addressed extraordinarily by manipulating the female rate of goat offspring to expand the goat population and goat milk yield. No studies have reported bioinformatic analyses of X- and Y-bearing sperm of dairy goats, although this will contribute to exploring novel and applied sex-skewing technologies. Regulatory subunit of the histone methyltransferase complex (DPY30) was determined to be the key differentially expressed protein (DEP) among 15 DEPs identified in the present study. The spatiotemporal expression of DPY30 strongly suggested a functional involvement of the protein in spermatogenesis. DPY30 promoted meiosis via upregulating SYCP3, which played a crucial role in mediating sex ratio skewing in goats. Although DPY30 suppressed the self-renewal of spermatogonia stem cells through AKT/PLZF, DPY30 inhibition in the testis did not induce testicular dysgenesis. Based on the biosafety assessment in mice testes, lentivirus-mediated DPY30 knockdown in bucks' testes increased X-bearing sperm proportion and female kids' rate (22.8 percentage points) without affecting sperm quality, pregnancy rate, and kidding rate. This study provides the first evidence of the DEGs in the sexed sperm of dairy goats. DPY30 inhibition in the testes of bucks increased the female kids' rate without influencing reproductive performance. The present study provides evidence for expanding the female dairy goat population to address the concern of dairy product shortage.

TIE-GANs: single-shot quantitative phase imaging using transport of intensity equation with integration of GANs

Significance

Artificial intelligence (AI) has become a prominent technology in computational imaging over the past decade. The expeditious and label-free characteristics of quantitative phase imaging (QPI) render it a promising contender for AI investigation. Though interferometric methodologies exhibit potential efficacy, their implementation involves complex experimental platforms and computationally intensive reconstruction procedures. Hence, non-interferometric methods, such as transport of intensity equation (TIE), are preferred over interferometric methods.

Aim

TIE method, despite its effectiveness, is tedious as it requires the acquisition of many images at varying defocus planes. The proposed methodology holds the ability to generate a phase image utilizing a single intensity image using generative adversarial networks (GANs). We present a method called TIE-GANs to overcome the multi-shot scheme of conventional TIE.

Approach

The present investigation employs the TIE as a QPI methodology, which necessitates reduced experimental and computational efforts. TIE is being used for the dataset preparation as well. The proposed method captures images from different defocus planes for training. Our approach uses an image-to-image translation technique to produce phase maps and is based on GANs. The main contribution of this work is the introduction of GANs with TIE (TIE:GANs) that can give better phase reconstruction results with shorter computation times. This is the first time the GANs is proposed for TIE phase retrieval.

Results

The characterization of the system was carried out with microbeads of 4    μ m size and structural similarity index (SSIM) for microbeads was found to be 0.98. We demonstrated the application of the proposed method with oral cells, which yielded a maximum SSIM value of 0.95. The key characteristics include mean squared error and peak-signal-to-noise ratio values of 140 and 26.42 dB for oral cells and 100 and 28.10 dB for microbeads.

Conclusions

The proposed methodology holds the ability to generate a phase image utilizing a single intensity image. Our method is feasible for digital cytology because of its reported high value of SSIM. Our approach can handle defocused images in such a way that it can take intensity image from any defocus plane within the provided range and able to generate phase map.

Diagnosis of Oral Cancers by Targeting VPAC Receptors: Preliminary Report

INTRODUCTION

Oral cancer is a major health problem. The study of exfoliative cytology material helps in the differentiation of premalignant and malignant alterations of oral lesions. The objective of this study was to assess the feasibility of detecting oral cancer by targeting genomic VPAC (combined vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide) receptors expressed on malignant oral cancer cells.

PATIENTS & METHODS

All patients with suspected oral cavity cancers/lesions formed the study group. The samples from the oral cavity lesion or suspicious area were collected with a cytology brush. The harvested material was examined for malignant cells by 1. the standard PAP stain and 2. targeting the VPAC receptors on the cell surface using a fluorescent microscope. Similarly, malignant cells were identified from cells shed in oral gargles.

RESULTS

A total of 60 patients with oral lesions were included in the study. The histopathological diagnosis was squamous cell carcinoma in 30 of these. The VPAC receptor positivity both on the brush cytology staining as well oral gargle staining was more sensitive than the brush cytology PAP staining. The accuracy of the various techniques was as follows, brush cytology PAP staining at 86.67%, brush cytology VPAC staining at 91.67% and oral gargle VPAC staining at 95%.

CONCLUSIONS

This preliminary study validates our belief that malignant cells in the saliva can be identified by targeting the VPAC receptors. The test is simple, easy, non-invasive and reliable in the detection of oral cancers.

The comparative evaluation of CK17 expression in histologic and cytological sections of oral squamous-cell carcinoma using immunohistochemistry

BACKGROUD

Squamous-cell carcinoma of the mouth accounts for 90% of all oral cancers and despite advances in treatment methods, its 5-year survival rate is reported to be about 68%. This is due to the late diagnosis of the disease and its resistance to radiotherapy and chemotherapy treatments. One of the methods for diagnosing oral lesions is exfoliative cytology, which is a noninvasive method and can be easily carried out in a dental office.

AIM

The purpose of this study is to find a method that in addition to being fast, accurate and less aggressive has high value and a good degree of accuracy for diagnosis of oral squamous-cell carcinoma.

MATERIALS AND METHODS

In this descriptive-analytical study, 14 patients who were diagnosed with oral squamous-cell carcinoma and 14 specimens from exfoliative cytology of the same tissue before surgery were examined. Immunohistochemically stained specimens were examined by two pathologists simultaneously. Next, five nonoverlapping sections with magnification (×400) and the number of cells stained with the cytokeratin marker 17 are counted and the average percentage of each slide is determined. One-sample t-test is used to analyze the data and significance level in tests is considered 0.05.

RESULTS

In examining the diagnostic value of cytology, we concluded that out of 280 affected cells, 211 cells were stained. Therefore, the sensitivity of cytology in the diagnosis of squamous-cell carcinoma of the mouth is 75.4%. In other words, cytology correctly identifies 75.4% of affected cells as affected. Also, the positive predictive value of cytology was 100%.

