Conventional Exfoliative Cytology Research Articles

Accuracy of liquid‐based cytology (LBC) in the oral mucosa according to novel diagnostic guidelines in Japan: Classification of cytology for oral mucosal disease (JSCC, 2015)

AbstractIntroductionRecently, the applications of liquid‐based cytology (LBC) have been extended to oral cytology, and in 2015, diagnostic guidelines having roots in the Bethesda System for oral exfoliative cytology were published by the Japanese Society of Clinical Cytology (JSCC): Classification of cytology for oral mucosal disease (JSCC, 2015). Here we aimed to evaluate the applicability of LBC in the oral mucosa in accordance with the novel diagnostic guidelines.MethodsTwo preparation techniques (conventional exfoliative cytology [CEC] with LBC and LBC alone) were used in this study. Intraepithelial lesions of the oral mucosa histologically diagnosed by biopsy or resection materials were selected as samples and multiple intraepithelial lesions in a single patient were counted. Deep‐seated lesions under the oral mucosa were excluded. The performance of cytological diagnosis was evaluated in each technique by comparing cytological diagnoses with histological diagnoses in accordance with the diagnostic guidelines.ResultsThe sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cytological diagnosis in CEC with LBC were 61%, 73%, 86%, 41%, and 64% (P ≤ .023), respectively. For LBC alone, these values were 55%, 79%, 92%, 29%, and 60% (P ≤ .024), respectively. The rates of inadequate samples were 0.83% for CEC with LBC and 1.2% for LBC alone against whole samples.ConclusionLBC showed good specificity, positive predictive value, and low rate of inadequate specimen, so it was suitable for oral cytology. The data used for this study reflect a large contribution in daily medical examination.

Comparative analysis of oral rinse-based cytology and conventional exfoliative cytology: A pilot study.

Oral exfoliative cytology is a novel technique of using cells to detect dysplastic changes in the oral cavity in potentially malignant disorders and malignant oral lesions in resourced challenged areas. The aim of this study was to compare specimen adequacy and cellular clarity between oral rinse-based smears and conventional smears in normal controls, histologically confirmed and clinically diagnosed squamous cell carcinoma, and oral leukoplakia. For many years, oral rinse-based cytology has been used to detect candidal colonization in microbiology. Emphasis has been placed to detect changes in oral rinse-based cytology. From this research and development, oral rinse-based cytology has evolved as a method of preparing samples for examination in cytopathology. Oral exfoliated cells from 10 cases of smears of potentially malignant disorders (oral leukoplakia), 10 cases of histologically confirmed and clinically diagnosed squamous cell carcinoma, and 10 controls with healthy mucosa were taken. Smears were stained with the Papanicolaou stain and were examined independently by two different oral pathologists. The results were compared to assess four parameters such as nuclear cytoplasmic ratio, sample adequacy, cellular distribution, and cellular clarity in both the smears. The results were then analyzed with SPSS (version 20) software using the descriptive statistics such as mean and standard deviation and inferential statistics such as t-test and one-way ANOVA. The level of significance was set at 5%. Oral rinse-based cytology was significantly more efficient than conventional exfoliative cytology in terms of cellular clarity (P < 0.001), cellular distribution (P < 0.001), and sample adequacy (P < 0.001). Oral rinse-based cytology shows overall improvement in cellular clarity, sample adequacy as compared to traditional exfoliative cytology.

Comparison of conventional smear cytology and manual liquid based cytology based on smears from normal oral exfoliated cells

