Bilimoria K F, Bhargava K, Mani N J, Shah R A
Acta Cytol. 1977 Mar-Apr;21(2):196-8.
A group of 57,518 industrial workers of Gujarat, India were screened for oral cancerous and precancerous oral lesions between 1967 and 1971. All subjects were 35 years of age or older and 95 per cent were males. The 27,841 oral lesions found were examined by cytologic scrapings and 13,230 were biopsied. Also, all lesions were followed clinically to assure a malignancy was not overlooked. There were 51 oral cancers diagnosed (.18% of the lesions and .09% of the entire study group). Computing all the cytologic smears, there was an overall accuracy exceeding 99 per cent. When assessing just the malignancies, the accuracy decreased to 80.4 per cent. Since there was a high degree of clinical suspicion on the part of the screeners, only one unsuspected cancer was discovered by cytology. There were four false positive interpretations; and 53 other specimens classified as "suspicious" subsequently were shown to be benign. Although exfoliative cytology has proved useful in assessing oral lesions as an adjunct to biopsy, the low frequency of oral cancer limits the value of this technique as a screening modality. Most false negatives have been associated with leukoplakic (hyperkeratotic) lesions. Therefore, in a persistent oral lesion, even though a cytologic scraping may not be suspicious or characteristic of malignancy, a biopsy should still be strongly considered.
1967年至1971年间，对印度古吉拉特邦的57518名产业工人进行了口腔癌及癌前口腔病变筛查。所有研究对象年龄均在35岁及以上，其中95%为男性。对发现的27841处口腔病变进行了细胞学刮片检查，并对13230处病变进行了活检。此外，对所有病变进行了临床随访，以确保没有遗漏恶性肿瘤。共诊断出51例口腔癌（占病变的0.18%，占整个研究组的0.09%）。计算所有细胞学涂片，总体准确率超过99%。仅评估恶性肿瘤时，准确率降至80.4%。由于筛查人员有高度的临床怀疑，通过细胞学仅发现了1例未被怀疑的癌症。有4例假阳性诊断；另外53例最初分类为“可疑”的标本后来被证明是良性的。尽管脱落细胞学已被证明作为活检的辅助手段在评估口腔病变方面有用，但口腔癌的低发病率限制了该技术作为筛查方式的价值。大多数假阴性与白斑（角化过度）病变有关。因此，对于持续存在的口腔病变，即使细胞学刮片可能不怀疑为恶性或不具有恶性特征，仍应强烈考虑进行活检。