Current advances in noninvasive methods for the diagnosis of oral squamous cell carcinoma: a review

Oral squamous cell carcinoma (OSCC), one of the most common types of cancers worldwide, is diagnosed mainly through tissue biopsy. However, owing to the tumor heterogeneity and other drawbacks, such as the invasiveness of the biopsy procedure and high cost and limited usefulness of longitudinal surveillance, there has been a focus on adopting more rapid, economical, and noninvasive screening methods. Examples of these include liquid biopsy, optical detection systems, oral brush cytology, microfluidic detection, and artificial intelligence auxiliary diagnosis, which have their own strengths and weaknesses. Extensive research is being performed on various liquid biopsy biomarkers, including novel microbiome components, noncoding RNAs, extracellular vesicles, and circulating tumor DNA. The majority of these elements have demonstrated encouraging clinical outcomes in early OSCC detection. This review summarizes the screening methods for OSCC with a focus on providing new guiding strategies for the diagnosis of the disease.

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

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

Evaluation and Comparison of Genomic DNA Extraction Methods and PCR Optimization on Archival Formalin-Fixed and Paraffin-Embedded Tissues of Oral Squamous Cell Carcinoma

Recovery and amplification of nucleic acids from archived formalin-fixed tissue samples is the most developing field in retrospective genetic studies. We compared different deparaffinization methods and DNA isolation techniques, and intergroup comparisons were performed to evaluate the effectiveness of different storing methods for archival OSCC samples based on obtained mean DNA quantity, quality, and PCR amplification of the P53 gene. The study comprised 75 archival histologically diagnosed OSCC samples which were divided into Group I: Formalin-fixed paraffin-embedded tissue blocks and Group II: Long-term formalin-fixed tissue. A comparison of different deparaffinization methods showed that xylene deparaffinization is an efficient method to obtain suitable DNA. Comparing different DNA isolation techniques illustrated that the conventional phenol–chloroform method gives better integrity to DNA in contrast with the kit method. Comparison between FFPET and long-term FFT samples demonstrated that samples fixed in formalin overnight and embedded in wax yield better quality and quantity DNA in comparison with long-term samples fixed in formalin. To obtain suitable integrity of DNA, tissue samples should be stored by fixing in formalin overnight followed by preparation of paraffin tissue blocks, deparaffinization by xylene, and subjecting them to the conventional phenol–chloroform DNA isolation protocol.

Classification of cytological samples from oral potentially malignant lesions through Raman spectroscopy: A pilot study

The potential of Raman microspectroscopy of exfoliated cells has been demonstrated for oral cancer diagnosis. In this study, brush biopsies were collected from the buccal mucosa/tongue of healthy donors (n = 31) and from oral mucosal dysplastic lesions (n = 31 patients). Raman spectra were acquired and subjected to partial least squares-discriminant analysis (PLS-DA). The patient samples could be differentiated from healthy donor samples with 96% sensitivity and 95% specificity. Furthermore, PLS-DA models were developed based on cytopathological and histopathological assessment. Low and high grade dysplasia could be discriminated with 64% sensitivity and 65% specificity based on cytopathological assessment, while 81% sensitivity and 86% specificity could be achieved when histopathological assessment was within six months of the brush biopsy sampling. Therefore, this explorative study has successfully demonstrated that Raman spectroscopy may have a role in monitoring patients with dysplasia and may reduce the need for multiple biopsies.

Cytomorphometric analysis of squames obtained from normal mucosa, leukoplakia and oral squamous cell carcinoma

Introduction

Exfoliative cytology is becoming increasingly important in the early diagnosis of oral cancers, as a procedure for obtaining cell samples, which can be analyzed by sophisticated diagnostic techniques. Quantitative techniques, based on the evaluation of parameters such as nucleus area, cytoplasm area and nucleus-to-cytoplasm area ratio, may increase the sensitivity of exfoliative cytology for early diagnosis of oral cancers, since these techniques are precise, objective and reproducible.

Objectives

This study was undertaken to employ the cytomorphometric quantitative techniques to determine the value of exfoliative cytology and to assess this method to analyze the effectiveness in providing additional diagnostic test for the detection of early oral malignancy.

Materials and Methods

The study consisted of three groups. The experimental group comprised of 20 subjects with oral leukoplakia and 20 subjects with oral squamous cell carcinoma of the buccal mucosa. The control group comprised of 10 apparently healthy subjects. They were subjected to clinical examination and cytosmear of the buccal mucosa. A standard wooden tongue spatula/metal spatula moistened with normal saline was used to obtain scrapings of buccal mucosa. The scrapings were spread on plain glass slides and immediately fixed in Biofix spray, followed by staining with the Papanicolaou technique. Then, the microscopic pictures were captured onto a computer and are cytomorphometrically analyzed using an image analyzer. Since this study involved multiple groups, one-way analysis of variance (ANOVA) was used for comparing the parameters for multiple groups. Where significant difference was seen, the ANOVA test was followed by Mann-Whitney test, for pairwise comparison.

Results

The mean count of nuclear area and nuclear diameter showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of cell area and cell diameter showed a decrease from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of nuclear/cytoplasm area ratio showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant.

Conclusion

With the advancements in the field of quantitative exfoliative cytology, interest in oral cytology has once again emerged in the diagnosis of oral premalignancy and malignancy. Computer-aided analysis with the sophisticated software increases the speed and accuracy of cytological measurements, which are repeatable. These versatile systems facilitate quantitative oral cytological assessments, which may become a viable procedure for the early detection of oral premalignancy and malignancy.

Oral mucosa changes associated with chronic oral and inhalation exposure to 2,4-dichlorophenoxiacetic acid (2,4-D) in Wistar rats

The respiratory tract and the oral mucosa are the first areas contaminated by pesticides. The herbicide dichlorophenoxyacetic acid (2,4-D) is a widely used pesticide across the world for both crops and gardens. The aim of this study was to evaluate oral mucosal damage after an experimental simulation of chronic oral and inhalational environmental exposure to 2,4-D formulation. Eighty male Wistar rats were exposed to three distinct concentrations of 2,4-D formulation (low-187.17 mg/m3; medium-313.31 mg/m3; and high-467.93 mg/m3). Oral exposure (through contaminated feed) or inhalation exposure lasted 6 months. Rat tongues were collected for cyto- and histopathology. There was a difference between exposure groups in the intensity of tissue congestion. Most rats exposed to 2,4-D presented mucosal inflammation at both cytology and histology (P < 0.05). Hyperkeratosis only occurred in rats exposed orally at the high concentration. There was an increase in the number of nucleoli-organizing regions in the dorsal epithelium as the 2,4-D concentration increased (P < 0.001). The inhalation route was more associated with increased mitosis figures and nucleoli-organizing region count (P < 0.05). Chronic oral and inhalation exposure to high concentrations of 2,4-D formulation caused an increase in the proliferation rate and thickness of the tongue epithelium and stimulated the inflammatory response in the tissue.

