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Fiwek P, Irga-Jaworska N, Wojtylak S, Biernat W, Emerich K, Pomiecko D. Assessment of Cytological Changes in the Oral Mucosa in Young Hematological Patients Treated with Systemic Chemotherapy. J Clin Med 2023; 12:jcm12072665. [PMID: 37048748 PMCID: PMC10095229 DOI: 10.3390/jcm12072665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Background and Objectives: The primary objective of the undertaken study was to determine the morphological changes that occur within the oral epithelium in children undergoing chemotherapy following a diagnosis of hematological malignancies. Materials and Methods: The study group consisted of 18 patients diagnosed with leukemia or lymphoma undergoing treatment with chemotherapy. Swabs (liquid-based cytology) were collected from the oral cavity for microscopic evaluation at baseline, during the chemotherapy cycle with oral mucositis symptoms present, and upon completion of the cycle. Both the neutrophil count and oral mucositis (OM) were registered using the WHO (World Health Organization) scale. The control group included 41 children who were generally healthy. All samples underwent microscopical analyses at the Department of Pathology, Medical University of Gdansk, Poland. Results: A total of 190 cytological preparations were evaluated. The baseline preparations revealed similar cytological images, and the superficial cells of the epithelial layers were seen. A significant (p < 0.01) increase in the number of cells in the intermediate layer of the oral epithelium, as well as a decrease (p < 0.01) in the volume of cells in the superficial layers, was observed in further stages of cytostatic treatment. Conclusions: A decrease in the percentage of superficial epithelial cells with a corresponding increase in the number of intermediate epithelial cells is considered to be a result of toxic damage to the oral mucosa during chemotherapy.
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Affiliation(s)
- Paula Fiwek
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Hematology and Oncology, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Szymon Wojtylak
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Katarzyna Emerich
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
| | - Dagmara Pomiecko
- Department of Paediatric Dentistry, Medical University of Gdansk, 80-208 Gdansk, Poland
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Kokubun K, Nakajima K, Yamamoto K, Akashi Y, Matsuzaka K. Evaluation of oral brush liquid-based cytology for oral squamous cell carcinoma: a comparative study of cytological and histological diagnoses at a single center. BMC Oral Health 2023; 23:145. [PMID: 36906554 PMCID: PMC10007825 DOI: 10.1186/s12903-023-02839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE Liquid-based cytology is highly useful in oral cytology. However, there are only few reports on the accuracy of this method. The current study aimed to compare oral liquid-based cytological and histological diagnoses and to evaluate items that should be considered in oral cytological diagnosis for oral squamous cell carcinoma. METHODS We included 653 patients who underwent both oral cytological and histological examinations. Data on sex, specimen collection region, cytological and histological diagnoses, and histological images were reviewed. RESULTS The overall male-to-female ratio was 1:1.18. The tongue was the most common specimen collection region, followed by the gingiva and buccal mucosa. The most common cytological examination result was negative (66.8%), followed by doubtful (22.7%) and positive (10.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis were 69%, 75%, 38%, and 92%, respectively. Approximately 8.3% of patients with a negative cytological diagnosis had a histological diagnosis of oral squamous cell carcinoma. Furthermore, 86.1% of histopathologic images of cytology-negative squamous cell carcinomas exhibited well-differentiated keratinocytes lacking atypia on the surface. The remaining patients developed recurrence, or they had low cell counts. CONCLUSION Liquid-based cytology is useful in screening oral cancer. However, a cytological diagnosis of superficial-differentiated oral squamous cell carcinoma is occasionally inconsistent with the histological diagnosis. Therefore, histological and cytological examinations should be performed if tumor-like lesions are suspected clinically.
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Affiliation(s)
- Katsutoshi Kokubun
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
| | - Kei Nakajima
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kei Yamamoto
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Yoshihiko Akashi
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kenichi Matsuzaka
- Department of Pathology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
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Accuracy of liquid-based brush cytology and HPV detection for the diagnosis and management of patients with oropharyngeal and oral cancer. Clin Oral Investig 2021; 26:2587-2595. [PMID: 34839418 PMCID: PMC8898233 DOI: 10.1007/s00784-021-04228-5] [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: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 12/03/2022]
Abstract
Objectives This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment. Material and methods Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed. Results Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment. Conclusions Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment. Clinical relevance Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.
