Comparative analyses between the smoking habit frequency and the nucleolar organizer region associated proteins in exfoliative cytology of smokers' normal buccal mucosa

Quantitative analysis of AgNOR counts and pap stain in exfoliative cytology specimens of oral mucosa in bidi smokers and nonsmokers

Background:

Bidi smoking is a serious health hazard which is common throughout South Asia and parts of the Middle East. It has been strongly implicated to various benign and malignant lesions of oral cavity and oropharynx. These tobacco-filled leaves deliver more than three times the amount of nicotine, carbon monoxide, and tar as cigarettes which exert injurious effects on cells reflected in terms of accelerated proliferative activity in normal oral mucosal cells.

Aim:

This study aimed to compare the exfoliated cells from the oral mucosa of bidi smokers and nonsmokers, with emphasis on proliferative activity.

Materials and Methods:

Exfoliative smears were obtained from the oral mucosa of forty participants (twenty nonsmokers and twenty smokers) with age group ranging from 30-80 years, in and around Barwala (Haryana). The cytologic smears were evaluated using Papanicolaou (PAP) stain and AgNOR in order to evaluate the presence of cytological alterations suggestive of inflammation, dysplasia, keratinization, and proliferative activity of epithelial cells. Only PAP Class I and Class II smears were observed.

Results:

Comparison of the mean number of AgNORs showed a significant difference between nonsmokers and smokers. Inflammatory alterations were found in 70% of smokers and 55% of nonsmokers. A significant difference in proliferative activity was observed between smokers and nonsmokers classified as PAP Class II.

Conclusion:

A significant difference of AgNORs/nucleus was observed between bidi smokers and nonsmokers.

The Effect of Hookah Use on Buccal Mucosa: Evaluation of Repair Index

Background and aim:

Cigarettes, hookah, and tobacco are the most important etiologic factors for oral cancers and dysplastic lesions. This study was undertaken to determine the correlation between hookah use and the percentage of cells with micronucleus, karyorrhexis, karyolysis, and broken egg in the buccal mucosa; and secondly to compare hookah user and non-user in terms of repair index.

Materials and methods:

The present historical cohort study was carried out on 72 samples taken from 36 hookah users and 36 control subjects. Smear samples were obtained from participants’ buccal mucosa for cytological evaluation using Papanicolaou technique. Then, the percentages of cells with micronucleus, karyorrhexis, karyolysis, and broken egg were recorded and the repair index was calculated. Data were analyzed using Mann-Whitney U test.

Results:

A total of 72 samples taken from 36 hookah users and 36 control subjects were evaluated. The means of micronucleus scores in the buccal mucosa cells of hookah users and controls were 10.7±2.6 and 5.8±2.0, the karyorrhexis scores in the hookah users and controls were 0.1±0.06 and 0.04±0.06, and the karyolysis scores in hookah users and controls were 0.16±0.05 and 0.08±0.06, respectively. These differences were statistically significant between hookah users and controls (P<0.001). The broken egg score was 0.66±0.07 for the hookah users and 0.03±0.04 for the control group, revealing a statistically significant difference (P<0.036). Finally, the repair index values were 0.03±0.01 and 0.05±0.13 in hookah users and controls, respectively. This difference was also significant (P<0.026).

Conclusion:

The percentages of cells with micronucleus, karyorrhexis, karyolysis, and broken egg in the buccal mucosa of hookah users were significantly higher than those in control group; in addition, the repair index of the buccal mucosa cells in hookah users was significantly lower than that in the control group.

Epithelial oral mucosal cells: Do they behave differently when exposed to oral carcinogens?

OBJECTIVE

To assess the level of maturation and proliferation of epithelial cells and the correlation with immunocytochemical expression of adhesion (E-cadherin) and cell differentiation (involucrin) markers.

METHODS

Cytopathological samples were obtained from four groups of patients: control (CG, n=30); alcohol/tobacco (ATG, n=31), leucoplakia (LG, n=31), and squamous cell carcinoma (SCCG, n=22). Cytopathological smears were collected from all groups for AgNOR, Papanicolaou and immunocytochemical staining.

