Document Detail

Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas.
Jump to Full Text
MedLine Citation:
PMID:  25013502     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
The present study aimed to investigate the efficiency of exfoliative cytology by correlating the clinical lesions of oral squamous cell carcinoma (OSCC) with exfoliative cytology and histopathological findings. Cases of OSCC diagnosed between 1984 and 2010 were analyzed. The inclusion criteria for the present study were the availability of detailed clinical findings and a diagnosis of the disease through exfoliative cytology and histopathology. The cases were assessed and assigned scores, which were then submitted to modal expression analysis, which considers the higher frequency scores, thus relating the variables. The cytological findings demonstrated that the majority of the cases had malignant potential. Exfoliative cytology should be used as a supplementary tool for the diagnosis of OSCC, as it enables the early detection of these lesions. However, cytology should not be used as a substitute for histopathological examination.
Authors:
Michele Cardoso Sousa; Monica Ghislaine Oliveira Alves; Luciano Albino Souza; Adriana Aigotti Haberbeck Brandão; Janete Dias Almeida; Luiz Antonio Guimarães Cabral
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-03
Journal Detail:
Title:  Oncology letters     Volume:  8     ISSN:  1792-1074     ISO Abbreviation:  Oncol Lett     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-7-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101531236     Medline TA:  Oncol Lett     Country:  -    
Other Details:
Languages:  ENG     Pagination:  799-802     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Oncol Lett
Journal ID (iso-abbrev): Oncol Lett
Journal ID (publisher-id): OL
ISSN: 1792-1074
ISSN: 1792-1082
Publisher: D.A. Spandidos
Article Information
Download PDF
Copyright © 2014, Spandidos Publications
open-access:
Received Day: 07 Month: 10 Year: 2013
Accepted Day: 24 Month: 4 Year: 2014
Print publication date: Month: 8 Year: 2014
Electronic publication date: Day: 03 Month: 6 Year: 2014
pmc-release publication date: Day: 03 Month: 6 Year: 2014
Volume: 8 Issue: 2
First Page: 799 Last Page: 802
PubMed Id: 25013502
ID: 4081384
DOI: 10.3892/ol.2014.2212
Publisher Id: ol-08-02-0799

Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas
MICHELE CARDOSO SOUSA
MONICA GHISLAINE OLIVEIRA ALVES
LUCIANO ALBINO SOUZA
ADRIANA AIGOTTI HABERBECK BRANDÃO
JANETE DIAS ALMEIDA
LUIZ ANTONIO GUIMARÃES CABRAL
Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP, Univ. Estadual Paulista, São José dos Campos, São Paulo 12245-000, Brazil
Correspondence: Correspondence to: Mrs. Monica Ghislaine Oliveira Alves, Univ. Estadual Paulista, 777 Engenheiro Francisco José Longo Avenue, São José dos Campos, São Paulo 12245-000, Brazil, E-mail: mgoliveiraalves@gmail.com

Introduction

Oral squamous cell carcinoma (OSCC) is the most common type of cancer of the oral cavity worldwide (13). In Brazil, the annual number of cancer-associated mortalities is 6,214, with ~14,120 news cases reported in 2010. OSCC is the sixth most common type of cancer and the most frequent type of head and neck cancer (4). The disease primarily affects males between 40 and 65 years old (2). Smoking is the most significant etiological factor for the development of OSCC, and the risk of OSCC increases markedly if smoking is combined with alcohol consumption (57). The lateral border of the tongue is the most affected oral site (2,8). In patients with OSCC, survival is directly associated with early diagnosis (6,9), particularly in those with a potentially malignant disorder, including leukoplakia and erythroplakia, which may precede the development of OSCC or be present in association with OSCC (10).

In the early stages, OSCC frequently clinically manifests as inoffensive with asymptomatic lesions. As a consequence, patients are likely to postpone medical care, thus delaying the diagnosis and adequate treatment, resulting in a poorer prognosis (11,12). By contrast, the difficulty in establishing an accurate diagnosis is lower in cases in which the symptoms are more pronounced (3). Anatomopathological examination of lesion biopsies is the most important method for diagnosing OSCC (3,13,14). However, obtaining a sample through biopsy is invasive and technically difficult (15). Exfoliative cytology has been shown to be an efficient diagnostic method, particularly in the more advanced stages of the disease (13), and cytological analysis is beneficial for assessing cellular alterations in epithelial tissues exhibiting a normal appearance (16).