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Picciani BLS, Dziedzic A, Werneck JT, Marinho MA, Dick TNA, Quintanilha NR, Dias EP. Atypical oral candidiasis in a psoriatic patient during targeted immunotherapy with an interleukin 17 inhibitor (secukinumab). BMC Oral Health 2021; 21:292. [PMID: 34103043 PMCID: PMC8186152 DOI: 10.1186/s12903-021-01653-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/03/2021] [Indexed: 04/24/2023] Open
Abstract
Background Secukinumab is a human monoclonal antibody immunoglobulin that neutralises interleukin (IL)-17A, and as such, is effective in the treatment of psoriasis. However, as IL-17A is essential in protection against fungal infections, patients treated with this drug may develop candidiasis. This report presents a case of atypical oral candidiasis occurring during targeted drug immunotherapy with an interleukin 17 (IL-17) inhibitor (secukinumab), with the aim of emphasisinge the necessity of periodical oral health assessment and monitoring. It provides a rational clinical approach to therapeutic protocol in the treatment of side effects associated with novel medications for autoimmune diseases.
Case presentation Symptomatic tongue lesions were observed in a 50-year-old female patient on a monthly systemic treatment of 300 mg of secukinumab, which appeared after 60 days of using the medication. Two inconclusive biopsies and an unsuccessful application of oral corticosteroids made the diagnostic process challenging. Papillae on the back of the tongue were atrophied, forming a well-defined erythema and white non-detachable plaques on the lateral border of the tongue. Cytopathological and histopathological exam results were compatible with a diagnosis of oral candidiasis. Topical antifungal medication led to subsequent regression of the tongue lesions. During asymptomatic period and follow up for 7 months, a reduced monthly dose 150 mg of secukinumab was administered. Conclusions Patients undergoing treatment with IL-17 blockers, such as secukinumab, should be carefully monitored in order to avoid oral side effects resulting from the use of this medication.
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Affiliation(s)
- Bruna Lavinas Sayed Picciani
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Rio de Janeiro, Brazil. .,Postgraduate Program in Dentistry, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil. .,Dental Center for Patients with Special Needs, Instituto Rir, Rio de Janeiro, Brazil.
| | - Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Katowice, Poland
| | - Juliana Tristão Werneck
- Postgraduate Program in Dentistry, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | - Marcello Alves Marinho
- Postgraduate Program in Dentistry, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil
| | - Thaylla Núñez Amin Dick
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Nara Regina Quintanilha
- Medical Clinic Service, Hospital Antônio Pedro, School of Medicine, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Eliane Pedra Dias
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Gaida K, Deuerling L, Neumann H, Remmerbach TW. Comparison between two cell collecting methods for liquid-based brush biopsies: a consecutive and retrospective study. BMC Oral Health 2021; 21:195. [PMID: 33863321 PMCID: PMC8052744 DOI: 10.1186/s12903-021-01557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background This study compares two different cell collectors, the Orcellex Brush (rigid brush) and the Cytobrush GT (nylon brush), using liquid-based cytology. A comparison of their obtainment procedures was also considered. The aim was to determine the diagnostic accuracy for detection of malignancy in oral brush biopsies. PICO-Statement: In this consecutive and retrospective study we had as population of interests, patients with oral lesions, the intervention was the brush biopsy with two different cell collectors and the control was healthy oral mucosa. The outcome of the study was to compare both cell collectors. Methods From 2009 to 2018, 2018 patients with oral lesions were studied using the nylon brush (666 cases) and rigid brush (1352 cases). In the first cohort five smears per patient were taken with the nylon brush, while each patient received one smear with the rigid brush in the second cohort. These were further processed in a liquid-based procedure. Cytological evaluations were categorised into ‘negative’, which were considered as negative, whereas ‘doubtful’, ‘suspicious’ and ‘positive’ cytological results were overall considered as positive for malignancy in comparison to the final histological diagnoses. Additionally, the clinical expenditure for each collector was estimated. Results 2018 clinically and histologically proven diagnoses were established, including 181 cases of squamous cell carcinomas, 524 lichen, 454 leukoplakias, 34 erythroplakias and 825 other benign lesions. The sensitivity and specificity of the nylon brush was 93.8% (95% CI 91.6–95.5%) and 94.2% (95% CI 91.8–95.5%) respectively, whereas it was 95.6% (95% CI 94.4–96.6%) and 84.9% (95% CI 83.8–87.5%) for the rigid brush. The temporal advantage using the plastic brushes was 4× higher in comparison to the nylon brush. The risk suffering from a malignant oral lesion when the result of the brushes was positive, suspicious, or doubtful was significantly high for both tests (nylon brush OR: 246.3; rigid brush OR: 121.5). Conclusions Both systems have a similar sensitivity, although only the rigid brush achieved a satisfactory specificity. Additional methods, such as DNA image cytometry, should also be considered to improve the specificity. Furthermore, the rigid brush proved to be more effective at taking a sufficient number of cells, whilst also being quicker and presenting less stress for the patient.
