Exfoliative Cytology Research Articles

Adenoid cystic carcinoma of the cribriform pattern and solid lung: case report

Adenoid cystic carcinoma (ACC) is a malignant neoplasm originating in the salivary glands. However, this type of tumor can be located less frequently in other sites, in this case we focus on the lung. The following case report is about a 63-year-old male, with 2 months of evolution with the presence of dry cough, fever and chest pain. Adenoid cystic carcinoma is diagnosed through biopsy, whether guided by bronchoscopy, thoracoscopy or thoracotomy and exfoliative cytology, these methods allow us to make a definitive diagnosis, which is confirmed by histology/ immunohistochemistry.

Assessment of the quality of oral biopsy procedure videos shared on YouTube.

The aim of this study was to assess the quality of free-to-access videos on oral biopsy procedures on the YouTube platform. We conducted a search on YouTube using the term "oral biopsy" and selected the first 100 videos in order of relevance. The following exclusion criteria were applied: language other than English, videos that did not cover oral biopsy techniques, videos on nonhuman specimens, postoperative instructions, personal experiences, exfoliative cytology, or "brush biopsy." Forty-seven selected videos were classified based on their duration, country of origin, date of upload to the system, author, information source and number of views, and likes and dislikes. Video quality was analyzed using DISCERN, the Global Quality Scale (GQS), and the Video Information and Quality Index (VIQI). The majority (78.7%) of analyzed videos were uploaded by dentists, originating from India (48.9%), with a mean duration of 11.8 min (SD, 20.4), with 104.5 likes (SD, 186.4) and 7.1 dislikes (SD, 10.55). The mean values for DISCERN, GQS, and VIQI were 1.3 (SD, 0.52), 2.1 (SD, 1.04), and 9.62 (SD, 1.69), respectively. The majority of videos on oral biopsy published on YouTube are of low quality.

Comparison of liquid-based cytology and conventional preparations in nongynecological cytology

Abstract Introduction: The liquid-based cytology (LBC) has shown significant advantages over conventional preparation in cervical cytology. The use of LBC in aspiration and exfoliative nongynecologic cytology has been on the rise since the last few years with relatively few studies being available depicting its role in fine-needle aspiration cytology (FNAC) from other sites. The study aimed to determine the diagnostic efficacy of LBC in nongynecological exfoliative as well as FNAC samples and compare the conventional and LBC methods for cytomorphological differences. Materials and Methods: This is a cross-sectional, analytical study that included the samples collected from two tertiary care centers over 8 months (January 2022 to August 2022). A total of 168 consecutive samples of aspiration and exfoliative nongynecological cytology were included. In each case, two passes were carried out one for a conventional smear (CS) and the other for LBC by Eziprep/Thin Prep (TP) method followed by smear staining with H and E stain and Leishman’s stain. The slides were studied by two observers for cellularity, background (blood and necrotic cell debris), informative background (such as colloid, stromal fragments, etc.), presence of monolayer cells, and cell architecture with nuclear and cytoplasmic details by a semiquantitative scoring system. Statistical analysis was performed using Wilcoxon signed-rank test on the SPSS program and histopathology correlation was attempted wherever available by using OpenEpi software version 3. Results: The mean age was 40 years, with the majority being females (70%). The TP smears were qualitatively superior to CS with statistical differences observed in fluid cytology. There was no statistical difference observed at other sites; except TP being superior to CS with regard to the background in breast cytology. The arithmetic mean in TP was higher than CS in all the parameters. Conclusions: The cytology smears of TP were qualitatively superior to CS in aspiration and nongynecological cytology. Overall diagnostic accuracy was comparable in both techniques. The core competencies addressed in this article are: Medical knowledge, Procedural skills, Practice-based learning and improvement, and Professionalism.

Sampling Methods and their Prospects in Liquid-Based Cytology of Oral Mucosa: A Comparative Study.

Examining epithelial cells in the mouth cavity is simple and non-invasive with exfoliative cytology. Liquid-based cytology is an additional diagnostic technique that can improve the specificity and sensitivity of conventional cytology. The purpose of our study was to describe the consistency of normal oral mucosa samples obtained with three different tools: the Cytobrush®, dermatological curette, and OralCDx® for liquid-based cytology. Literature review was done, and reporting of the improvements in the field of investigation and diagnosis has been reported. The present communication aims toward comparing three different sampling instruments such as Cytobrush, curette, and OralCDx for liquid-based cytology of the oral mucosa.

Gender-based cytomorphometric analysis of buccal exfoliated cells in a South Indian population.

