Brush biopsy with DNA-image cytometry: a useful and noninvasive method for monitoring malignant transformation of potentially malignant oral disorders

Abstract

Oral and pharyngeal cancer is the sixth most common cancer worldwide, the 5-year survival rate has not yet increased. A key factor in rates not having improved is the lack of early detection. This study was undertaken to estimate the diagnostic accuracy of brush biopsy with DNA-image cytometry (a noninvasive method) for potentially malignant oral disorders compared with tissue biopsy pathology in China. Exfoliative cells were obtained using a cytobrush cell collector from oral mucosa of 52 subjects, followed by scalpel biopsy from the same region. Nuclear DNA contents (ploidy) were measured after Feulgen restaining, using an automated DNA image cytometer. Exfoliative cytology with DNA-image cytometry and histopathological diagnosis were performed separately at different institutions. Histological investigation was considered the gold standard. We reported that the sensitivity of DNA aneuploidy for the detection of cancer cells in potentially malignant oral disorders was 86.36 %, its specificity was 90.00 %, its positive predictive value was 86.36 %, and its negative predictive value was 90.00 %. Brush biopsy with DNA-image cytometry is a useful method for monitoring potentially malignant oral disorders.

Identification of Malignancy-Associated Changes in Histologically Normal Tumor-Adjacent Epithelium of Patients with HPV-Positive Oropharyngeal Cancer

“…Although previous studies have reported that brush biopsies are problematic for general OPC screening because they cannot directly sample tumors arising in tonsillar crypts [ 7 ], brush biopsies of clearly visible and accessible OPC lesions have been reported to be effective for HPV detection [ 7 , 42 ]. Further, brush biopsies in the adjacent oral cavity, where tissues are less convoluted, have been reported to have high sensitivity and specificity for the detection of DNA aneuploidy, a nuclear morphological marker of neoplastic cell transformation [ 43 ]. Thus, the identification of MACs in surface epithelium represents the initial step towards the development of a brush biopsy-based screening method for early-stage oropharyngeal tumors in high-risk populations.…”

Is DNA ploidy related to smoking?

“…As Souto et al, the presence of aneuploidy could be attributed to the cell degeneration found in the superficial layer of the epithelium. Nevertheless, according to Ma et al, it should be considered that the DNA content analysis in exfoliated cells can yield false‐positive results in some cases due to the overlapping cells and the presence of an inflammatory exudate and necrotic cells. The authors reported false‐positive and false‐negative rates of 13.64% and 10%, respectively, in 52 cases of intraoral lesions.…”

“…The following step to progression may lead to aneuploidy with oral potentially malignant disorders, which can undergo transformation to oral squamous cell carcinoma (SCC) . The analysis of DNA content is a useful tool to study and predict the behavior of oral malignant lesions and their precursors . Aneuploidy indicates the loss or acquisition of one or more chromosomes, events that affect the total DNA content of a cell …”

“…DNA ploidy can be analyzed by different methods, including FISH and imaging cytometry . According to Siebers et al, DNA ploidy analysis by imaging cytometry appears to be the most appropriate method for the long‐term monitoring of lesions.…”

Value of automatic DNA image cytometry for diagnosing lung cancer

“…However, the study of Bisht et al ( 23 ) reported that certain minor changes and chromosomal abnormalities cannot be detected by DNA analysis. When the number of diploid cells predominates over that of heteroploid cells, DNA analysis may still not detect abnormal cells ( 21 , 30 ). In addition, DNA quantitative analysis does not reveal heteroploid cells if the tumor chromosomes maintain a balance between loss and replication ( 18 , 31 ).…”