Abstract
Introduction:Oral leukoplakia, the most common potentially malignant oral disorder (PMOD) may progress to oral squamous cell carcinoma (OSCC). Although, the current standard of care for assessing its malignant potential remains histological examination and assessing the severity of dysplasia, DNA ploidy analysis has been suggested as a surrogate marker to predict the behaviour of PMODs. Objectives:To detect aneuploidy and to correlate ploidy status with different grades of dysplasia in both tissue and cytology samples to predict the behaviour of these potentially malignant disorders and to assess the diagnostic utility of cytology samples for ploidy analysis. Methodology:After obtaining ethical clearance and consent, tissue and cytology samples of leukoplakia were collected and grouped based on the dysplastic findings into low-risk (n=20) and high-risk (n=20). DNA ploidy analysis was done using high resolution flow cytometry and its diagnostic utility was assessed. Results:Diagnostic utility was expressed in terms of sensitivity, specificity, PPV and NPV. On comparing the ploidy status of individual cases between tissue and cytology samples, cytology was able to accurately determine the ploidy status in majority of the cases. In the low-risk group, cytology had a sensitivity and specificity of 100% and a PPV and NPV of 100% with an overall diagnostic accuracy of 100%. Among the high-risk group, cytology had a sensitivity of 80% and specificity of 100% with a PPV of 100% and NPV of 83.33% and had an overall diagnostic accuracy of 90%. Combining both groups together, it had a sensitivity of 85.71% and specificity of 100% with a PPV of 100% and NPV of 92.31% and had an overall diagnostic accuracy of 94.74%. Conclusion:Overall, this study showed a positive correlation between cytology and tissue samples and ploidy and grade of dysplasia and cytology proved to be a simple and efficient with a reasonable diagnostic value.
Highlights
Oral leukoplakia, the most common potentially malignant oral disorder (PMOD) may progress to oral squamous cell carcinoma (OSCC)
Age and sex matched 40 subjects who were clinically diagnosed as oral leukoplakia were included in the study, and categorized into low-risk and high-risk based on histologic grading and comprised of 20 subjects in each group
Aneuploidy in cytology samples, was found in 20% of low grade and in 40% of high grade dysplasias, which showed a positive correlation between the grade and ploidy status, not statistically significant (p = 0.239) (Table 2)
Summary
The most common potentially malignant oral disorder (PMOD) may progress to oral squamous cell carcinoma (OSCC). Methodology: After obtaining ethical clearance and consent, tissue and cytology samples of leukoplakia were collected and grouped based on the dysplastic findings into low-risk (n=20) and high-risk (n=20). Results: Diagnostic utility was expressed in terms of sensitivity, specificity, PPV and NPV. In the low-risk group, cytology had a sensitivity and specificity of 100% and a PPV and NPV of 100% with an overall diagnostic accuracy of 100%. Among the high-risk group, cytology had a sensitivity of 80% and specificity of 100% with a PPV of 100% and NPV of 83.33% and had an overall diagnostic accuracy of 90%. The estimated prevalence of oral leukoplakia worldwide is approximately 2%, with an annual malignant transformation rate into OSCC of approximately 1% (Petti et al, 2003; Van der Waal et al, 2009). The prevalence of leukoplakia in India varies from 0.2% to 5.2% and the malignant transformation rates varied from 0.13% to 10% in various Indian populations (Mehta et al, 1969; Singh et al, 2004)
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