Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

Abstract

<b><i>Introduction:</i></b> Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. <b><i>Material and Methods:</i></b> This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. <b><i>Results:</i></b> On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (<i>p</i> value <0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. <b><i>Conclusion:</i></b> In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

Analysis of false-negatives in exfoliative cytology in oral potentially malignant disorders: A retrospective cohort study

“…The combination of these methods may be useful in determining the location of cell collection for OEC. Singh et al [28] conducted a histopathological study comparing direct examination, such as visual examination, and cytopathological diagnosis, and suggested the need to use more quantitative and objective indicators to determine the benignity or malignancy of mucosal lesions. Therefore, more careful evaluation is necessary to determine the extent and grades of the lesion by direct visual examination and staining methods.…”

MR histology reveals tissue features beneath heterogeneous MRI signal in genetically engineered mouse models of sarcoma

“…tumors, nuclear size and feature variance, as described above, are associated with tumor grade and aggressiveness (42)(43)(44). Although T2* is not widely employed in the clinical setting, further exploration of its utility may add great value to UPS MRI.…”