Comparative analysis of nucleomorphometric parameters in methyl green-pyronin-stained sections of oral epithelial dysplasia, oral submucous fibrosis and oral squamous cell carcinoma

Context:

The diagnosis and grading of epithelial dysplasia is based on a combination of architectural and cytological changes. A gradual increase in quantitative DNA aberrations has been found to correlate with increasing degree of dysplasia in oral mucous membranes.

Aims:

The aim of this study is to assess nuclear parameters in potentially malignant and malignant lesions of the oral cavity and to assess cytomorphometric changes in the nucleus and nucleolus in oral epithelial dysplasia (OED), oral submucous fibrosis (OSMF), oral squamous cell carcinoma (OSCC) and normal oral mucosa using methyl green-pyronin staining to determine its suitability for detecting potentially malignant lesions and the stage of carcinogenesis.

Methods:

Forty-five archival sections of OED, OSMF and OSCC and 5 cases of normal oral mucosa as the control group were stained according to methyl green-pyronin-staining protocol. Cytomorphometric parameters such as nuclear diameter, nucleolar diameter, number of nucleoli and cytoplasmic RNA were assessed.

Statistical Analysis Used:

The study was subjected to statistical analysis to evaluate the association between morphometric parameters using analysis of variance test, followed by Bonferroni's post hoc analysis.

Results:

A progressive increase in the nuclear parameters as well as cytoplasmic RNA content was observed between normal mucosa through dysplasia and OSMF to OSCC.

Conclusion:

This study serves as an effective diagnostic aid in assessing nuclear parameters in potentially malignant and malignant epithelial lesions affecting oral cavity.

Comparison of the Efficacy of Sediment Cytology over Oral Brush Cytology in Oral Leukoplakia

INTRODUCTION

A method called sediment cytology includes the investigation of smears arranged from the sediment of the biopsy specimen fixatives. The sediment from this fixative is used to prepare smears and provides a potentially rich source for cytological material. Investigation of the fixative sediment and understanding of the cytological picture with pertinent clinical and radiological information permits diagnosis in a few hours.

AIM

To evaluate the diagnostic efficacy of sediment cytology and oral brush cytology compared with histopathological findings in oral leukoplakia (OL) cases.

METHODS

Cytological smears were obtained from 30 clinically diagnosed OL lesions using 2 techniques: oral cytobrush and 10% formalin fixative sedimentation. Both smears were stained with Papanicolaou. Cytological smear evaluation was conducted with respect to cellularity, cell distribution, cellular clumping, and the presence of blood, debris, inflammatory cells, and microbial colonies. The cytopathological scores for all cases were compared between sediment and brush cytology and correlated with the histopathological diagnosis. For statistical analysis, the κ test and the Wilcoxon matched-pair test were used.

RESULTS

The cytobrush technique had a sensitivity of 83.3% for OL cases histopathologically diagnosed as severe dysplasia, while the sediment cytology technique had a sensitivity of 16.6%. For moderate/mild dysplasia cases, the cytobrush technique had a sensitivity of 7.7%, whereas the sediment technique showed no diagnostic sensitivity.

CONCLUSION

Based on the results from the present study, sediment cytology, unlike oral brush cytology, is not a useful screening tool for the preliminary diagnosis of potentially malignant oral lesions.

Application of in vivo stain of methylene blue as a diagnostic aid in the early detection and screening of oral cancerous and precancerous lesions

Background:

Periodic clinical examination of the oral cavity is the mainstay for the early detection of oral cancers which can be further aided by screening individuals with high-risk factors that will identify candidates who should receive treatment to prevent cancer progression and reduce patient mortality. Among the diagnostic tools, in vivo staining is advocated as a simple, inexpensive and fairly sensitive method.

Materials and Methods:

The present study involved the examination of fifty patients suspected of oral malignant or precancerous lesions by methylene blue staining. The results of methylene blue uptake were compared with a simultaneous biopsy of these lesions, while benign epithelial lesions were included as the negative subjects of screening.

Results:

The results revealed a sensitivity of 89%, a specificity of 91%, a positive predictive value of 97% and a negative predictive value of 73%.

Conclusion:

We recommend that methylene blue staining is a useful diagnostic adjunct in a large, community-based oral cancer screening program for high-risk individuals.

Cytological changes in oral mucosa induced by smokeless tobacco

INTRODUCTION

This study investigated the cellular changes in the mouth of smokeless tobacco (shamma) users among Saudi citizens from the Najran region.

METHODS

Healthy 61 shamma users and healthy 61 non-users participated in this study after informed consent. A mouth swap was taken from each study subject and investigated for cellular changes using a Papanicolaou stain. The results were analyzed using the t-test per cent of the StatPac statistical program.

RESULTS

Keratinization, binucleation and combined results were associated with shamma use. The number of shamma users with abnormal histology was 14 (22.9%) (p≤0.0001). The shamma types associated with the abnormal cytology were: Suhaily (9/36; p=0.0014), black (2/9; p=0.08), white (2/6; p=0.41), and red (1/1; p=1.00). The percentage of the tissues with abnormal histology decreased with the increase in the duration and frequency of smokeless tobacco use, except for the white shamma which increased with the increase in the frequency.

CONCLUSIONS

Shamma use affected the mouth epithelial cytology of 22.9% of its users. The histological changes were inflammation, keratinization, binucleation, and atypia. The Suhaily smokeless tobacco was associated with the highest percentage of the abnormal cytology results, while the duration and frequency of smokeless tobacco use decreased the number of tissues with abnormal histology.

