Liu Y, Gao Y, Chen X J, Hua H
Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Feb 18;51(1):16-20. doi: 10.19723/j.issn.1671-167X.2019.01.004.
To evaluate the diagnostic efficiency of oral mucosa disease, especially oral squamous cell carcinoma (OSCC) and oral potential malignant disorders (OPMDs) by DNA cytometry compared with histopathological diagnosis, so as to find a convenient, simple and low-invasive method for screening and follow-up.
203 subjects with OSCC, OPMDs and other oral mucosa disease without dysplasia according to the inclusion criteria and exclusion criteria were recruited from Peking University School and Hospital of Stomatology. The mean age was (52.44±13.55) years, 98 males and 105 females. Brush biopsy was taken before scalpel biopsy at the same site. The brush biopsy sample was screened by moticytometer system for DNA cytometry after Feulgen stain, and histopathological examination were taken for the scalpel tissue. Data from DNA cytometry were used to calculate the parameters, such as sensitivity, specificity, positive and negative predictive values, odds ratios, Youden index (YI), positive and negative likelihood ratios, compared with the golden standard, histopathological diagnosis. DNA cytometry and histopathological diagnosis were performed back to back.
Totally, 42 OSCC and 4 tumor in situ (TIS), 39 oral leukoplakia (OLK) with dysplasia (17 mild dysplasia, 13 medium dysplasia and 9 severe dysplasia), 29 OLK with hyperplasia, 1 verrucous OLK, 83 oral lichen planus (OLP) and 5 inflammation were included in our research. We grouped the OSCC, TIS and dysplasia as the positive group and others without dysplasia as the negative group, the sensitivity of DNA cytometry was 79.07%, the specificity was 81.20%, and the diagnostic accuracy was 80.30%,We grouped the OSCC and TIS as the tumor group, OLP, OLK with hyperplasia and inflammation as the non-tumor group, The sensitivity of DNA cytometry in diagnosing OSCC and TIS was 95.65%, and the specificity was 81.2%, The diagnostic accuracy was 85.28%. positive predictive values 66.67%, negative predictive values 97.94%, ratio odds 95, positive likelihood ratio 5.09, negative likelihood ratio 0.05, and Youden index 0.77. For the dysplasia, we grouped the different dysplasia together as the dyaplasia group, OLP, OLK with hyperplasia and inflammation as the non-tumor group, the sensitivity of DNA cytometry in diagnosing dyaplasia is 60%, the specificity is 81.2%. The diagnostic accuracy is 75.8%, positive predictive values 52.17%, negative predictive values 85.59%, ratio odds 6.48, positive likelihood ratio 3.19, negative likelihood ratio 0.49, and Youden index 0.41.
DNA cytometry is convenient and low-invasive, which can be used as an adjuvant method for screening the early OSCC and OPMDs, monitoring the prognosis of OSCC after surgery. Further large-scale and long period prospective studies are necessary to validate the better value of DNA cytometry.
通过DNA细胞计量术评估口腔黏膜疾病，尤其是口腔鳞状细胞癌（OSCC）和口腔潜在恶性疾病（OPMDs）的诊断效率，并与组织病理学诊断进行比较，以寻找一种便捷、简单且低侵入性的筛查和随访方法。
根据纳入标准和排除标准，从北京大学口腔医学院招募了203例患有OSCC、OPMDs和其他无发育异常的口腔黏膜疾病的受试者。平均年龄为（52.44±13.55）岁，男性98例，女性105例。在同一部位进行手术刀活检前先进行刷检活检。刷检活检样本经Feulgen染色后，通过细胞计数仪系统进行DNA细胞计量术筛查，对手术刀活检组织进行组织病理学检查。将DNA细胞计量术的数据用于计算敏感性、特异性、阳性和阴性预测值、比值比、约登指数（YI）、阳性和阴性似然比等参数，并与金标准组织病理学诊断进行比较。DNA细胞计量术和组织病理学诊断依次进行。
本研究共纳入42例OSCC和4例原位癌（TIS）、39例有发育异常的口腔白斑（OLK）（17例轻度发育异常、13例中度发育异常和9例重度发育异常）、29例增生性OLK、1例疣状OLK、83例口腔扁平苔藓（OLP）和5例炎症。我们将OSCC、TIS和发育异常归为阳性组，其他无发育异常的归为阴性组，DNA细胞计量术的敏感性为79.07%，特异性为81.20%，诊断准确性为80.30%。我们将OSCC和TIS归为肿瘤组，OLP、增生性OLK和炎症归为非肿瘤组，DNA细胞计量术诊断OSCC和TIS的敏感性为95.65%，特异性为81.2%，诊断准确性为85.28%，阳性预测值为66.67%，阴性预测值为97.94%，比值比为95，阳性似然比为5.09，阴性似然比为0.05，约登指数为0.77。对于发育异常，我们将不同程度的发育异常归为发育异常组，OLP、增生性OLK和炎症归为非肿瘤组，DNA细胞计量术诊断发育异常的敏感性为60%，特异性为81.2%，诊断准确性为75.8%，阳性预测值为52.17%，阴性预测值为85.59%，比值比为6.48，阳性似然比为3.19，阴性似然比为0.49，约登指数为0.41。
DNA细胞计量术便捷且低侵入性，可作为筛查早期OSCC和OPMDs、监测OSCC术后预后的辅助方法。需要进一步开展大规模、长期的前瞻性研究以验证DNA细胞计量术更好的价值。