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Affiliation(s)
- Kristin Gaida
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany
| | - Lena Deuerling
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany
| | - Heinrich Neumann
- Medical Care Centre for Histology, Cytology and Molecular Diagnostics, 52351, Düren, Germany
| | - Torsten W Remmerbach
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany.
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Kujan O, Idrees M, Anand N, Soh B, Wong E, Farah CS. Efficacy of oral brush cytology cell block immunocytochemistry in the diagnosis of oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med 2021; 50:451-458. [PMID: 33368584 DOI: 10.1111/jop.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell block immunocytochemistry in the diagnosis of oral leukoplakia as minimally invasive diagnostic adjuncts. METHODS Seventy-two patients diagnosed clinically with either oral leukoplakia (OLK) or oral squamous cell carcinoma were included. Oral brush samples using Orcellex® brushes were obtained from all participants directly before undergoing surgical biopsy. Cell blocks were prepared for all samples and assessed for cytomorphology and immunocytochemistry of DNA mismatch repair proteins (MSH-6, MSH-2, MLH-1 and PMS-2). A combined index score of immunocytochemistry expression and cytology grading was compared against the gold standard (histopathological diagnosis). RESULTS A significant association was observed between the cytological assessments of oral liquid-based brush cytology samples and the histopathological diagnosis (P < .005). In addition, there was a significant inverse correlation between the grade of oral epithelial dysplasia and the cumulative score of the studied DNA mismatch repair proteins (P < .005). Grading criteria for both oral liquid-based brush cytology and immunocytochemistry cumulative index scores are proposed based on the analysis of receiver operating characteristic curve coordinates. The diagnostic accuracy of this approach was outstanding in terms of discrimination between the presence or absence of oral epithelial dysplasia (0.961) and squamous cell carcinoma (0.977) separately. CONCLUSION Oral liquid-based brush cytology cell block immunocytochemistry provides a reliable strategy to investigate oral mucosal epithelial disorders. This approach presents a minimally invasive, highly accurate and non-technically demanding method for the surveillance of oral potentially malignant disorders and squamous cell carcinoma.
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Affiliation(s)
- Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Neeraj Anand
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Brandon Soh
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Elton Wong
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia.,Head and Neck Pathology, Australian Clinical Labs, Subiaco, WA, Australia
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Non-Invasive Early Detection of Oral Cancers Using Fluorescence Visualization with Optical Instruments. Cancers (Basel) 2020; 12:cancers12102771. [PMID: 32992486 PMCID: PMC7601016 DOI: 10.3390/cancers12102771] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Oral cancer has a high mortality rate. Then, oral cancer screening is needed for early detection and treatment. Fluorescence visualization is non-invasive, convenient, and in real-time, and examinations can be repeated. Our study aimed to show the usefulness of oral cancer screening with fluorescence visualization. A total of 502 patients were performed using fluorescence visualization that was analyzed using subjective and objective evaluation. Results of this study, subjective evaluation for detection oral cancer was high sensitivity and low specificity, while objective evaluation using imaging processing analysis was high sensitivity and high specificity. Therefore, oral cancer screening using fluorescence visualization is useful for the detection of oral cancer. The widespread use of this screening can reduce the mortality rate of oral cancer. Abstract Background: Oral cancer screening is important for early detection and early treatment, which help improve survival rates. Biopsy is the gold standard for a definitive diagnosis but is invasive and painful, while fluorescence visualization is non-invasive, convenient, and real-time, and examinations can be repeated using optical instruments. The purpose of this study was to clarify the usefulness of fluorescence visualization in oral cancer screening. Methods: A total of 502 patients, who were examined using fluorescence visualization with optical instruments in our hospitals between 2014 and 2019, were enrolled in this study. The final diagnosis was performed by pathological examination. Fluorescence visualization was analyzed using subjective and objective evaluations. Results: Subjective evaluations for detecting oral cancer offered 96.8% sensitivity and 48.4% specificity. Regarding the objective evaluations, sensitivity and specificity were 43.7% and 84.6% for mean green value, 55.2% and 67.0% for median green value, 82.0% and 44.2% for coefficient of variation of value, 59.6% and 45.3% for skewness, and 85.1% and 75.8% for value ratio. For the sub-analysis of oral cancer, all factors on objective and subjective evaluation showed no significant difference. Conclusions: Fluorescence visualization with subjective and objective evaluation is useful for oral cancer screening.
