Remmerbach T W, Weidenbach H, Pomjanski N, Knops K, Mathes S, Hemprich A, Böcking A
Department of Oral, Maxillofacial and Plastic Surgery, University of Leipzig, Nürnberger Strasse 57, D-04103 Leipzig, Germany.
Anal Cell Pathol. 2001;22(4):211-21. doi: 10.1155/2001/807358.
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.
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 excised 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.
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 sensitivity to 98.2%, specificity to 100%, positive predictive value to 100% and negative to 99.5%.
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.
本前瞻性研究旨在报告在我们诊所从白斑、溃疡或其他可疑口腔病变采集的传统口腔脱落细胞学检查的诊断准确性。此外，我们检查了DNA图像细胞术作为辅助诊断工具。我们的假设是DNA非整倍性是口腔刷片中肿瘤细胞早期识别的敏感且特异的标志物。
将从181例患者口腔黏膜肉眼可疑病变的脱落涂片以及因建立组织学诊断而切除的临床看似良性的口腔病变中获得的251例细胞学诊断结果，与各患者的组织学和/或临床随访结果进行比较。另外，使用电视图像分析系统在福尔根复染后测量核DNA含量。
我们对口腔涂片进行癌细胞检测的细胞学诊断敏感性为94.6%，特异性为99.5%，阳性预测值为98.1%，阴性预测值为98.5%。如果观察到异常DNA干系或DNA含量大于9c的细胞，则判定为DNA非整倍性。在此基础上，原位口腔鳞状细胞癌或浸润性癌涂片的DNA非整倍性患病率为96.4%。口腔涂片DNA非整倍性对癌细胞检测的敏感性为96.4%，特异性为100%，阳性预测值为100%，阴性为99.0%。两种技术联合使用可将敏感性提高到98.2%，特异性提高到100%，阳性预测值提高到100%，阴性提高到99.5%。
对于所有临床上被视为可疑癌变的可见口腔病变进行刷片细胞学检查，是一种易于实施、廉价、非侵入性、无痛、安全且准确的筛查方法，可用于检测各个阶段口癌前病变、原位癌或浸润性鳞状细胞癌。我们得出结论，DNA图像细胞术是一种非常敏感、高度特异且客观的辅助工具，可用于早期识别口腔涂片中的肿瘤上皮细胞。
