Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
Department of Environmental Pathology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan.
J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e390-e395. doi: 10.1016/j.jormas.2022.02.001. Epub 2022 Feb 5.
Keratinized lesions have been a conceivable false-negative (FN) factor in oral exfoliative cytology (OEC); however, other factors are poorly analyzed. In this study, we aimed to identify the factors influencing the accuracy of OEC and FNs focusing on the lesion characteristics, patient background, and surgeon factors in oral potentially malignant disorders (OPMD).
We retrospectively studied 44 patients who underwent both OEC and histopathological diagnosis. Sensitivity, specificity, FN rate, false-positive (FP) rate, and prevalence of both methods were compared. Similarly, accuracy indices were compared among clinical diagnosis groups (leukoplakia vs. other diagnosis). The association between patient and surgeon-related factors influencing FN OEC results were investigated using Fisher's exact test and a multiple logistic regression analysis.
Overall, the sensitivity; specificity; and FN, FP, and prevalence rates of OEC were 31.8%, 82.1%, and 68.8%, 17.9%, and 36.4%, respectively. Leukoplakia was significantly more common in clinical diagnosis (P = 0.007) with sensitivity, specificity, and FN rates of 20.0%, 95.2%, and 80.0%, respectively. Contrarily, non-keratinized lesions had sensitivity, specificity, and FN of 83.3%, 85.7%, and 16.7%, respectively. In the prevalent group, leukoplakia and anucleate squamous cells were significantly associated with FN cases (P = 0.013, P = 0.050). On multivariate analysis in OEC negative patients, age ≤64 (P = 0.050) and location on the tongue (P = 0.047) was independently associated with FNs.
FN of OEC was conceivable to be due to poor deep-seated cell sampling, which was associated with leukoplakia, age, and location. Therefore, these factors may be considered in the evaluation of OEC results.
角化病变一直是口腔脱落细胞学（OEC）中可能出现假阴性（FN）的因素；然而，其他因素分析得还不够充分。在这项研究中，我们旨在确定影响 OEC 准确性的因素，并重点关注口腔潜在恶性疾病（OPMD）中的病变特征、患者背景和外科医生因素。
我们回顾性研究了 44 名同时接受 OEC 和组织病理学诊断的患者。比较了两种方法的敏感性、特异性、FN 率、FP 率和患病率。同样，在临床诊断组（白斑 vs. 其他诊断）之间比较了准确性指标。使用 Fisher 精确检验和多变量逻辑回归分析调查了影响 FN OEC 结果的患者和外科医生相关因素之间的关联。
总体而言，OEC 的敏感性、特异性和 FN、FP 和患病率分别为 31.8%、82.1%和 68.8%、17.9%和 36.4%。白斑在临床诊断中更为常见（P=0.007），敏感性、特异性和 FN 率分别为 20.0%、95.2%和 80.0%。相反，非角化病变的敏感性、特异性和 FN 分别为 83.3%、85.7%和 16.7%。在流行组中，白斑和无核鳞状细胞与 FN 病例显著相关（P=0.013，P=0.050）。在 OEC 阴性患者的多变量分析中，年龄≤64 岁（P=0.050）和舌部位置（P=0.047）与 FN 独立相关。
OEC 的 FN 可能是由于深层细胞采样不佳所致，这与白斑、年龄和位置有关。因此，在评估 OEC 结果时可以考虑这些因素。
