Greenspan J S, De Souza Y G, Regezi J A, Daniels T E, Greenspan D, MacPhail L A, Hilton J F
Department of Stomatology and Oral AIDS Center, University of California San Francisco, USA. stom%
Oral Dis. 1998 Jun;4(2):95-9. doi: 10.1111/j.1601-0825.1998.tb00264.x.
It has been observed that the cytopathic changes in hairy leukoplakia (HL) correlate with ultrastructural evidence of intra-keratinocyte herpes-type viral particles. In situ hybridization is considered to be the definitive confirmation of Epstein-Barr virus (EBV)-induced HL. This study evaluated the consistency of histopathological findings, which many believe to be diagnostic, with in situ hybridization for EBV-DNA in 60 patients with lesions clinically suggestive of HL.
Hematoxylin and eosin (H&E)-stained sections were reviewed independently by three oral pathologists who did not know the hybridization results. The presence in keratinocytes of nuclear inclusions and/or homogenization, believed to be specific for EBV in these lesions, was used as an indicator for infection. Cytoplasmic changes were evaluated separately.
With in situ hybridization, 48 cases were positive and 12 were negative. When the two methods were compared, pathologist concurrence ranged from 83% to 92%. False negatives ranged from 6% to 19%, and false positives ranged from 8% to 25%. Cytoplasmic ballooning, homogenization, and perinuclear clearing were evident in all cases of hybridization-confirmed HL; however, these changes were also noted in 75% (9/12) of the cases with negative hybridization results. Most confirmed HL cases exhibited both nuclear homogenization and inclusions, although the former was more consistently seen.
Cytoplasmic changes did not agree well with EBV-DNA hybridization results, whereas nuclear changes demonstrated good, but not complete, agreement. In appropriate clinical settings, the finding of nuclear inclusions and/or homogenization may be of diagnostic value. However, because the potential for false positives and negatives is high, H&E cytopathology should not be used as a substitute for in situ hybridization in the definitive diagnosis of oral hairy leukoplakia.
据观察，毛状白斑（HL）中的细胞病变与角质形成细胞内疱疹病毒样颗粒的超微结构证据相关。原位杂交被认为是爱泼斯坦-巴尔病毒（EBV）诱导的HL的决定性确诊方法。本研究评估了60例临床疑似HL病变患者的组织病理学检查结果（许多人认为该检查结果具有诊断价值）与EBV-DNA原位杂交结果的一致性。
三位不了解杂交结果的口腔病理学家独立复查苏木精-伊红（H&E）染色切片。角质形成细胞中核内包涵体和/或均质化的存在（被认为是这些病变中EBV的特异性表现）被用作感染指标。分别评估细胞质变化。
原位杂交结果显示，48例为阳性，12例为阴性。当比较这两种方法时，病理学家的一致率在83%至92%之间。假阴性率在6%至19%之间，假阳性率在8%至25%之间。在所有杂交确诊的HL病例中均可见细胞质气球样变、均质化和核周透亮；然而，在杂交结果为阴性的病例中，75%（9/12）也观察到了这些变化。大多数确诊的HL病例同时表现出核均质化和核内包涵体，尽管前者更常见。
细胞质变化与EBV-DNA杂交结果的一致性不佳，而核变化显示出良好但不完全的一致性。在适当的临床情况下，发现核内包涵体和/或均质化可能具有诊断价值。然而，由于假阳性和假阴性的可能性较高，在口腔毛状白斑的确诊诊断中，H&E细胞病理学不应替代原位杂交。