RESULTS

There was an increase in anucleated cells in ATG compared to CG and in LG compared to lesion-free groups (P<.05). In addition, there was a higher rate of intermediate cells in lesion-free groups than in LG (P=.001). When these findings were correlated with positive E-cadherin expression, there was a smaller number of anucleated and intermediate cells (P<.05). The proliferation rate was higher in the SCCG than in the CG (P<.05) and in the ATG compared to LG (P<.05). Moreover, cell proliferation increased in the presence of positive E-cadherin expression in the ATG and LG. No statistically significant results were obtained for involucrin analysis.

CONCLUSION

Cytopathology combined with quantitative techniques such as Papanicolaou, AgNOR, and immunocytochemical expression of E-cadherin detects changes associated with oral carcinogenesis. The innovative approach used in this study allows assessing the expression of cell adhesion (E-cadherin) and differentiation (involucrin) markers by means of oral mucosal cytopathology. The E-cadherin imunocytochemical expression indicated changes associated with the oral carcinogenesis process. An increase in cell proliferation rate in oral squamous cell carcinoma group was associated with the lower immunoexpression of E-cadherin. Cytopathology combined with quantitative techniques and immunocytochemical expression of E-cadherin may detect early alterations associated with oral carcinogenesis.

Risk prediction for oral potentially malignant disorders using fuzzy analysis of cytomorphological and autofluorescence alterations in habitual smokers

AIM

This study aims to develop a novel noninvasive method for early cancer trend diagnosis in habitual smokers by corroborating cytomorphological and autofluorescence alterations.

MATERIALS & METHODS

A total of 120 subjects were included and categorized into nonsmoker, smoker and clinically diagnosed oral potentially malignant disorder (OPMD) patients. Oral exfoliative epithelial cells were studied through differential interference contrast and fluorescence microscopy. Fuzzy trend analysis was performed using measured parameters for determining the risk factors among smokers.

RESULTS

The risk assessment in this study showed a positive correlation of smoking duration with early cancer risk factors with a correlation co-efficient of 0.86.

CONCLUSION

Alterations in cellular morphology and autofluorescence intensities showed positive correlation with OPMD. The present study will benefit to investigate early prediction of OPMD among susceptible individuals.

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.

Nuclear changes in oral mucosa of alcoholics and crack cocaine users

The effects of drugs of abuse on oral mucosa are only partly understood. The aims of the present study were to: (1) evaluate the frequency of nuclear changes in normal-appearing oral mucosa of alcoholics and crack cocaine users and (2) assess their association with cell proliferation rate. Oral smears were obtained from the border of the tongue and floor of the mouth of 26 crack cocaine users (24 males and 2 females), 29 alcoholics (17 males and 12 females), and 35 controls (17 males and 18 females). Histological slides were submitted to Feulgen staining to assess the frequency of micronuclei (MN), binucleated cells (BN), broken eggs (BE), and karyorrhexis (KR). A significant increase in the frequency of MN was observed in cells exfoliated from the tongue of crack cocaine users ( p = 0.01), and alcoholics showed a higher frequency of KR in cells obtained from the floor of the mouth ( p = 0.01). Our findings suggest that the use of crack cocaine induces clastogenic effects, whereas alcoholism is associated with higher degrees of keratinization in the floor of the mouth.

Exfoliative cytology as a tool for monitoring pre-malignant and malignant lesions based on combined stains and morphometry techniques

BACKGROUND

Prevention and early diagnosis have the greatest potential for public health and are the most effective method in the long-term to control oral cancer. The aim was to apply PAP staining together with AgNOR staining and morphometric analysis in oral exfoliative cytology, to determine the sensitivity and specificity of these methods in the detection of malignant changes for the purposes of both initial population monitoring and follow-up.

METHODS

AgNOR, Papanicolau, and morphometric tests were conducted in samples of patients with oral cancer, oral potentially malignant disorders and controls (opposite side of lesions). Specificity and sensitivity values for each stain method and the curve under ROC area were estimated.