To assess differences based on gender in nuclear area (NA), cytoplasmic area (CA), and nuclear-cytoplasmic ratio (N:C ratio) values for clinically normal buccal smears in apparently healthy subjects of a South Indian population, thereby providing definitive baseline cytomorphometric measurements for the South Indian population. Buccal smears were collected from 60 healthy subjects (30 males and 30 females) of a South Indian population above 18 years in age. Values of the NA and CA were measured, and the N:C ratio calculated, using ImageJ software. Statistical analysis of the data with independent t tests and 95% confidence intervals was done using SPSS version 21 (significance set at P < 0.05). The results showed that there were significant differences in the NA, CA, and N:C values between males and females irrespective of age (P = 0.01). Definitive gender-specific baseline cytomorphometric data can be established using exfoliative cytology for the South Indian population, and this may be helpful in deciphering the occurrence of oral pre-malignant diseases and oral squamous cell carcinoma in this population, as the incidence of these conditions varies with gender and different ethnic groups.

Tumor cell-based glycolytic metabolism and single-cell sequencing of urinary exfoliated cells for the diagnosis and molecular profiling of urothelial carcinoma

Objective: To explore the diagnostic values of HK2 testing and single-cell sequencing in the urothelial carcinoma (UC). Methods: The qualified urine specimens of 265 suspected UC patients or postoperative patients from the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China were collected. Both exfoliative cytology and HK2 testing were performed on clinically suspected UC or postoperative patients. The performance of diagnostic cytology and HK2, including consistency, sensitivity, specificity, positive predictive value and negative predictive value, was evaluated based on histopathological, clinical and imaging diagnosis. Isolated HK2 metabolically abnormal cells were subject to single-cell sequencing to verify the reliability of HK2 detection performance and to explore the molecular characteristics of UC. Results: The concordance rate of HK2 testing and cytology for detecting UC was 90.3% (102/113, Kappa=0.604). Compared with cytology, the sensitivity of HK2 was significantly higher (85.2% versus 75.6%, P=0.024). The detection sensitivity of combined HK2 testing and cytology was increased to 91.1%. HK2 testing was significantly more sensitive than cytology for diagnosing UC in the upper urinary tract (81.8% versus 65.5%, P=0.022). It was also more sensitive than cytology for diagnosing early-stage UC (82.6% versus 69.5%, P=0.375) and low-grade UC (69.6% versus 47.8%, P=0.125). Single-cell sequencing of the ten patients, whose samples were positive for HK2, demonstrated highly concordant copy number variations (CNVs) in tumor cells from the same UC patient, with heterogeneity in CNV profiles among different patients. Deletion of chromosome 8p was found in 3 of the 4 urine samples of renal pelvis UC. The 2 patients with benign lesions had no CNVs in all sequenced cells. Conclusions: The test for abnormal urinary glycolytic HK2 metabolism can assist urine cytology to improve the sensitivity of UC diagnosis, and it provides a novel and reliable approach for early detection of upper urinary tract UC and lower grade UC. Meanwhile, this study has preliminarily revealed the feasibility of single-cell sequencing in urinary samples, which is expected to improve the diagnostic specificity of HK2 testing.

Diagnosis of Oral Cancers by Targeting VPAC Receptors: Preliminary Report.

Oral cancer is a major health problem. The study of exfoliative cytology material helps in the differentiation of premalignant and malignant alterations of oral lesions. The objective of this study was to assess the feasibility of detecting oral cancer by targeting genomic VPAC (combined vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide) receptors expressed on malignant oral cancer cells. All patients with suspected oral cavity cancers/lesions formed the study group. The samples from the oral cavity lesion or suspicious area were collected with a cytology brush. The harvested material was examined for malignant cells by 1. the standard PAP stain and 2. targeting the VPAC receptors on the cell surface using a fluorescent microscope. Similarly, malignant cells were identified from cells shed in oral gargles. A total of 60 patients with oral lesions were included in the study. The histopathological diagnosis was squamous cell carcinoma in 30 of these. The VPAC receptor positivity both on the brush cytology staining as well oral gargle staining was more sensitive than the brush cytology PAP staining. The accuracy of the various techniques was as follows, brush cytology PAP staining at 86.67%, brush cytology VPAC staining at 91.67% and oral gargle VPAC staining at 95%. This preliminary study validates our belief that malignant cells in the saliva can be identified by targeting the VPAC receptors. The test is simple, easy, non-invasive and reliable in the detection of oral cancers.