Role of Single-Agent Methotrexate as a Neoadjuvant Chemotherapy in Oral Cavity Cancers

Oral cancers are the most common cancer in India due to tobacco abuse in the form of chewing, smoking, and inhalation. Majority of these patients present late at advanced disease stage. Such patients have significant morbidity irrespective of the intent of treatment; the survival rate is very poor. To improve loco-regional control and survival, neoadjuvant chemotherapy has been started in many centers all over the world. To study the effect of injecting methotrexate as a single agent in (1) down-staging and increasing operability of oral cancers, (2) need for reconstructive surgery, and (3) recurrence. A total of 50 patients with biopsy-proven oral malignancy were selected over a period of 2 years from August 2014 to August 2016 for the study. Patients were subjected to weekly dose of injecting methotrexate 1 mg/kg given intravenously for 6 weeks. All patients underwent surgery after completing 6 cycles of methotrexate. A total 50 patients were started on inj. methotrexate of which 9 patients did not complete neoadjuvant chemotherapy. 53.7% of patients showed more than 50% decrease in tumor size. 29.26% of patients showed complete disappearance of cervical lymph nodes and 31.7% of patients showed more than 50% decrease in size of cervical lymph nodes. 48.78% of patients were managed with wide local excision with primary closure, decreasing the need of reconstructive surgery. 94.74% of patients did not show any recurrence in follow-up period of 1 year. Single agent methotrexate is effective in down-staging oral cancers, improving operability and decreasing morbidity and recurrence among patients.

Toward early diagnosis of oral cancer: Diagnostic utility of cytomorphological features, a pilot study

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.

Diagnosis of oral lichen planus from analysis of saliva samples using terahertz time-domain spectroscopy and chemometrics

The ability to diagnose oral lichen planus (OLP) based on saliva analysis using THz time-domain spectroscopy and chemometrics is discussed. The study involved 30 patients (2 male and 28 female) with OLP. This group consisted of two subgroups with the erosive form of OLP (n  =  15) and with the reticular and papular forms of OLP (n  =  15). The control group consisted of six healthy volunteers (one male and five females) without inflammation in the mucous membrane in the oral cavity and without periodontitis. Principal component analysis was used to reveal informative features in the experimental data. The one-versus-one multiclass classifier using support vector machine binary classifiers was used. The two-stage classification approach using several absorption spectra scans for an individual saliva sample provided 100% accuracy of differential classification between OLP subgroups and control group.

The challenge of the approach to oral cancer in primary health care

The aim of this study was to understand the performance of dentists in public health about mouth cancer. A cross-sectional study was performed whit 121 dentists from Fortaleza Health Department, interviewed through a semi-structured questionnaire. The study did not identify statistically significant difference regarding the ability to perform biopsy by gender, year of graduation, expertise or time of public service. Only 22 professionals (18.2%) reported being able to perform biopsies and 13 (10.7%) would do so at the Family Health Unit. The reference and counter-reference system, by including another stage in patient care, increase the possibility of absenteeism from patient to health service. Although clearly identify the relevance of oral cancer mortality in the population, the vast majority of dentists is not equipped to perform the biopsy as a routine activity. Whereas the vast majority of biopsies of the oral tissues is performed as an outpatient, low technological complexity to perform the procedure and the effectiveness of biopsy in the early diagnosis of oral cancer, it is essential to hold this procedure in primary care, what can effectively contribute to decreasing mortality from oral cancer.

Immunoexpression of programmed cell death 4 protein in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma

Background:

Oral squamous cell carcinoma (OSCC) is the frequently reported cancer of the head and neck. Recent studies are being conducted to evaluate the role of potential markers for diagnosing the stages of development of OSCC from normal cells.

Aim:

The aim of this study is to evaluate and compare the immunoexpression of programmed cell death 4 (PDCD4) protein in normal oral mucosa, oral epithelial dysplasia (OED) and OSCC.

Materials and Methods:

Histologically diagnosed, formalin-fixed paraffin-embedded archived cases (n = 100) of normal mucosa (n = 10), OED (n = 60) and OSCC (n = 30) were analyzed immunohistochemically in the present retrospective study using monoclonal rabbit antihuman PDCD4. OED and squamous cell carcinoma were graded according to the World Health Organization and Broder's histological grading criteria, respectively. Clinical parameters and immunohistochemical results were analyzed by Fisher exact test using SPSS software. P <0.05 was indicative of significant differences.

Results:

PDCD4 expression was observed in the normal oral mucosa, OED and OSCC. The maximum expression was observed in the normal oral mucosa, which reduced significantly in OED and OSCC (P = 0.017). With the increase in the transformation from normal cells to cancer cells, a shift from nuclear to cytoplasmic staining was observed indicating predominant cytoplasmic localization of stain as a feature of altered cells.

Conclusion:

The present study delineates the molecular difference between the normal, dysplastic and carcinomatous cells; and points toward the role of PDCD4 localization in the proliferation of cells. This study thus highlights the need for further research with inclusion of long follow-up period and other pathological criteria such as inflammation and microenvironment, immune status of patient and tumor stage, which could aid in the development of prospective diagnostic options.

Oral Brush Liquid-Based Cytology: A Study of Concordance between a Cytotechnologist and a Cytopathologist

OBJECTIVE

Oral cancer accounts for almost 40% of all cancers in the Indian subcontinent. Techniques like oral scrape cytology are helpful in early diagnosis of premalignant lesion and thus prevention of malignant transformation. The purpose of this study is to evaluate the performance of cytotechnologists in assessing the adequacy and preliminary diagnostic accuracy of oral brush liquid-based cytology.

STUDY DESIGN

110 oral brush liquid-based cytology smears were prospectively screened by a cytotechnologist for adequacy assessment, and a preliminary diagnosis was recorded. Smears were subsequently studied by the reporting cytopathologist for the final diagnosis. The performance of the cytotechnologist in the assessment of adequacy and the preliminary diagnosis were compared with the final interpretation rendered by the cytopathologist.

RESULTS

There was no significant difference in adequacy assessment between both observers, and good concordance was observed in the identification of frankly malignant lesions; however, in premalignant cases, complete agreement in all the cases was not observed. Maximum numbers of discrepant cases were seen in high-grade squamous intraepithelial lesions, 4/17 were downgraded to low-grade squamous intraepithelial lesions and 2/17 to negative for intraepithelial lesion or malignancy, respectively.

CONCLUSION

Trained cytotechnologists are capable of assessing the adequacy and identifying the malignancy in oral brush liquid-based cytology smears, and hence there is potential for them to perform initial screening of such cases.

