Department of Pathology, M.L.N. Medical College, Allahabad, India.
Department of Community Medicine, M.L.N. Medical College, Allahabad, India.
Acta Cytol. 2021;65(6):522-528. doi: 10.1159/000518582. Epub 2021 Sep 1.
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.
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.
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 (p 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.
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.
由于南亚国家比西方人口更多地使用烟草，因此其口腔上皮异型增生和口腔鳞状细胞癌（SCC）的发病率非常高。目前，目视检查和脱落细胞学检查是最常见的筛查和诊断方式，但这是一种主观分析。核大小、细胞大小和核质比等定量分析可能提供更准确的诊断并提高可重复性。本研究旨在评估形态计量学作为脱落细胞学的辅助诊断手段的作用，并得出一个显著的临界值，以识别慢性烟草使用者中发生 SCC 的风险人群。
这是一项在一家三级医院进行的为期 2 年的门诊前瞻性研究。评估了 150 例有至少 5 年慢性烟草使用史的病例。使用醋酸进行目视检查。采集口腔刮片进行细胞学和形态计量分析，然后在可能的情况下进行切开活检进行组织病理学评估。
在形态计量分析中，从正常细胞学涂片到口腔异型增生到 SCC，平均核面积和核质比（N:C）增加，而细胞质面积减少。方差分析和事后 Tukey 的诚实显著差异检验显示 3 组之间存在统计学差异（p 值<0.05）。使用 Youden 的指数计算出一个显著的 N:C 比值的临界值为≥0.08，其敏感性和特异性分别为 88%和 94%。
在高危病例中，形态计量学可以作为脱落细胞学和目视检查的有用辅助手段，用于早期准确诊断和及时干预口腔潜在恶性和恶性病变，从而改善预后。