Cytological Detection of Iron Overload and Cytomorphometric Changes in buccal Mucosa of Βeta Thalassemia Major Patients

Aim: In this study, the phenomenon of oral exfoliative cytology is explored and buccal squamous cells are examined for intracytoplasmic, Prussian blue stained, iron containing granules. In addition, these buccal squamous cells are subjected to morphometric measurements of their nuclear and cytoplasmic diameter along with their ratios. Methods: It was a Descriptive, Cross sectional study including 120patients of Thalassemia Major, ranging from 4 -18 years with repeated blood transfusions and a serum ferritin level of 1000ng/ml at minimum. Scrapings were obtained from buccal mucosa for cytological examination and stained with Prussian Blue Stain. Results: The study included 45 female and 75 male patients with a mean age 11.04(± 3.81) years. 56out of 120 patients were positive for Prussian blue and thus showed 46.6% positivity. The mean cytoplasmic diameter was 50.90 (± 0.64) microns and mean nuclear diameter was 9.31(±0.53) microns. Mean Nuclear to cytoplasmic (NC) ratio was 0.182(± 0.01) and ranged from 0.165 and 0.211 microns. Conclusion: The positivity of Prussian blue in our study is clearly less than most of the quoted figures while alterations in morphometric features of buccal squamous cells are quite consistent with reported data. In our study, we observed iron containing granules not only in the cytoplasm but also on surface of cells like a clue cell dispersed outside the cell, individually or in discrete clusters and as faint bluish hue in background. Keywords: Iron overload, Cytomorphometry, buccal smear, Prussian blue, Beta Thalassemia

Uncommon case of cytopathological features of sialadenoma papilliferum.

Sialadenoma papilliferum, a benign and rare salivary gland neoplasm, accounts for 0.4%-1.2% of all salivary gland tumors and occurs primarily in minor salivary glands of the oral cavity. Here, we report a case of sialadenoma papilliferum and its associated cytological findings. A papillary tumor was incidentally detected on the palate of an 86-year-old Japanese man. Conventional oral exfoliative cytology was performed; the cytology smear exhibited epithelial clusters composed of atypical epithelial cells with a high nuclear/cytoplasm ratio and arranged in sheet or small papillary-like projections. Cytoplasmic vacuoles were also observed in the papillae. It was difficult to make a definitive diagnosis due to the presence of uncommon cytological features. The excisional biopsy specimen revealed histological features characteristic of sialadenoma papilliferum. Mutational analysis detected BRAFV600E mutation, which confirmed the diagnosis of sialadenoma papilliferum. To the best of our knowledge, no prior cytomorphological evaluations of sialadenoma papilliferum have been reported in detail. Oral exfoliative cytology specimens from salivary gland tumors can demonstrate uncommon cytomorphological features. A differential diagnosis of sialadenoma papilliferum can be based on the observation of mildly atypical epithelial cells that form small papillary-like structures.

Cytomorphometry of Normal Exfoliated Gingival Cells: An Analytical Study

Introduction: Gingiva is lined by stratified squamous epithelium. One of the most common types of carcinoma in the world is oral cancer. Gingival cancers are a common type of oral neoplasm. In order to compare normal tissue with pathological smears using exfoliative oral cytology with morphometry, a baseline must be established. A study was conducted to obtain nuclear area (NA), cytoplasmic area (CA), and N:C ratio-nuclear: Cytoplasmic ratio of exfoliated normal gingival cells and to correlate it with healthy individuals by their age and gender. Methodology: Exfoliated gingival squamous cell smears were obtained from 200 subjects (100 males, 100 females) belonging to age groups &lt;20 years, 21–40 years, 41–60 years, and &gt;60 years. Smears were fixed and stained by routine Hematoxylin and Eosin staining procedure. With the use of both ocular micrometer and stage micrometer different cellular parameters were measured. Student’s t-test was used for statistical analysis. Results: There were significant differences in NA, CA, and N:C ratio with age regardless of gender. Different age groups of males showed significant variations (P &lt; 0.0001) in all the above parameters. The same was true for different age groups of females. In terms of NA, CA, and N:C ratio, the difference between both genders was significant regardless of age. Conclusion: Gingival smears showed age and sex-linked changes in NA, CA, and nuclear: Cytoplasmic ratio. It might serve as a standard for these variables when comparing similar measurements based on pathologic smears of malignant or premalignant nature.

Detection and Comparision of Cytopathological Changes in Smokers and Non-Smokers: A Comparative Study

Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers smokers. Material Methods: Smears sample were collected according to site (buccal mucosa, tongue palate) from 100 subjects among smokers non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.

Diagnostic and Prognostic Implications of the Oral Exfoliative Cytology in Oral precancer And Cancer Detection

Diagnostic and Prognostic Implications of the Oral Exfoliative Cytology in Oral precancer And Cancer Detection

From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012.