Serum-based diagnostic prediction of oral submucous fibrosis using FTIR spectrometry

Oral submucous fibrosis (OSF) is found to have the highest malignant potentiality among all other pre-cancerous lesions. However, its detection prior to tissue biopsy can be challenging in clinics. Moreover, biopsy examination is invasive and painful. Hence, there is an urgent need of new technology that facilitates accurate diagnostic prediction of OSF prior to biopsy. Here, we used FTIR spectroscopy coupled with chemometric techniques to distinguish the serum metabolic signatures of OSF patients (n=30) and healthy controls (n=30). Serum biochemical analyses have been performed to further support the FTIR findings. Absorbance intensities of 45 infrared wavenumbers differed significantly between OSF and normal serum FTIR spectra representing alterations in carbohydrates, proteins, lipids and nucleic acids. Nineteen prominent significant wavenumbers (P≤0.001) at 1020, 1025, 1035, 1039, 1045, 1078, 1055, 1100, 1117, 1122, 1151, 1169, 1243, 1313, 1398, 1453, 1544, 1650 and 1725cm^-1 provided excellent segregation of OSF spectra from normal using multivariate statistical techniques. These findings provided essential information on the metabolic features of blood serum of OSF patients and established that FTIR spectroscopy coupled with chemometric analysis can be potentially useful in the rapid and accurate preoperative screening/diagnosis of OSF.

Yoga as an Integrative Approach for Prevention and Treatment of Oral Cancer

Despite tremendous advancements in medicine, the number of oral cancer cases continues to increase, and the need for integrating alternate medicine or adopting an integrative approach has become a compelling cost-effective requirement for the management and treatment of diseases. Conventional treatment of oral cancer involves surgery followed by radiotherapy with or without chemotherapy which causes several complications including poor quality of life and high chances of recurrence of cancer. Oral cancer is often linked with obesity which is major risk factors in other cancers. Apart from obesity, oral cancer is thought to have an inverse relation with neurodegenerative disorders presumably because cell death decreases in the former case and increases in the latter. Ancient mind-body techniques such as yoga have not been adequately tested as a tool to synergize the cellular equilibrium pertaining to the treatment of oral cancer. Nerve growth factor (NGF), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) are among the early experimental cellular biomarkers that may be used to probe the modulation of oral cancer, obesity, and neurodegenerative disorders. Yoga has been reported to influence these molecules in healthy individuals but whether their expression can be altered in patients of oral cancer by yoga intervention is the subject of this research being discussed in this review article. Therefore, the present article not only reviews the current status of research studies in oral cancer, obesity, and neurodegenerative disorders but also how these are linked to each other and why the investigations of the putative NGF pathway, involving TNF-α and IL-6, could provide useful clues to understand the molecular effects brought about by yoga intervention in such patients.

Analysis of silver binding nucleolar organizer regions in exfoliative cytology smears of potentially malignant and malignant oral lesions

Nucleolar organizer regions are nucleolar components that contain proteins that are stained selectively by silver methods; they can be identified as black dots throughout the nucleolus and are known as silver binding nucleolar organizer regions (AgNOR). The number of AgNOR is related to the cell cycle and the proliferative activity of the cells. We investigated AgNOR using exfoliative cytology smears of potentially malignant oral lesions. Eighty individuals were divided into four equal groups: healthy controls, oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. The mean number of AgNOR in each study group gradually increased from control to oral leukoplakia to oral submucous fibrosis to oral squamous cell carcinoma. The proliferative index was increased in the oral premalignant and malignant patients compared to normal subjects. The mean AgNOR size gradually increased from control to oral leukoplakia to oral submucous fibrosis to oral squamous cell carcinoma. Spherical shaped AgNOR were most common in controls, whereas large, clustered and kidney shapes were most common in oral squamous cell carcinoma. Multiparameter analysis of AgNOR in oral exfoliative smears is a simple, sensitive and cost-effective method for differentiating premalignant from malignant lesions and can be used in conjunction with routine cytomorphological evaluation.

Liquid-based versus conventional cytology of oral brush biopsies: a split-sample pilot study

OBJECTIVE

The aim of this prospective split sample study was to evaluate the applicability of liquid-based cytology (LBC) of oral brush biopsies for detection of oral cancer.

METHODS

Two different preparation techniques were investigated: the conventional transfer procedure to glass slides and the LBC preparation method. The obtainments of epithelial cells were performed five times with a nylon brush and transferred onto five glass slides. Additionally, the brushes, which were normally discarded, were stored in a fixative solution. Conventional slides and respective thin layers from a total of 113 cases were reviewed with both techniques.

RESULTS

Thin layers showed excellent morphology on a clear background, which allowed an accurate diagnosis. In contrast, the conventional glass slides showed significantly more blood contamination and cell overlapping. The sensitivity of conventional cytological diagnosis was 96.3%, the specificity archived 90.6%, the positive predictive value was 96.3% and the negative predictive value scored 90.6%. The sensitivity of the cytological diagnosis using thin layers archived 97.5%, the specificity was 68.8%, the positive predictive value revealed 88.76% and negative predictive value was 91.7%.

CONCLUSION

Our findings indicate that in oral cytology, LBC may replace other types of wet-fixed preparations using the full amount of collected cells, resulting in enhanced specimen quality archiving comparable values of diagnostic accuracy.

CLINICAL RELEVANCE

LBC facilitates the cell collection due to simpler handling and less transfer errors by dentists and may improve the overall diagnostic accuracy of oral brush biopsies in future.

Improvization of conventional cytology by centrifuged liquid-based cytology in oral exfoliative cytology specimen

BACKGROUND

Exfoliative cytology is the microscopic examination of shed or desquamated cells from the epithelial surface. Centrifuged liquid-based cytology (CLBC) is a modified technique that was used in the current study.

AIMS

To compare the efficacy of CLBC with conventional cytology in apparently normal mucosa after staining with Papanicolaou (PAP) stain.

MATERIALS AND METHODS

Fifty cases of apparently normal mucosa from healthy subjects were selected for the study. The first sample was taken and spread on the slide by the conventional technique. The second sample was flushed out in a suspending solution, centrifuged, and the cell pellet obtained was used to make the smear. The stained smears were compared for seven parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, cellular elongation, mucus, and inflammatory cells. Chi-square test was used for statistical analysis and P ≤ 0.05 was considered to be statistically significant.