Raab and Grzybicki (17) proposed that correlation analyses are highly valuable in the fields of cytopathology and surgical pathology, as correlation analysis generates much data that may be used to improve diagnostic testing and screening processes. However, it is necessary to develop standardized methods for correlation analyses and to use correlation data to redesign testing and screening processes to enhance the quality of such processes, as well as patient safety (17).

The present study aimed to correlate the clinical lesions of OSCC with exfoliative cytology and histopathological findings in order to assess the efficiency of exfoliative cytology.


Materials and methods
Patients

The present study was approved by the Ethics Committee of Institute of Science and Technology, UNESP, Univ. Estadual Paulista (São José dos Campos, Brazil; protocol no. 044/2009-PHCEP) and patients provided written informed consent. Cases of OSCC that were diagnosed at the Institute of Science and Technology, UNESP, Univ. Estadual Paulista between 1984 and 2010 were analyzed. The clinical, histological and cytological records of patients observed at the Stomatology outpatient clinic were reviewed for data collection.

Patients were included in the present study based on the following inclusion criteria: (i) The availability of detailed clinical findings; and (ii) the diagnosis of OSCC using exfoliative cytology and histopathology. Scores were attributed to the morphological features of each case. The clinical findings are presented based on the degree of aggressiveness of the OSCC (Table I).


Exfoliative cytology

Patients underwent exfoliative cytology of the lesion using a cytobrush (Vagispec, Jaraguá do Sul, SC, Brazil), and all samples were stained using the Papanicolaou method. The results were classified with using the following criteria proposed by Papanicolaou and Trout (18) (Table II): Class I, normal; class II, inflammatory changes; class III, atypical cells, suspect smear; class IV, non-conclusive of malignancy; and class V, malignant.

Histological staining

The histological sections obtained from the patients with OSCC were stained using hematoxylin and eosin, and were analyzed using light microscopy by an examiner. Slides were scored between 1 and 4 according to the system proposed by Anneroth et al (19) (Table III).

For better correlation, the results were submitted to modal expression using the scores, considering the higher frequency scores related to each other.


Results and Discussion

In total, 53 of the 316 OSCC cases met the inclusion criteria; 41 were male and 12 were female, with an age range between 28 and 88 years. Table IV shows the correlation between the clinical, cytological and histological findings. Among the 53 cases analyzed, 28.3% were classified as Papanicolaou class III, 3.77% as class IV and 58.71% as class V. Thus, 86.79% of the cases were found to have malignant potential.

Previous studies that have compared the efficacy of exfoliative cytology and histopathology for the diagnosis of OSCC have shown that exfoliative cytology is an effective method (1,13,20). In the present study, only 53 cases of OSCC met the inclusion criteria. The majority of these cases were from the Stomatology Outpatient Clinic of the Institute of Science and Technology, indicating that exfoliative cytology may be primarily used at universities. Although this technique is practical, inexpensive, simple and non-invasive (3,13,21), dentists do not use this method routinely for the early detection of OSCC (14,22).

The results of the present study showed no direct correlation between the clinical, cytological and histological scores. This finding indicates that it is not possible to predict the behavior of OSCC based solely on the observation of clinical features. In accordance with this, in the present study, a histological score of 2 or 3 was attributed to three cases of erythroleukoplakia, demonstrating that the mild clinical findings did not correspond with the aggressive histological characteristics. In addition, a histological score of 1 was attributed to one case presenting a nodule that was clinically scored as 2.

In the present study, three cases showing clinical features of a shallow ulcer <2 cm, exulceration >2.5 cm and a destructive and infiltrative ulcer were classified as Papanicolaou class I or II using cytological analysis. These findings, which demonstrate the lack of efficiency of exfoliative cytology, may be explained by non-representative sampling and/or individual subjectivity (17,23), since this is a retrospective study in which the cytological tests were not performed by the same examiner.

