Cytologic and DNA-Cytometric Early Diagnosis of Oral Cancer

Abstract

Objective. The aim of this prospective study was to report on the diagnostic accuracy of conventional oral exfoliative cytology taken from white‐spotted, ulcerated or other suspicious oral lesions in our clinic. In addition we checked DNA‐image cytometry as an adjuvant diagnostic tool. Our hypothesis is that DNA‐aneuploidy is a sensitive and specific marker for the early identification of tumor cells in oral brushings. Study design. 251 cytological diagnoses obtained from exfoliative smears of 181 patients from macroscopically suspicious lesions of the oral mucosa and from clinically seemingly benign oral lesions which were exisiced for establishing histological diagnoses were compared with histological and/or clinical follow‐ups of the respective patients. Additionally nuclear DNA‐contents were measured after Feulgen restaining using a TV image analysis system. Results. Sensitivity of our cytological diagnosis on oral smears for the detection of cancer cells was 94.6%, specificity 99.5%, positive predictive value 98.1% and negative predictive value 98.5%. DNA‐aneuploidy was assumed if abnormal DNA‐stemlines or cells with DNA‐content greater 9c were observed. On this basis the prevalence of DNA‐aneuploidy in smears of oral squamous cell carcinomas in situ or invasive carcinomas was 96.4%. Sensitivity of DNA‐aneuploidy in oral smears for the detection of cancer cells was 96.4%, specificity 100%, positive predictive value 100% and negative 99.0%. The combination of both techniques increased the sensivity to 98.2%, specificity to 100%, positive predictive value to 100% and negative to 99.5%. Conclusions. Brush cytology of all visible oral lesions, if they are clinically considered as suspicious for cancer, are an easily practicable, cheap, non‐invasive, painless, safe and accurate screening method for detection of oral precancerous lesions, carcinoma in situ or invasive squamous cell carcinoma in all stages. We conclude that DNA‐image cytometry is a very sensitive, highly specific and objective adjuvant tool for the early identification of neoplastic epithelial cells in oral smears.

Predictive value of image cytometry for diagnosis of lung cancer in heavy smokers

“…It was increased with histological progression from normal through pre-invasive to malignant lesions, with median values of 0.034, 0.051, and 0.070%, respectively, which suggested that the high level of 5cER was related to the respective stage of development of pulmonary malignancy. Similar results have also been reported in other cancer studies [15,28]. It has been reported that 10-30% of bronchial carcinomas develop without cytomorphologically diagnostic malignant cells [29].…”

“…In several studies, image cytometry has been used to quantify the DNA content of cells, with the intention to differentiate malignant from benign lesions in various tissues, e.g. lung, oral, mucosal cervix, bladder and others [13][14][15].…”

Retracted: Impact of genomic instability in risk assessment and chemoprevention of oral premalignancies

“…Cytologic brushing is equivalent or even superior to biopsies at detecting oral cancer. 59 To our knowledge, corresponding results for oral premalignant lesions have not been reported.…”

Diagnostic Aids in Oral Cancer Screening

“…Yet these techniques are used for research purposes and are not clinically applicable. (Bourhis et al 1996 ;Remmerbach et al 2001;Maraki, Becker, and Boecking 2004;Maraki, Hengge, et al 2006;Maraki, Yalcinkaya, et al 2006;Yamazaki et al 2008 ;Nagamani et al 2010;Mohtasham et al 2010;OHTA et al 2010;Böcking et al 2011). In addition these methods are expensive and are not widely accessible and only expert clinicians can use them for early diagnosis.…”