Liquid-based cytology (LBC), since its inception in the 1990s, has shown significant advantages over conventional exfoliative cytology. LBC gives better results than conventional method as it not only enhances both sensitivity and specificity, but also provides material for further investigations. However, LBC requires expensive automated devices and materials, which might not be affordable for many cytopathology laboratories in countries with poor resources. In order to formulate an economic cytological procedure with the accuracy of LBC, smears made out of manual liquid based cytology (MLBC) technique was followed in this study and the results were compared with respective conventional cytology smears. To the authors’ knowledge, this is the first comparative study between MLBC and conventional method done for oral cavity in normal buccal mucosa. One hundred apparently normal subjects who reported to the outpatient department were selected after obtaining informed consent from all the subjects. Two Scrapings were made in each patient from the clinically normal appearing buccal mucosa. Both conventional and MLBC smears were stained by routine Papanicolaou technique and evaluated by three independent observers for specimen adequacy, thickness of the smear, uniformity of cell distribution, clarity or resolution of the cells, presence of background artifacts, and staining characteristics of the cells. Each parameter was graded as satisfactory; satisfactory but limited; or unsatisfactory. Number of satisfactory results obtained in MLBC smears was significantly higher than that by conventional smears. After comparison of smears prepared from conventional cytology and manual liquid-based cytology, we conclude that manual liquid-based cytology is both cost effective and also technically sound method with specific and clear results.

Cytopathological Changes Induced by the Crack Use in Oral Mucosa

Aims: To evaluate cytological alterations, inflammation, and microbial charge of the oral mucosa epithelium in crack users in in terms of the amount and duration of use. Methods: Two hundred thirty four crack users (case group) and 120 non-users (control group) participated in this study. Clinically healthy epithelial cells were collected from the posterior mouth floor, using the conventional exfoliative cytology. Some of the aspects evaluated were as follows: Papanicolaou classification, nuclear area (NA), cytoplasmic area (CA), nuclear/cytoplasmic area ratio (NA/CA), inflammation, microbial charge, keratinization, enucleated superficial cells, and binucleation. Results: The average time of crack consumption was 9.8 years (±7.1) and the average quantity of use was 13.97 g/week (±18.5). The average NA values and NA/CA ratio were increased and CA values were decreased in the case group compared to those in the controls (p < 0.05). Papanicolaou class II, intense inflammation, and intense microbial charge were more prevalent in the case group than in the controls (p < 0.05). There was a significant association between high quantity of smoked crack rocks per week and increased CA values, absence of keratinization, and presence of enucleated superficial cells (p < 0.05). Conclusion: Crack use seemed to induce inflammatory alterations and early indicators of malignant transformation on the oral mucosa epithelium.

A new approach to exfoliative cytology: A comparative cytomorphometric study.

Early detection of oral premalignancy and malignancy using simple screening aids play a promising role in curbing the disease. The primary aim of this study is to evaluate and the secondary aim of this study is to compare the cytomorphometry and cellular atypia in keratinocytes obtained from oral rinse and conventional exfoliative cytology in normal oral mucosa and clinically diagnosed oral leukoplakia. The study comprised of 55 clinically diagnosed cases of leukoplakia and 55 age and sex matched normal controls. Smears were prepared using oral rinse technique followed by the conventional exfoliative cytology. Papanicoloau stained smears were evaluated for atypia and subjected to image analysis. Based on the presence of atypia they were further divided into three groups (Group 1-cases with atypia, Group 2-without atypia and Group 3-normal controls) and analyzed. Statistical analysis used one-way analysis of variance followed by Tukey Honestly Significant Difference test for intergroup analysis and unpaired students t-test to compare the two methods. Smears prepared with both methods demonstrated atypia in 18 cases. The cellular diameter and cellular area (CA) were progressively increased from Group 1 through Groups 2 and 3 in both the smears. Nuclear diameter and nuclear area and nuclear cytoplasmic ratio progressively decreased from Group 1 through Groups 2 and 3. Both the methods showed no significant differences among the cellular parameters except in normal controls. Cytomorphometric analysis of keratinocytes obtained with oral rinse method and wooden spatula can serve as a useful screening aid to detect oral leukoplakia. Oral rinse method being more convenient results in smears of better quality.