Exfoliative cytology involves the analysis of superficial epithelial cells that are obtained through scraping (24,25) the lesion using a sterile cytobrush (22). Thus, collecting deeper cells from plaques or nodules is difficult, which compromises the accuracy of the technique (1,15). This limitation was observed in the present study, in which three cases presenting with nodules and one case presenting with an erythroleukoplakia plaque were diagnosed as cytological score 1. In the present study, analysis of the cytological findings suggested that the majority of the cases had malignant potential, indicating that exfoliative cytology may be beneficial as a supplementary tool for diagnosing OSCC.

Oral cytology is useful for monitoring patients undergoing treatment in order to guide the selection of sites for incisional biopsies (26,27) and to analyze lesions with malignant potential with high sensitivity and specificity, leading to an early diagnosis (28). In addition, oral cytology has been used to identify changes prior to their clinical visibility (27). The advantages of exfoliative cytology make it a particularly useful diagnostic method for obtaining early test results. Furthermore, cases with more symptoms that are associated with more advanced stages of the disease are easily diagnosed due to the obvious clinical features (29).

At present, dentists observe the development of non-specific ulcers for 14 days after the first visit, and then establish an objective diagnosis (30). Thus, exfoliative cytology may obtain a more rapid diagnosis (5,19,31).

Although exfoliative cytology should not be used as a substitute for histopathological examination, the present study has demonstrated the efficiency of exfoliative cytology for the diagnosis of OSCC and has shown that it may be beneficial as an additional tool to enable early referral of patients to a specialized service.


