Oral exfoliative cytology – A technical appraisal in oral diseases

Oral exfoliative cytology is one of the easy, simple, economical and non-cumbersome diagnostic adjunct. It involves examining the exfoliated buccal cells for alterations in cellular and nuclear features. It offers the advantage of being useful in less resource setting areas. Though associated with many false results, the newer technological advancements have proven its diagnostic efficiency. Oral exfoliative cytology can readily be used as adjunct to disease diagnosis, however, it cannot replace biopsy.

Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and e-cigarette users compared to nonsmokers. We obtained smears from the buccal mucosa of 68 participants divided in 3 groups (smokers, e-cigarette users and nonsmokers), which were further processed with Papanicolaou stain. The frequencies of micronuclei and micronucleated cells were recorded and statistically analyzed at a level of significance of p < 0.05. The mean micronuclei values per 1000 cells were 3.6 ± 1.08 for smokers, 3.21 ± 1.12 for e-cigarette users and 1.95 ± 1.05 for nonsmokers. The mean values of micronucleated cells per 1000 cells were 2.48 ± 0.91 for smokers, 2.39 ± 1.07 for e-cigarette users and 1.4 ± 0.68 for nonsmokers. Smokers and e-cigarette users had significantly higher values of micronuclei and micronucleated cells compared to nonsmokers, but there were no significant differences between smokers and e-cigarette users. We concluded that the micronuclei count can be used as an early indicator for alterations of oral mucosa and exfoliative cytology represents an accessible tool which could be applied for mass screening.

Oral Squamous Cells and Age Estimation in Exfoliative Cytology with Hematoxylin and Eosin Stain– A Quantitative Study

Introduction: Exfoliative cytology in age estimation is a simple, painless, less invasive collection of exfoliative cells from epithelial layers, used as a diagnostic aid for age estimation. The oral cavity is an ideal site for exfoliative epithelial cells with a physiological turnover of cells, turnover decreases as the age increases show age variation with cellular morphological changes. Age estimation is one of the important factors to identify an individual and also helps to know the chronological age of a person. Aim: To analyze and estimate the age from buccal smear and comparing the average cellular size under Image morphometric analysis. Materials and Methods: Buccal mucosal smears are taken using a wooden spatula in gentle motion of scraping and smeared on a clean glass slide and fixed in 95% ethanol immediately after smearing a minimum of around 15 minutes and stained with Haematoxylin and eosin stain. After staining, the cells were observed by microscope and measured by a paint tool. Pearson correlation analysis was done using SPSS software. Results: The cell and nuclear size difference values observed using a Pearson correlation coefficient were statistically significant with p value<0.05 revealing that there is shrinkage in cells with increase in age. Conclusion: Exfoliative cytology is a successful and vastly growing technology that is used for the detection of premalignant lesions.

Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

<b><i>Introduction:</i></b> Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. <b><i>Material and Methods:</i></b> This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. <b><i>Results:</i></b> On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (<i>p</i> value &#x3c;0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. <b><i>Conclusion:</i></b> In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

Role of exfoliative cytology in diagnosis of oral lesions: With special reference to rule out malignancy

Oral malignancy is very common in India because of the excessive use of tobacco chewing and smoking. Procedure of Cytology is inexpensive and unchallenging that can be carried out effortlessly at outdoor patient department to diagnose malignancy at early stage. The present study was carried out to detect cancer pre-invasive stage by use of exfoliative cytology and to probe the probability of using this technique in diagnosis of other oral lesions thought as premalignant ones. A total 102 patients referred from OPD and Surgery Department of a Private Hospital, Dispensary and Cancer Hospital, Delhi, between August 2019 to April 2020 , were included in this study. Two smears were taken by scrap method, from each patient and were prepared after air dried stained with RAPID PAP stain. According to the Papanicolaou classification the smear were assessed along with clinical, epidemiological data and classified in group I to IV. In our result 25 cases were normal, leukoplakia 47 cases with mean age 47.5 years, 85% male. Predominantly 53% Smear show anucleated squames. 06 cases were Oral submucous fibrosis ,66.7% were female with mean age 38.3 years and, the present smear revealed rarification of nuclei in 66% cases. 02 cases of mucosal hyperemia (Erythema), one-one case of traumatic ulcer and granular buccal mucosa were included. Out of 12 cases of malignancy, male were 75% with mean age of 46 year. Buccal mucosa and tongue were the common site with incidence of 60%. The smear showed inflammatory cells in 100%, malignant cells in 75% cases either in groups or in singles. The third type of cells 60%, 37% the undifferentiated cells, and 5% cases Tadpole cells. In this study 75% cases were positive for cancer, 10% were suspicious for cancer and remaining 15% were given as negative for cancer. For the diagnosis of presence or absence of malignancy in a lesion with high accuracy rate Cytology is reliable diagnostic tool. The oral cytologic technique is effortless to do and can provide the help of surgeon/physician, instead of performing an invasive procedure, like a biopsy, or desire more information regarding a lesion before referring the patient.