Brush Cytology with Immunocytochemical Evaluation of VEGF Expression versus Biopsy in Clinically Precancerous Laryngeal Lesions: Can We Diagnose Laryngeal Cancer Only with Brush Cytology?

Abstract

Introduction. Laryngeal squamous cell carcinoma (LSCC) is the most common SCC of the head and neck. The high incidence of this malignancy and the low survival rate necessitate the development of novel diagnostic approaches. Aim of this study is to compare the diagnostic value of laryngeal brush cytology combined with VEGF immunocytochemistry versus histopathology of clinically precancerous lesions of the larynx. Material and Methods. Thirty patients with precancerous or suspected malignant laryngeal lesions underwent microlaryngoscopy, during which samples were taken for cytological, immunocytochemical, and histological analysis. Cytology and histology results were classified as follows: benign lesions, atypia/moderate dysplasia, and malignancy, whereas the expression of VEGF was evaluated as strong, moderate, weak, and zero expression, based on the percentage of cells stained. Results. The cytology results were in accordance with the histology results in 86.7% of the patients. The exfoliative cytology's sensitivity was estimated at 85% and its specificity at 90%. Its positive prognostic value was 94%, while its negative prognostic value was 75%. The additional immunocytochemical evaluation of VEGF expression increased all the noted parameters. Discussion. Exfoliative cytology of laryngeal lesions is a minimal-invasive, easily applicable procedure during microlaryngoscopy and reliable in terms of diagnostic value. Under certain conditions it could be held also in local anesthesia. Concurrent immunocytochemical analysis of VEGF expression further enhances its diagnostic value.

The combination of brush cytology with the results of histopathological examination in laryngeal cancer diagnosis

“…Additionally, VEGF expression was determined in the material from liquid-based cytology. The high VEGF expression is associated with a higher relapse rate and faster disease progression [34]. In the framework of the 2017 research conducted by Ajayan et al involving a group of 50 patients, slightly over 70% sensitivity of brush cytology and 100% specificity were obtained.…”

Method for Collecting Single Epithelial Cells from the Mouse Larynx

“…[42][43][44] Brushing has also been employed to collect samples of precancerous malignant laryngeal lesions in head and neck cancer patients. 45 The optimization and use of the brush method to collect cells in small animals, like mice, will support preclinical research related to upper airway diseases, specifically the laryngeal epithelium. We acknowledge that instead of brushing, the whole larynx can be enzymatically dissociated into single cells that can be used for scRNA-seq, and non-target cells then removed during downstream analysis.…”

“…Using a brush approach, others have reported collecting cytological smears from the laryngeal mucosa primarily from humans and some large animals to study laryngeal abnormalities and tissue engraftment to reverse laryngeal structural disorders 42–44 . Brushing has also been employed to collect samples of precancerous malignant laryngeal lesions in head and neck cancer patients 45 . The optimization and use of the brush method to collect cells in small animals, like mice, will support preclinical research related to upper airway diseases, specifically the laryngeal epithelium.…”