RESULTS

There was a statistically significant difference between CLBC and conventional cytology with parameters such as adequate cellularity (P = 0.001), clear background (P = 0.001), uniform distribution (0.005), cellular overlapping, and cellular elongation (P = 0). The presence of mucus and inflammatory cells was minimal as the samples were collected from healthy subjects.

CONCLUSION

CLBC has better efficacy over the conventional method in all the parameters analyzed.

Evaluation of p16 hypermethylation in oral submucous fibrosis: A quantitative and comparative analysis in buccal cells and saliva using real-time methylation-specific polymerase chain reaction

Aims:

The aim of this study was to quantitatively investigate the hypermethylation of p16 gene in buccal cells and saliva of oral submucous fibrosis (OSMF) patients using real-time quantitative methylation-specific polymerase chain reaction (PCR) and to compare the values of two methods.

Subjects and Methods:

A total of 120 samples were taken from 60 subjects selected for this study, of which 30 were controls and 30 patients were clinically and histopathologically diagnosed with OSMF. In both groups, two sets of samples were collected, one directly from the buccal cells through cytobrush technique and the other through salivary rinse. We analyzed the samples for the presence of p16 hypermethylation using quantitative real-time PCR.

Results:

In OSMF, the hypermethylation status of p16 in buccal cells was very high (93.3%) and in salivary samples, it was partially methylated (50%). However, no hypermethylation was found in controls suggesting that significant quantity of p16 hypermethylation was present in buccal cells and saliva in OSMF.

Conclusions:

This study indicates that buccal cell sampling may be a better method for evaluation than the salivary samples. It signifies that hypermethylation of p16 is an important factor to be considered in epigenetic alterations of normal cells to oral precancer, i.e. OSMF.

Evaluation of Various Nuclear Cytological Changes in Normal Buccal Mucosa and Peritumoural Area in Patients with Oral Squamous Cell Carcinoma Receiving Concomitant Chemoradiotherapy

Objectives. To evaluate the role of serial cytological assay in calculating the nuclear response of contralateral normal buccal mucosa and peritumoural area of squamous cell carcinoma of oral cavity in patients receiving fractionated radiotherapy (RT) and chemotherapy. Materials and Methods. This prospective, nonrandomized study was comprised of 76 histologically confirmed cases of oral squamous cell carcinoma on cyclical chemoradiation treatment. Chemoradiosensitivity was evaluated using serial scrape smears taken before and after immediate exposure to CCRT, at 17th day of CCRT (mid of treatment), and at the end of treatment. The nuclear changes, such as multinucleation, micronucleation, karyorrhexis, karyolysis, nuclear budding, prominent nucleoli, and binucleation occurring in both irradiated cancer cells and contralateral normal buccal mucosa, had a statistically significant dose related increase with concomitant chemoradiotherapy (p < 0.05). Conclusion. We recommend regular use of serial cytological assay during CCRT as it may prove to be a valuable tool for assessment of chemoradiosensitivity and persistence of tumour/dysplastic cells after radiotherapy.

Comparative cytomorphometric analysis of oral mucosal cells in normal, tobacco users, oral leukoplakia and oral squamous cell carcinoma

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.

Evaluation of brush cytology and DNA image cytometry for the detection of cancer of the oral cavity

BACKGROUND

Cancer of the oral cavity is the sixth most common malignancy reported worldwide. This study was undertaken to evaluate the efficacy of brush cytology and the adjunctive role of DNA image cytometry (ICM) in the diagnosis of oral cancer.

METHOD

Oral brush smears and biopsy were obtained from 100 consecutive patients presenting with suspicious oral lesions. DNA-ICM was performed on 96 cytology smears which had adequate cellularity.

RESULTS

On cytology, 54 cases were benign, 36 were malignant, 6 were suspicious for malignancy, and 4 were inadequate due to scanty cellularity. On histopathologic examination, 49 cases were diagnosed as squamous cell carcinoma and 51 cases as benign. The sensitivity of brush cytology for the detection of cancer was 83.3% and the specificity was 95.8%. The positive and negative predictive values were 95.2% and 85.2%, respectively, with a diagnostic accuracy of 86%. Out of 96 cases analyzed by image analysis to assess DNA ploidy, 33 cases were aneuploid and 63 were diploid. The sensitivity, specificity, positive predictive value, and negative predictive value of DNA-ICM were 68.7%, 100%, 100%, and 76.1%, respectively, giving a diagnostic accuracy of 81%. The combination of cytology and DNA cytometry increased the sensitivity to 92% and specificity to 100%.

CONCLUSION

The study demonstrates the usefulness of DNA-ICM as an adjunct to brush cytology to diagnose oral cancer. It reduces the false negative cases on cytology and also adds to objectivity in cytologically doubtful cases.

Salivary detection of human Papilloma virus 16 & 18 in pre-malignant and malignant lesions of oral cavity: Is it feasible in Pakistani context of Socio-Cultural Taboos?

OBJECTIVE

To evaluate salivary detection of HPV-16 & 18 would be feasible and informative biomarker for oral pre-malignant and malignant lesion in our population.

METHODS

This non-interventional, case control study was carried out at department of E.N.T, Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital Karachi, Pakistan between July 2011 to December 2012. Total of 105 cases were recruited. These were divided in three groups 'A', 'B' & 'C' having 35 subjects each. Group'A' constitutes patients having strong clinical evidence of oral pre-malignant lesions (PML). Group 'B' includes histologically proven oral squamous cell carcinoma (OSCC) and Group 'C' comprised disease free subjects as controls. After taking informed consent, relevant clinical history was recorded on institutional approved performa. Saliva from all subjects was procured by standard 'drooling method'. Samples were stored at +4°C and later transferred to Laboratory to store at-20°C before further process. Samples were centrifuged at 4500 rpm for 15 minutes at 4°C. Cell pellets sediments were used for identification of HPV-16 & 18 by real-time PCR method. Data was entered and analysed using SPSS version 16. P-value of 0.05 was taken as standard.