From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference. Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined, organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarter's building were evident; in 2008, starting the construction of new facilities was decided. The Institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.

Nuclear and Nucleolar Morphometric Changes in MGP Stained Oral Epithelial Cells In Cigarette Smokers and Non Smokers

Aim: To compare nuclear and nucleolar morphometric changes in methyl green pyronin stained oral epithelial cells in cigarette smokers, passive smokers and non smokers Study design: A comparative cross sectional study Place and duration: Carried out in Postgraduate Medical Institute, Lahore. Duration was 6 months, March 2022 to August 2022. Methods: 120 subjects were equally divided into three main groups, cigarette smokers, passive smokers and non smokers, each fulfilling the inclusion and exclusion criteria. Buccal smears were collected by exfoliative cytology of mucosa and then stained by methyl green pyronin stain. The quantitative nuclear morphometric parameters i.e., nuclear and nucleolar diameter and area, and number of nucleoli, were measured. Results: Themedian of all nuclear parameters of smokers was significantly higher as compared to passive smokers and non-smokers in MGP stain (p ≤ 0.05). Further, effect of duration of smoking on morphometric variables showed significant (p&lt; 0.05) results amongst the smokers in MGP stain. However, no significant differences were seen in all morphometric parameters with respect to frequency of cigarette smoking. Conclusion: The study confirms nuclear morphometric changes in oral epithelial cells of cigarette smokers indicating that smoking does influence cellular alterations. The simplicity of cytology technique with the use of methyl green pyronin stain is valuable screening tool for detecting early oral mucosal changes in high risk patients. Keywords: smoking, exfoliative cytology, nuclear morphometric parameters, methyl green pyronin stain.

MALIGNANT TRANSFORMATION OF ORAL LEUKOPLAKIA – A REVIEW

Oral Leukoplakia is one of the most common oral premalignant lesions and dened as white patch or plaque that does not rub off clinically identied as another entity. Etiological factors are smoking, viral and fungal agent and specic nutrients and deciency may have role in the development and progression. Clinically it can be classied as homogenous and non-homogenous. It most seen on buccal mucosa and lateral border of tongue. Malignant transformation of oral leukoplakia is about 5-18%. A higher chance of it transformation has been seen in non-homogeneous, high risk anatomic structures such as the oor of the mouth or the tongue, as well as a history of non-smoking. It can be diagnosed by biopsy, toluidine blue staining or lugol s iodine and exfoliative cytology. Management is surgical excision, cryosurgery, CO2 laser, retinoids, photodynamic therapy

Cytomorphometric Changes of Buccal Exfoliated Pap Stained Smears among COVID-19 Recovered Patients; Sudan 2022

Introduction: COVID-19 is known to cause various changes in oral mucosa which can be detected by exfoliative cytology. The present study aimed to determine the cytomorphometric change of oral mucosa exfoliated Pap-stained smears for COVID-19 recovered patients at Khartoum state 2022. Methods: This was a cross-sectional comparative, community-based study conducted at Khartoum State. Eighty (80) participants who recovered from COVID-19 enrolled in the study as cases and twenty (20) healthy participants as the control group. Results: In the present study the ages of the participants ranged between 19-75 years. Mean was significantly different in cytoplasm diameter (CD), nucleus diameter (ND), and nuclear/cytoplasmic ratio (N/CR) between the patients who recovered from COVID-19 versus the healthy group (69.71μm versus 37.45μm, P. value= 0.001; 10.02μm versus 6.05μm, P. value= 001; and 28.9 μm versus 18.0μm, P. value= 0.016) respectively. Conclusion: The marked changes in cytomorphometric parameters caused by infection with COVID-19 prove that infection with the virus causes changes in the buccal mucosa. These findings will help in the screening and diagnosis of the disease.

Exfoliative Cytology and Genetic Analysis for a Non-Invasive Approach to the Diagnosis of White Sponge Nevus: Case Series

White Sponge Nevus (WSN) is a rare benign disorder associated with mutations in genes coding for cytokeratin 4 (KRT4) and 13 (KRT13) characterized by dyskeratotic hyperplasia of mucous membranes. This study was aimed at examining different approaches (cytology, pathology and genetic analysis) to WSN diagnosis. A series of four patients with asymptomatic white diffuse oral lesions were evaluated and, before performing an incisional biopsy for pathology, an oral brush Thin Prep was collected for exfoliative liquid-based cytology (LBC). DNA for genetic analysis was also obtained from patients and both their parents, using buccal swabs. Pathology and cytology showed similar results, leading to the same diagnosis of hyperkeratotic epithelium with acanthosis and spongiosis, without atypia, demonstrating the efficiency of LBC for the differential diagnosis. Sequencing analysis revealed at least 6 rare variants in the KRT4 and KRT13 genes in each patient, contributed in part by both unaffected parents. Thin Prep for oral exfoliative cytology and genetic analysis are sufficient for an accurate diagnosis of WSN. The combination of cytological and genetic analyses could substitute the histologic exam, providing a non-invasive alternative for incisional biopsy.

