Nuclear pleomorphism-based cytopathological grading in human oral neoplasm

Abstract

Objective ― The objective of the present study is record the nuclear pleomorphism in various stages of oral carcinogenesis and to analyse their utility in cytopathological grading for early detection of human oral cancer Material and Methods ― In this hospital based case-control study, oral site, age-group and sex-matched 272 subjects (136 cases and 136 normal healthy individuals) were included. Scraped exfoliated cytosmears were collected from the affected oral site of the subjects and smearing was done in the pre-cleaned-coded glass-slides. Two such slides were prepared from each subject. The cytosmears were immediately fixed in aceto-alcohol (1 part of glacial acetic acid: 3 part of absolute ethyl alcohol) fixative. One set of the slide was stained with Papanicolaou’s stain and the other set was counter-stained with Giemsa’s Solution for cytopathological analysis. Test of proportion (z-test) was followed and the critical ratio (z-value) was calculated for the test of significance. Results ― Nuclear pleomorphism in the form of round, oval, spindle, elongated fiber as well as irregular shapes were mostly observed in oral squamous cells during different stages of carcinogenesis. Appearance of such nuclear pleomorphism in human oral neoplasm may be considered as a sign of cellular alternation in general and index of oral carcinogenesis in particular. In the present study, the frank malignant cases mimic to be either premalignant lesions or benign/carcinoma in situ were detected on the basis of nuclear pleomorphism-based cytopathological grading and so an increasing trend was observed from precancerous lesions to malignant cases due to shifting of numbers. Diagnostic tests also indicated that the Sensitivity was calculated to be 83.5%, Specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 30% and the accuracy was found to be 84.6%. Therefore, the nuclear pleomorphism-based cytopathological grading system makes itself an ideal screening test for early detection of human oral cancer. Conclusion ― Pattern of nuclear pleomorphism corresponding to various cytological atypias is a common feature observed during different stages of oral carcinogenesis and thus, it has a practical implication in grading and early detection of oral cancer.