RESULTS

The diagnostic variables which allowed greatest accuracy in identifying malignancy relative to the healthy control were cluster (76.92%), satellite (75.64%), and total (90%). The diagnosis was seen to be associated with PAP and total AgNOR, total AgNOR and PAP, total AgNOR and satellites and clusters, and total AgNOR nuclear area/cytoplasmic area ratio.

CONCLUSIONS

The total number of AgNOR is a reliable marker for detecting neoplastic cells; this method increases sensitivity and specificity by decreasing the likelihood of false negatives or positives, as the accuracy obtained was 90%. It is also a low-cost, non-invasive, simple methodology that can be recommended to help the early detection of oral cancer and monitoring of patients with a first diagnosis of cancer.

Evaluation of cytological alterations of oral mucosa in smokers and waterpipe users

OBJECTIVE

Oral mucosal epithelia of smokers and waterpipe users are more susceptible to malignant alterations. The aim of this study was morphometric evaluation of the effects of using waterpipe on normal oral mucosa.

MATERIALS AND METHODS

IN A CROSS SECTIONAL STUDY, CYTOLOGIC SMEAR SAMPLES FROM THE FOLLOWING THREE DIFFERENT AREAS: buccal mucosa, lateral surface of the tongue, and floor of the mouth (right) were taken from 40 smokers, 40 waterpipe users, and 40 normal individuals. They were then stained using Papanicolaou staining technique. Quantitative cytologic alterations such as nuclear and cytoplasmic size, nuclear-cytoplasmic (N/C) ratio, Feret ratio (FR), percent of karriorhexis, vacuolization of cytoplasm, two or multilobed nuclei, inflammation, and candida were evaluated. Quantitative evaluation was performed using MoticPlus 2 software, and 50 cells in each slide were studied. Practitioners were matched with age and sex in three groups.

RESULTS

An increase in nuclear size, the N/C ratio, and F.R, while a decrease in cytoplasm size were observed in lateral surface of the tongue, buccal mucosa and floor of the mouth of smokers, waterpipe users and normal individuals, respectively (p≤0.001). No statistically significant differences were observed in percent of karriorhexis, vacuolization of cytoplasm, and two or multilobed nuclei in oral mucosa of smokers, waterpipe users (p=0.8), and normal individuals (p=0.9) in buccal mucosa, tongue, and mouth floor areas. However, the percentage of inflammation and candida in smokers (p<0.001) and waterpipe users (p=0.002) were higher than normal individuals.

CONCLUSION

Smoking and using waterpipe are effective in creating some quantitative cytometric alterations in oral mucosa; however, smoking shows greater effect in the cytometric alterations than using waterpipe. Role of cytology in screening and detection of oral mucosa malignancies in smokers and waterpipe users needs further studies.

Evaluation of oral mucosal epithelium in diabetic male patients by exfoliative cytology method

Background

The goal of present study is to examine comparatively the epithelium of oral mucosa in persons with diabetes types I and II and the healthy persons by cytomorphometric method.

Methods

Cytology smear was prepared from oral mucosa epithelium in 24 persons with diabetes and 30 healthy persons were stained by papanicolao method. Its before, from patients were requested acquiring written. The quantitative cytomorphometric characteristics were measured in each group by motic plus 2 software. Also, the qualitative evaluation of cytology slides are performed in three groups.

Results

There were decrease in the nuclear and cytoplasmic size, (P < 0.001) and increase in the ratio of nuclear to cytoplasm size in buccal mucosal areas (P = 0.001) and tongue (P = 0.011) of diabetic persons compared to the healthy persons. There was no significantly statistical difference in diabetic persons types I and II in buccal mucosal area (P = 0.15) and tongue (P = 0.86) in quantitative characteristics of cytomoerphometry. In nuclear and cytoplasm size, there was a significant statistical difference in persons with diabetes type I and persons of control I and persons with diabetes type II and persons of control II in buccal mucosa and the tongue (P < 0.001). Bilobed or multi-lobed nuleous, karyorrhexis and vacuolization of cytoplasm were more in diabetic persons compared to the healthy ones (P < 0.001).

Conclusion

Diabetes are effective in creating some quantitative and qualitative cytometric alterations in the oral mucosa but the type of diabetes doesn’t seem to be effective on these changes.