RESULTS

In group 'A', HPV-16 was detected in 3 (8.6%) cases while HPV-18 was not detected in any of the subject. In group 'B', HPV-16 was detected in 07 (20%) while HPV-18 was found in 06 (17.1%) cases. Mixed HPV-16 and HPV-18 were found in 02 (5.7%) cases. In group 'C', HPV-16 was detected in 03(8.6%) while HPV-18 was not detected in any of the subjects. Significant relationship was observed between the groups for HPV-18 detection (P= 0.002) while for HPV-16, no significant association was found (P= 0.245).

CONCLUSION

HPV infection for the causation of oral cancer cannot be fully established possibly due to small sample size. More over differences in genetic makeup, environment, indulgence in peculiar risk factor habits, sexual practices and difficult evaluation of the acquisition of viral load due to socio-cultural and religious restrictions could be the reason.

Prevalence of fungal hyphae in potentially malignant lesions and conditions-does its occurrence play a role in epithelial dysplasia?

BACKGROUND

Oral cancer is a major public health problem in India. A key factor that has led to lack of improvement in prognosis of oral cancer over the years, is delay in diagnosis and treatment. In many instances, a significant proportion of oral squamous cell carcinomas develop from premalignant lesions and conditions. Identification of such lesions and conditions is very important in order to prevent malignant transformation. The role of fungal infections has been studied and holds promise as an indicator to predict malignant transformation. So we designed a study to analyze the prevalence of fungal hyphae in biopsies of patients with clinically diagnosed cases of premalignant lesions and conditions.

AIMS AND OBJECTIVES

To determine and compare the prevalence of fungal hyphae in biopsies of patients with clinically diagnosed cases of potentially malignant lesions and conditions and to assess the possible association between the degree of epithelial dysplasia and presence or absence of fungal hyphae.

MATERIALS AND METHODS

Clinically suspected and histopathologically diagnosed 70 cases of potentially malignant lesions and conditions (29 leukoplakia, 16 submucous fibrosis and 25 lichen planus) made up the study group. Three tissue sections (5μm) of each were stained with hematoxylin and eosin (H and E), periodic acid-Schiff's reagent (PAS) and Grocott's methenamine silver (GMS) and evaluated for fungal hyphae. The data collected was statistically analyzed by using Chi-square test and Statistical Package for Social Sciences (SPSS) software.

RESULTS

The estimated prevalence of fungal hyphae in cases with or without dysplasia in leukoplakia was 41.4%, lichen planus 36% and submucous fibrosis 25%. There was a significant association between degree of epithelial dysplasia with presence or absence of fungal hyphae in all the study groups.

CONCLUSION

Presence of fungal hyphae in potentially malignant lesions and conditions may prove to be a useful indicator in predicting malignant transformation.

Techniques for early diagnosis of oral squamous cell carcinoma: Systematic review

Background and objectives

The diagnosis of early oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) is of paramount clinical importance given the mortality rate of late stage disease. The aim of this study is to review the literature to assess the current situation and progress in this area.

Material and Methods

A search in Cochrane and PubMed (January 2006 to December 2013) has been used with the key words “squamous cell carcinoma”, “early diagnosis” “oral cavity”, “Potentially Malignant Disorders” y “premalignant lesions”. The inclusion criteria were the use of techniques for early diagnosis of OSCC and OPMD, 7 years aged articles and publications written in English, French or Spanish. The exclusion criteria were case reports and studies in other languages.

Results

Out of the 89 studies obtained initially from the search 60 articles were selected to be included in the systematic review: 1 metaanalysis, 17 systematic reviews, 35 prospective studies, 5 retrospective studies, 1 consensus and 1 semi-structured interviews.

Conclusions

The best diagnostic technique is that which we have sufficient experience and training. Definitely tissue biopsy and histopathological examination should remain the gold standard for oral cancer diagnose. In this systematic review it has not been found sufficient scientific evidence on the majority of proposed techniques for early diagnosis of OSCC, therefore more extensive and exhaustive studies are needed.

Key words: Squamous cell carcinoma, early diagnosis, oral cavity, potentially malignant disorders, premalignant lesions.

Touch imprint cytology: a rapid diagnostic tool for oral squamous cell carcinoma

Techniques for intraoperative pathologic examination of oral squamous cell carcinoma are rare in the literature. We evaluated the advantages and limitations of touch imprint cytology for intraoperative diagnosis of oral squamous cell carcinoma. We used 30 incisional biopsies of clinically diagnosed oral squamous cell carcinoma and compared touch imprint cytology to histopathological sections. Touch imprint cytology showed 24 specimens positive for malignancy, two suspicious for malignancy and four inadequate specimens. The accuracy of the test was 93.2%. Touch imprint cytology is an accurate, simple, rapid and cost-effective method that aids diagnosis of oral squamous cell carcinoma during operation, but it does not replace incisional biopsy.

Evaluation of exfoliative cytology in the diagnosis of oral premalignant and malignant lesions: A cytomorphometric analysis

BACKGROUND

Many oral squamous cell carcinomas (OSCCs) arise within regions that previously had premalignant lesion. Early diagnosis and prompt treatment of premalignant lesions offers the best hope of improving the prognosis in patients with OSCC. Exfoliative cytology is a simple and non-invasive diagnostic technique that could be used for early detection of oral premalignant and malignant lesions. This study was undertaken to evaluate the quantitative changes in nuclear area (NA), cytoplasmic area (CA) and nuclear-to-cytoplasmic ratio (NA/CA) in cytological buccal smears of oral leukoplakia with dysplasia (OLD) and OSCC patients while comparing with normal healthy mucosa.

MATERIALS AND METHODS

A quantitative study was conducted over 90 subjects including 30 cases each of OLD, OSCC and clinically normal oral mucosa. The smears obtained were stained with Papanicolaou (PAP) stain and cytomorphological assessment of the keratinocytes was carried out. The statistical tools included arithmetic mean, standard deviation, Chi-square test, analysis of variance, Tukey multiple comparison. P < 0.001 was considered as significant.

RESULTS

The mean NA of keratinocytes in the normal mucosa was 65.47 ± 4.77 μm(2) while for OLD it was 107.97 ± 5.44 μm(2) and 139.02 ± 8.10 μm(2) for that of OSCC. The differences show a statistically significant increment in NA (P < 0.001). There was significant reduction (P < 0.001) in the CA of keratinocytes from OSCC when compared with those from smears of OLD and normal mucosa with the values of 1535.80 ± 79.38 μm(2), 1078.51 ± 56.65 μm(2) and 769.70 ± 38.77 μm(2) respectively. The NA/CA ratio in the smears from normal oral mucosa, OLD and OSCC showed a mean value of 0.043 ± 0.004, 0.100 ± 0.008, 0.181 ± 0.015 respectively with a significant difference among the groups (P < 0.001).