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Osorio-Osorno YA, Arboleda Toro D, Arango JC, Parada-Sanchez MT. Optimized liquid-based cytology for the cellular and molecular analysis of oral keratinocytes: A promising diagnostic tool. Diagn Cytopathol 2020; 49:96-104. [PMID: 32877007 DOI: 10.1002/dc.24604] [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: 06/16/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Liquid-based cytology (LBC) has improved exfoliative cytology by facilitating the extraction of more precise information from epithelial cells. The aim of this study was to optimize a protocol using a conventional cytobrush to perform LBC, obtaining oral keratinocytes for their further cellular and molecular analysis. METHODS LBC was performed in 30 healthy donors from buccal mucosa. We evaluated the use of diethyl pyrocarbonate (DEPC)-treated Dulbecco's Modified Eagle Medium (DMEM) medium right after the collection of the cells. Cell morphology and viability were determined by Orcein staining and flow cytometry, respectively. RNA was extracted by the trizol method, and evaluated with spectrometry and electrophoresis. Finally, RNA was copied into cDNA and GAPDH and TLR2 genes were amplified by reverse transcription polymerase chain reaction (RT-PCR) and quantitative reverse transcription polymerase chain reaction (RT-qPCR) using specific primers. RESULTS Only DEPC-treated DMEM preserved the viability of intact intraepithelial keratinocytes. RNA quantity and quality improves in samples treated with DEPC. RNA integrity is comparable with a cell line control. GAPDH gene was successfully amplified by RT-PCR and RT-qPCR. CONCLUSIONS Therefore, LBC performed under these conditions becomes a reproducible technique for the retrieval of intraepithelial oral keratinocytes with good cell viability for cytomorphometric analysis, and extraction of good RNA quality suitable for molecular analyses such as PCR. We propose this LBC protocol as a complementary method to the cellular and molecular study of oral mucosa pathologies; however, it requires further study.
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Affiliation(s)
- Yuliana Andrea Osorio-Osorno
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - David Arboleda Toro
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Julian Camilo Arango
- Grupo Micología Médica y Experimental, School of Microbiology, Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Monica Tatiana Parada-Sanchez
- Departamento de Estudios Básicos Integrados, Grupo Estudios BioSociales del Cuerpo, School of Dentistry, Universidad de Antioquia, Medellin, Antioquia, Colombia
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Adeoye J, Thomson P. Strategies to improve diagnosis and risk assessment for oral cancer patients. ACTA ACUST UNITED AC 2020. [DOI: 10.1308/rcsfdj.2020.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To realise the benefits of new diagnostic techniques for the prediction of oral cancer, further validation and multicentre analyses are needed to determine their clinical impact in contemporary practice.
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Deuerling L, Gaida K, Neumann H, Remmerbach TW. Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11111813. [PMID: 31752196 PMCID: PMC6896118 DOI: 10.3390/cancers11111813] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from an identical number of oral lesions, then cytological diagnoses were made using liquid-based cytology. The final diagnoses in the study were 105 histologically proven squamous cell carcinomas (SCCs), 744 potentially malignant lesions and 503 cases of traumatic, inflammatory or benign hyperplastic oral lesions. The sensitivity and specificity of the liquid-based brush biopsy were 95.6% (95% CI 94.5–96.7%) and 84.9% (95% CI 83.0–86.8%), respectively. This led to the conclusion that brush biopsy is potentially a highly sensitive and reliable method to make cytological diagnoses of oral neoplasia. The main advantage of a brush biopsy over a scalpel biopsy is that it is less invasive and is more tolerated by the patients. Therefore, more lesions can be screened and more cancers can be detected at an early stage.