Effect of Progestin based Estrus Synchronization Protocol on Estrus Parameters, Hormonal Profile and Vaginal Cytology in Surti Goats

This investigation was conducted to study the effect of progestin and prostaglandin-based estrous synchronization protocol on estrus parameters, hormonal profile and vaginal cytology in Surti goats. Ten non-pregnant Surti goats were selected and subjected to estrus synchronization with intra-vaginal progesterone sponges (60 mg Medroxyprogesterone acetate, MAP) for 11 days followed by PGF2α injection (125 μgCloprostenol). Whole blood was collected on day 0 (before treatment), day 5, 11 (after treatment), at proestrus, estrus and diestrus for analyzing progesterone as well as estrogen hormone concentration. The vaginal exfoliative cytology was studied at proestrus, estrus and diestrus. Estrus parameters such as induction rate was 100%, time of onset of estrus from PG injection was 29.70 ± 1.06 h and duration was 30.74 ± 0.19 h. Significantly higher population of parabasal cells and superficial cells were observed during proestrus, intermediate cells in diestrus and cornified cells during estrus. At estrus, level of progesterone was lowest and estrogen was highest. Combination of progestin and prostaglandin-based protocol is successful in synchronization of estrous cycle with 100% estrus induction rate in Surti goats. Further in addition to other signs, vaginal exfoliative cytology can also be used for determining different phases of estrous cycle.

Cytomorphometric Analysis of Oral Buccal Mucosa of Dental Colleges' Students in Sulaimani City.

This study evaluates the cytomorphometric measures of cells obtained from the buccal mucosa of dental students to assess the fluctuation of the cellular characteristics among relatively normal subjects, with any potential correlations with demographic information, different habits, and hormonal disturbance. This prospective study included 100 dental students with no detectable oral alterations submitted to brush cytology. The smears were fixed with 95% ethyl alcohol and stained with hematoxylin and eosin stain. The stained section was observed under an image analyzer for cytomorphometric analysis. Cytopathological observations were recorded, including inflammation, microbial colonies, micronuclei, keratinization, overlapping, and hemorrhage. Chi-square tests were applied for non-parametric variables. One-way analysis of variance (ANOVA) was used to compare the cytometric parameters to habits and hormonal disturbances. A p-value &lt; 0.05 was considered statistically significant. The results showed close proximity among subjects in the matter of cytomorphometric measures; no significant influence of sex, smoking, alcohol drinking habits, and menstruation was found on cytomorphometric diameters or cytopathological observation, and vice versa, while polycystic ovary syndrome impacted nuclear and nuclear-cytoplasmic ratio (p = 0.003, p = 0.02), respectively. Oral exfoliative cytology combined with cytomorphometric analysis for the studied normal individuals can be helpful in various investigations of oral and systemic diseases.

The comparative evaluation of CK17 expression in histologic and cytological sections of oral squamous-cell carcinoma using immunohistochemistry.

Squamous-cell carcinoma of the mouth accounts for 90% of all oral cancers and despite advances in treatment methods, its 5-year survival rate is reported to be about 68%. This is due to the late diagnosis of the disease and its resistance to radiotherapy and chemotherapy treatments. One of the methods for diagnosing oral lesions is exfoliative cytology, which is a noninvasive method and can be easily carried out in a dental office. The purpose of this study is to find a method that in addition to being fast, accurate and less aggressive has high value and a good degree of accuracy for diagnosis of oral squamous-cell carcinoma. In this descriptive-analytical study, 14 patients who were diagnosed with oral squamous-cell carcinoma and 14 specimens from exfoliative cytology of the same tissue before surgery were examined. Immunohistochemically stained specimens were examined by two pathologists simultaneously. Next, five nonoverlapping sections with magnification (×400) and the number of cells stained with the cytokeratin marker 17 are counted and the average percentage of each slide is determined. One-sample t-test is used to analyze the data and significance level in tests is considered 0.05. In examining the diagnostic value of cytology, we concluded that out of 280 affected cells, 211 cells were stained. Therefore, the sensitivity of cytology in the diagnosis of squamous-cell carcinoma of the mouth is 75.4%. In other words, cytology correctly identifies 75.4% of affected cells as affected. Also, the positive predictive value of cytology was 100%.