Efficacy of Manual Liquid Based Cytology over Conventional Cytology in Oral Squamous Cell Carcinoma

Context/Background: Oral cytology has come long way from its primitive Papanicolau days. Liquid Based cytology has shown significant advantages over conventional exfoliative cytology. However, LBC requires expensive automated devices and materials which might not be affordable for many cytopathological laboratories in countries with limited resources. Manual liquid Based Cytology (MLBC) is a technique that enables cells to be suspended in a monolayer and thus improves detection of lesions and improvement of adequacy. Aim: To study and evaluate the diagnostic efficiency and reliability of MLBC in comparison with conventional PAP smear (CPS) of oral squamous cell carcinoma. Materials and Methods: Two smear were prepared from 50 patients, clinically diagnosed with Oral Squamous Cell Carcinoma. Each smear was subjected to MLBC and CPS methods. The slides were evaluated by two pathologists for the staining characterstics of nucleus and cytoplasm. The diagnostic efficiency of each smear was evaluated by comparing the cytological diagnosis of each method with histopathological diagnosis. Results: Increased detection rate with MLBC was 29.41%. Identifying cellular atypia by MLBC was more sensitive (44%) compared to CPS (34%) with similar specificity (100%). The percentage agreement by the two methods was 77.28%. Conclusion: MLBC is an easy, cost effective technique comparable to CPS; however, it warrants further study in its potential application in screening of oral precancer and cancer.

A comparative study between conventional and liquid‐based cytology in screening for anal intraepithelial lesions in HIV‐positive patients

Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low-cost and nonaggressive method, liquid-based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre-neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV-positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN-negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC- and LBC-negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid-based cytology are equally effective in screening for anal preneoplastic lesions.

Exfoliative Cytology and Cytocentrifuge Preparation of Oral Premalignant and Malignant Lesions

Objective: Oral exfoliative cytology is a sensitive and reliable diagnostic tool for the early diagnosis of oral cancer. Traditional exfoliative cytology, though popular, has limitations which could be overcome using cytocentrifuge preparations. The purpose of this study was to compare the efficacy of cytocentrifuged specimens with that of conventionally prepared smears in the diagnosis of oral premalignancy and malignancy. Study Design: Exfoliative cytology was performed on 30 patients with oral premalignant and malignant lesions. The yield was smeared immediately onto a slide for conventional exfoliative cytology (group A). The lesion was then scraped again and the yield was suspended in a bottle containing a fixative solution for cytocentrifuge apparatus-assisted smearing (group B). Both smears were stained with rapid Papanicolaou stain and assessed for cellularity, cellular and nuclear morphology, evaluation of mitosis and background. Result: All the criteria assessed were statistically significant (p value of <0.001) in group B except for mitosis, which was significant in group A. Conclusion: Cytocentrifuge preparations can preserve the cellular details and reduce the overlapping of cells, enabling precise interpretation and thus aiding in the diagnosis of premalignant and malignant lesions of the oral cavity.

The value of exfoliative cytology in the diagnosis of oral herpes simplex infection in immunosuppressed patients

Conventional exfoliative cytology was effective in confirming a clinical suspicion of oral mucosal infection by herpes simplex virus in nineteen out of twenty (95%) immunosuppressed patients who were studied.

Flow Cytometry of the Urinary Bladder

Flow cytometry now appears sufficiently developed technically to identify carcinoma of the bladder on irrigation specimens with accuracy comparable to that of conventional exfoliative cytology. The cancer cells are distinguished by abnormal levels of DNA per cell, which can be quantified with acridine orange, a metachromatic fluorescent dye for DNA and RNA. With this technique it is also possible to follow the development of carcinoma and assess the effects of treatment by quantifying the number of cancer cells present in the irrigation specimen.

Role of percutaneous fine needle aspiration in the diagnosis of lung cancer: our experience with 140 patients.

The authors have performed percutaneous fine needle aspiration (FNA) biopsy in 140 patients with pulmonary lesions of suspected neoplastic nature. In 63% of the cases histologic diagnosis could be made on the bioptic sample. Comparison of these findings with those obtained with conventional exfoliative cytology suggest that the latter technique gives higher percentage of histological characterization, it is free of complications and easier to perform. Thus, FNA appears to be an additional, irreplaceable tool when conventional methods fail to provide clear-cut information regarding the histologic nature of pulmonary lesions.