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Affiliation(s)
- Lena Deuerling
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Kristin Gaida
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Heinrich Neumann
- Medical Care Center for Histology, Cytology and Molecular Diagnostics, 52351 Düren, Germany;
| | - Torsten W. Remmerbach
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
- German Association of Oral Diagnostics (DGOD mbH), Wettiner Str. 10, 04105 Leipzig, Germany
- Correspondence:
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Kujan O, Huang G, Ravindran A, Vijayan M, Farah CS. CDK4, CDK6, cyclin D1 and Notch1 immunocytochemical expression of oral brush liquid-based cytology for the diagnosis of oral leukoplakia and oral cancer. J Oral Pathol Med 2019; 48:566-573. [PMID: 31172614 DOI: 10.1111/jop.12902] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to investigate the feasibility of using oral liquid-based brush cytology (OLBC) coupled with immunocytochemistry as a minimally invasive approach to stratify the cancer risk in patients with oral leukoplakia. METHODS Fifty-five patients diagnosed with either oral leukoplakia (OLK) or oral squamous cell carcinoma (OSCC) were recruited. All patients underwent oral brush biopsy followed by surgical biopsy. 275 liquid-based cytology preparations were made. Pap-stained OLBC slides were assessed using the modified 2014 Bethesda Cytology system. The expression of CDK4, CDK6, cyclin D1, and Notch 1 was immunocytochemically analysed and compared against the histopathological diagnosis. A combined index score of OLBC grading and protein expression was calculated. RESULTS A significant association was found between the definitive histopathological diagnosis and the cytological interpretation (P = 0.0005). The index scores of CDK4, CDK6, and cyclin D1 were significantly associated with the development of disease from non-dysplastic epithelium to OSCC. No significant association was observed between the Notch 1 index score and disease stage. The diagnostic accuracy of OLBC showed the highest values of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy: 84.6%, 70.4%, 73.3%, 82.6%, and 78.8%, respectively, compared with the cumulative protein index, CDK4/6 index, and the combined OLBC grading and CDK4/6 index. CONCLUSION This study has also demonstrated the efficacy of the use of OLBC in the detection of OED and OSCC, and showed that the use of CDK4, CDK6, cyclin D1, and Notch 1 immunocytochemistry failed to improve the diagnostic accuracy of OLBC suggesting they are not useful in the early detection of OSCC.
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Affiliation(s)
- Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Gareth Huang
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Ashwati Ravindran
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Monisha Vijayan
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Camile S Farah
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia.,Australian Centre for Oral Oncology Research & Education, Nedlands, Western Australia, Australia
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12
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Alsarraf A, Kujan O, Farah CS. Liquid‐based oral brush cytology in the diagnosis of oral leukoplakia using a modified Bethesda Cytology system. J Oral Pathol Med 2018; 47:887-894. [DOI: 10.1111/jop.12759] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 12/25/2022]
Affiliation(s)
| | - Omar Kujan
- UWA Dental School University of Western Australia Nedlands WA Australia
| | - Camile S. Farah
- UWA Dental School University of Western Australia Nedlands WA Australia
- Australian Centre for Oral Oncology Research & Education UWA Dental School University of Western Australia Nedlands WA Australia
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13
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Olms C, Hix N, Neumann H, Yahiaoui-Doktor M, Remmerbach TW. Clinical comparison of liquid-based and conventional cytology of oral brush biopsies: a randomized controlled trial. Head Face Med 2018; 14:9. [PMID: 29843756 PMCID: PMC5975412 DOI: 10.1186/s13005-018-0166-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Exfoliative cytology performed on oral brush samples can help dentists to decide, whether a given oral lesion is (pre-) malignant. The use of non-invasive brush biopsies as an auxiliary tool in the diagnosis of oral mucosal lesions has gained renewed interest since improvements in cytological techniques such as the development of adjuvant diagnostic tools and liquid-based cell preparation techniques. Methods The aim of this study was to compare the quality of two different preparation techniques (cell collectors): the conventional transfer procedure to glass slides and the so-called liquid-based cytology preparation method. Cell smears were collected from 10 orally healthy individuals (mean age: 24 years) from the palatine mucosa at two different times (baseline and 4 weeks later). Slides of both techniques were stained by Giemsa (n = 40) and May-Gruenwald Giemsa (n = 40). The statistical analysis was performed with Excel. Results On specimen analysis, the liquid-based cytology showed statistically significant improvement compared to conventional glass sides (p < 0.001). Thin layers, which were performed by liquid-based cytology showed significantly better results in the parameters (p < 0.001): uniform distribution, cellular overlapping, cellular disformation, mucus, microbial colonies and debris. The conventional glass slides approach showed more cell overlapping and contamination with extraneous material than thin layers, which were performed by Orcellex® Brush cell collectors. Conclusions Both techniques are diagnostically reliable. The liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility. Liquid-based cytology simplifies cell collection due to easier handling and less transfer errors by dentists.
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Affiliation(s)
- Constanze Olms
- Department of Dental Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany.
| | - Nathalie Hix
- Department of Dental Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany
| | - Heinrich Neumann
- Institute of Cytopathology, Am Propsthof 3, 53121, Bonn, Germany
| | - Maryam Yahiaoui-Doktor
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Torsten W Remmerbach
- Section of Oral Medicine, Department of Head Medicine and Oral Health, University of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany
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