CONCLUSION

Evaluation of nuclear and CA of keratinocytes by cytomorphometry can serve as a useful adjunct in the diagnosis and prognosis of a dysplastic lesion which may lead to OSCC.

Evaluation of ploidy status using DNA-image cytometry of exfoliated mucosal cells in oral lichen planus

Background:

Oral lichen planus (OLP) is one of the potentially malignant disorders (PMDs) with a malignancy rate of 0.2-2%. Aneuploidy is considered to be one of the important markers for malignant transformation and DNA-image cytometry (DIC) has been successfully employed in oral mucosal PMDs and also in tumors of the cervix, lung and biliary tract.

Aims:

In this study, we intend to assess the ploidy status of exfoliated cells in OLP using DIC.

Materials and Methods:

Exfoliated cells from 48 patients with different subtypes of OLP (reticular, plaque type, erosive and atrophic) and 10 controls were stained using Feulgen reaction and assessed for integrated optical density using image analysis software and the ploidy status was assessed.

Results:

All the patients in the control group and most of the patients (93.5%) who had reticular or plaque type of OLP (29 out of 31) exhibited diploid nuclei in the smears, whereas 11 patients who had erosive or atrophic types of OLP showed aneuploid nuclei.

Conclusions:

The patients with erosive or atrophic types of OLP are at more risk and assessment of ploidy status by exfoliative cytology can be used as an adjuvant for diagnosis.

Correlation of presence of Candida and epithelial dysplasia in oral mucosal lesions

BACKGROUND

Candida and epithelial dysplasia have long been associated with oro-mucosal lesions.

AIM AND OBJECTIVE

The present study was designed to evaluate the correlation between presence of Candida organisms and epithelial dysplasia in various oral mucosal lesions associated with areca nut and tobacco use.

MATERIALS AND METHODS

A total of 50 individuals were selected, between age range of 19-70 y. Three separate cytosmears were prepared for each participant. All the slides were stained with PAS stain and the best slide was viewed for candidal organisms.

STATISTICAL TESTS

The data was analysed using the SPSS version16. Chi square test was performed.

RESULTS

Out of these, samples of 26 participants displayed presence of Candida. It was further observed that all the samples that were positive for presence of Candida displayed the organism in hyphal form. Out of 50 biopsy specimens stained for presence of Candida using PAS stain, samples of only 2 participants demonstrated presence of Candida in hyphal form, whereas the biopsy specimens stained for demonstrating dysplastic changes using H&E stain displayed various levels of cellular atypia in samples of 16 participants. Out of these 12 were mild, 3 were moderate & 1 displayed severe dysplastic changes.

CONCLUSION

The study revealed a statistically non significant correlation between the presence of Candida and epithelial dysplasia in oral mucosal lesions.

Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas

The present study aimed to investigate the efficiency of exfoliative cytology by correlating the clinical lesions of oral squamous cell carcinoma (OSCC) with exfoliative cytology and histopathological findings. Cases of OSCC diagnosed between 1984 and 2010 were analyzed. The inclusion criteria for the present study were the availability of detailed clinical findings and a diagnosis of the disease through exfoliative cytology and histopathology. The cases were assessed and assigned scores, which were then submitted to modal expression analysis, which considers the higher frequency scores, thus relating the variables. The cytological findings demonstrated that the majority of the cases had malignant potential. Exfoliative cytology should be used as a supplementary tool for the diagnosis of OSCC, as it enables the early detection of these lesions. However, cytology should not be used as a substitute for histopathological examination.

Comparative Study of Genotoxicity in Different Tobacco Related Habits using Micronucleus Assay in Exfoliated Buccal Epithelial Cells

BACKGROUND

Oral cancer is one of the most debilitating diseases afflicting mankind. Consumption of tobacco in various forms constitutes one of the most important etiological factors in initiation of oral cancer. When the focus of today's research is to determine early genotoxic changes in human cells, micronucleus (MN) assay provides a simple, yet reliable indicator of genotoxic damage.

AIMS AND OBJECTIVES

To identify and quantify micronuclei in the exfoliated cells of oral mucosa in individuals with different tobacco related habits and control group, to compare the genotoxicity of different tobacco related habits between each group and also with that of control group.

PATIENTS AND METHODS

In the present study buccal smears of 135 individuals with different tobacco related habits & buccal smears of 45 age and sex matched controls were obtained, stained using Giemsa stain and then observed under 100X magnification in order to identify and quantify micronuclei in the exfoliated cells of oral mucosa.

RESULTS

The mean Micronucleus (MN) count in individuals having smoking habit were 3.11 while the count was 0.50, 2.13, and 1.67 in normal control, smoking with beetle quid and smokeless tobacco habit respectively. MN count in smokers group was 2.6 times more compared to normal controls. MN count was more even in other groups when compared to normal control but to a lesser extent.

CONCLUSION

From our study we concluded that tobacco in any form is genotoxic especially smokers are of higher risk and micronucleus assay can be used as a simple yet reliable marker for genotoxic evaluation.

An overview of the spindle assembly checkpoint status in oral cancer

Abnormal chromosome number, or aneuploidy, is a common feature of human solid tumors, including oral cancer. Deregulated spindle assembly checkpoint (SAC) is thought as one of the mechanisms that drive aneuploidy. In normal cells, SAC prevents anaphase onset until all chromosomes are correctly aligned at the metaphase plate thereby ensuring genomic stability. Significantly, the activity of this checkpoint is compromised in many cancers. While mutations are rather rare, many tumors show altered expression levels of SAC components. Genomic alterations such as aneuploidy indicate a high risk of oral cancer and cancer-related mortality, and the molecular basis of these alterations is largely unknown. Yet, our knowledge on the status of SAC components in oral cancer remains sparse. In this review, we address the state of our knowledge regarding the SAC defects and the underlying molecular mechanisms in oral cancer, and discuss their therapeutic relevance, focusing our analysis on the core components of SAC and its target Cdc20.