Concordance between cytopathology and incisional biopsy in the diagnosis of oral squamous cell carcinoma

Abstract

Oral cytopathology is a simple, non-invasive technique that could be used for early detection of oral premalignant and malignant lesions, but the effectiveness of this diagnostic approach remains controversial. The aim of this study was to evaluate the sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology for diagnosing oral squamous cell carcinoma (OSCC) and the diagnostic concordance between cytopathological and histopathological diagnoses. The study enrolled 172 patients at outpatient clinics who presented with oral lesions suspicious of malignancy. All patients underwent oral cytological scrapes followed by an incisional biopsy. Of 148 cases that were histopathologically diagnosed with OSCC, the cytopathological method diagnosed 123 positive cases and resulted in a suspicion of OSCC in 16 patients. Based on these data, the sensitivity was 83.1%, the specificity was 100.0%, the positive predictive value was 100.0%, the negative predictive value was 49.0%, and the accuracy was 85.5%. The diagnostic concordance between histopathological and cytopathological examinations was 83.1% for OSCC and 85.7% for non-neoplastic lesions. The results indicate that cytopathological diagnosis had good concordance with histopathological diagnosis and showed high sensitivity, specificity, positive predictive value, and accuracy. We conclude that the sensitivity of oral cytopathology is sufficient to justify its use as a diagnostic screening test and to confirm the malignant nature of epithelial cells, mainly for the classification of OSCC. Therefore, cytopathology may be a reliable method for referring patients who require diagnosis of suspected oral cancer for starting treatment.

Diagnostic Concordance Characteristics of Oral Cavity Lesions

“…The efficiencies of fine-needle aspiration cytology and brush cytology were defined in the literature [22, 23]. Fontes et al [24] reported that cytopathology was a reliable method with 83.1% sensitivity and 100% specificity for patients who require the diagnosis of suspected squamous cell carcinoma for starting treatment. Thus, when dealing with such pathologic lesions with high misdiagnosis rates, adjunct techniques such as fine-needle aspiration cytology, brush cytology, or blood-urine sample analysis should be considered when appropriate.…”

Nuclear pleomorphism-based cytopathological grading in human oral neoplasm

“…Out of these, exfoliative cytopathology is, particularly, valuable for mass screening of oral carcinoma. Evaluating the quality of cytology as a diagnostic method for OSCC, Fonte et al (2013) have reported that the sensitivity was 83.1%, the specificity was 100%, the positive predictive value (PPV) was 100%, the negative predictive value (NPV) was 49% and the accuracy was 85.5% [56]. Recently, compared with cytopathological and histopathological diagnoses, Hafez et al (2014) have also found that the sensitivity was 93.5%; specificity was 96.2%; PPV was 97.7%; NPV was 89.3% with a diagnostic accuracy of 94.4%.…”

Meta-analysis of magnetic resonance imaging accuracy for diagnosis of oral cancer

“…Nevertheless, patients are often diagnosed in an advanced stage of disease. Diagnosis is late in most cases because patients do not seek treatment or do not have easy access to professionals who can establish the diagnosis [4]. …”