References
1. Ramaesh T,Mendis BR,Ratnatunga N,Thattil RO. Diagnosis of oral premalignant and malignant lesions using cytomorphometryOdontostomatol Trop222328Year: 199911372099
2. de Faria PR,Cardoso SV,de A,Nishioka S,Silva SJ,Loyola AM. Clinical presentation of patients with oral squamous cell carcinoma when first seen by dentists or physicians in a teaching hospital in BrazilClin Oral Invest74651Year: 2003
3. Driemel O,Kunkel M,Hullmann M,von Eggeling F,Müller-Richter U,Kosmehl H,Reichert TE. Diagnosis of oral squamous cell carcinoma and its precursor lesionsJ Dtsch Dermatol Ges510951100Year: 2007 (In German). 18042091
4. Jemal A,Siegel R,Ward E,Hao Y,Xu J,Murray T,Thun MJ. Cancer Statistics, 2008CA Cancer J Clin587196Year: 200818287387
5. Ahmed HG,Ebnoof SO,Hussein MO,Gbreel AY. Oral epithelial atypical changes in apparently healthy oral mucosa exposed to smoking, alcohol, peppers and hot meals, using the AgNOR and Papanicolaou staining techniquesDiagn Cytopathol38489495Year: 201019894260
6. Jan JC,Hsu WH,Liu SA,Wong YK,Poon CK,Jiang RS,Jan JS,Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experienceJ Oral Maxillofac Surg69396404Year: 201121238843
7. Zygogianni AG,Kyrgias G,Karakitsos P,Psyrri A,Kouvaris J,Kelekis N,Kouloulias V. Oral squamous cell cancer: early detection and the role of alcohol and smokingHead Neck Oncol32Year: 201121211041
8. Holmes JD,Martin RA,Gutta R. Characteristics of head and neck cancer patients referred to an oral and maxillofacial surgeon in the United States for managementJ Oral Maxillofac Surg68555561Year: 201020171475
9. Bachar G,Hod R,Goldstein DP,Irish JC,Gullane PJ,Brown D,Gilbert RW,Hadar T,Feinmesser R,Shpitzer T. Outcome of oral tongue squamous cell carcinoma in patients with and without known risk factorsOral Oncol474550Year: 201121167767
10. Liu W,Wang YF,Zhou HW,Shi P,Zhou ZT,Tang GY. Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patientsBMC Cancer10685Year: 201021159209
11. Pitiphat W,Diehl SR,Laskaris G,Cartsos V,Douglass CW,Zavras AI. Factors associated with delay in the diagnosis of oral cancerJ Dent Res81192197Year: 200211876274
12. Peacock ZS,Pogrel MA,Schmidt BL. Exploring the reasons for delay in treatment of oral cancerJ Am Dent Assoc13913461352Year: 200818832270
13. Maraki D,Becker J,Boecking A. Cytologic and DNA-cytometric very early diagnosis of oral cancerJ Oral Pathol Med33398404Year: 200415250831
14. Morse DE,Psoter WJ,Cuadrado L,Jean YA,Phelan J,Mittal K,Buxó CJ,Cruz GD,Elias A. A deficit in biopsying potentially premalignant oral lesions in Puerto RicoCancer Detect Prev32424430Year: 200919250772
15. Epstein JB,Zhang L,Rosin M. Advances in the diagnosis of oral premalignant and malignant lesionsJ Can Dent Assoc68617621Year: 200212410942
16. Burzlaff JB,Bohrer PL,Paiva RL,Visioli F,Sant’Ana Filho M,da Silva VD,Rados PV. Exposure to alcohol or tobacco affects the pattern of maturation in oral mucosal cells: a cytohistological studyCytopathology18367375Year: 200717680816
17. Raab SS,Grzybicki DM. Cytologic-histologic correlationCancer Cytopathol119293309Year: 201121732549
18. Papanicolaou GN,Traut HF. Diagnosis of uterine cancer by the vaginal smearAm J Med Sci206811Year: 1943
19. Anneroth G,Batsakis J,Luna M. Review of literature and a recommended system of malignancy grading in oral squamous cell carcinomasScand J Dent Res95229249Year: 19873299675
20. Divani S,Exarhou M,Theodorou LN,Georgantzis D,Skoulakis H. Advantages and difficulties of brush cytology in the identification of early oral cancerArch of Oncol171112Year: 2009
21. Mehrotra R,Gupta A,Singh M,Ibrahim R. Application of cytology and molecular biology in diagnosing premalignant or malignant oral lesionsMol Cancer511Year: 200616556320
22. Queiroz JB,Lima CF,Burim RA,Brandao AA,Cabral LA,Almeida JD. Exfoliative cytology of the oral mucosa: comparison of two collection methodsGen Dent58e196e199Year: 201020829152
23. Nichols ML,Quinn FB Jr,Schnadig VJ,Zaharopoulos P,Hokanson JA,Des Jardins L,McCracken MM. Interobserver variability in the interpretation of brush cytologic studies from head and neck lesionsArch Otolaryngol Head Neck Surg11713501355Year: 19911845260
24. Almeida JD,Cabral LAG,Brandão AAH. Exfoliative cytology as a diagnostic method in stomatologyJ Dent Res73765Year: 1994
25. Acha A,Ruesga MT,Rodríguez MJ,Martínez de Pancorbo MA,Aguirre JM. Applications of the oral scraped (exfoliative) cytology in oral cancer and precancerMed Oral Patol Oral Cir Bucal1095102Year: 2005 (In Spanish). 15735540
26. Potter TJ,Summerlin DJ,Campbell JH. Oral malignancies associated with negative transepithelial brush biopsyJ Oral Maxillofac Surg61674677Year: 200312796875
27. Pérez-Sayánsm M,Somoza-Martín JM,Barros-Angueira F,Reboiras-López MD,Gándara-Vila P,Gándara Rey JM,García-García A. Exfoliative cytology for diagnosing oral cancerBiotech Histochem85177187Year: 201020426699
28. Pérez-Sayáns M,Reboiras-López MD,Gayoso-Diz P,Seijas-Naya F,Antúnez-López JR,Gándara-Rey JM,García-García A. Non-computer-assisted liquid-based cytology for diagnosis of oral squamous cell carcinomaBiotech Histochem875965Year: 201221526909
29. Friedrich RE. Delay in diagnosis and referral patterns of 646 patients with oral and maxillofacial cancer: a report from a single institution in Hamburg, GermanyAnticancer Res3018331836Year: 201020592388
30. Epstein JB,Gorsky M,Fischer D,Gupta A,Epstein M,Elad S. A survey of the current approaches to diagnosis and management of oral premalignant lesionsJ Am Dent Assoc13815551562Year: 200718056099
31. Mishra M,Mohanty J,Sengupta S,Tripathy S. Epidemiological and clinicopathological study of oral leukoplakiaIndian J Dermatol Venereol Leprol71161165Year: 200516394403

Article Categories:
  • Articles

Keywords: pathology, squamous cell carcinoma, oral cancer, cytology.

Previous Document:  Drug resistance reversed by silencing LIM domain-containing protein 1 expression in colorectal carci...
Next Document:  Investigation of the epidermal growth factor receptor mutation rate in non-small cell lung cancer pa...