Cytological Grading of Oral Submucous Fibrosis

Abstract

Oral submucous fibrosis (OSMF) is a condition that was first described in the 1950s. It is caused as a result of addiction to harmful areca nut products with or without tobacco. The rationale of using exfoliative cytology in our study lies in the epithelial physiology where continuous exfoliation of epithelial cells is a part of physiological turnover. Deeper cells, which are strongly adhered in normal conditions, become loose in the case of malignancy and exfoliate along with superficial cells. Our aim in this study was to compare the cellular changes such as formation of micronuclei within the cell and cytomorphometric analysis of the buccal mucosal cells of OSMF patients with that of normal controls. We identified thirty three such cases of OSMF on the basis of oral inspection and examination. We used exfoliative cytology and liquid based cytogy to obtain buccal cells. The smear thus prepared was stained with feulgan fast green, acridine orange and papanicolou. Micronuclei were identified and cytomorphometric analysis was done using Adelta software. There was a change in the hue of Papanicolou from pink to purplish indicating the degree of keratinization from normal cells to cells affected by OSMF. Acridine orange gave a green emission at wavelength 480-490 to normal cells, while it gave a bright red fluorescence in cells undergoing apoptosis. Mean cellular diameter decreased from normalcells affected oral lesions. Mean nuclear cytoplasmic ratio increased from normal-cells to those affected by oral lesions. Frequency of micronuclei increased from normal to the cells affected by oral lesions. Buccal cell mutations in premalignant and malignant lesions can serve as a useful tool for the bio-monitoring of oral lesions. Exfoliative Cytology being minimally invasive and cost effective can help in mass screening programmes.