Prospective, blinded comparison of cytology and DNA-image cytometry of brush biopsies for early detection of oral malignancy
Prospective, blinded comparison of cytology and DNA-image cytometry of brush biopsies for early detection of oral malignancy
复制标题
DOI：
10.1016/j.oraloncology.2012.12.006
复制
发表时间：
2013-05-01
期刊：
影响因子：
4.8
通讯作者：
Kunkel, M.
中科院分区：
文献类型：
--
作者：
Kaemmerer, Peer W.;Koch, F. P.;Kunkel, M.
目的：辅助技术，如DNA图像细胞术（DNA-ICM）已被归因于提高口腔刷活检的诊断性能。本研究的目的是评价刷活检，分析根据形态学标准和DNA-ICM与组织学研究结果在一个盲前瞻性trial.Materials和方法：八十八刷活检70例进行了采样。仅纳入临床可疑但不明显的口腔恶性病变。临床诊断为白斑36例，扁平苔藓18例，疣状红斑12例，红斑白斑9例，糜烂7例，硬结6例。结果：组织学诊断为鳞状上皮内异型增生8例（SIN 1 n = 6，SIN 2 n = 2），原位癌4例，T1癌25例。其余为白斑28例，扁平苔藓15例，局部炎症8例。刷检检出SIN > 1的恶性病变的敏感性为55%，特异性为100%。DNA-ICM的敏感性为70%，特异性为100%。两种方法联合应用的敏感性为76%，特异性为100%。假阴性结果的主要原因是采样错误与细胞不足（86%刷检和100% DNA-ICM）。结论：DNA-ICM有可能大大提高口腔刷检的纯形态学解释的灵敏度。与常规组织学诊断相比，方法固有的采样误差可能是灵敏度较低的原因。因此，DNA-ICM不应用于排除恶性肿瘤，当病变已经临床上怀疑口腔癌。(C)2012爱思唯尔有限公司保留所有权利。
Objectives: Adjunctive techniques like DNA image cytometry (DNA-ICM) have been attributed to enhance the diagnostic performance of oral brush biopsies. The aim of the study was an evaluation of brush biopsies, analysed according to morphological criteria and by DNA-ICM vs. histological findings in a blinded prospective trial.Materials and methods: Eighty eight brush biopsies of 70 patients were sampled. Only clinical suspicious but not evident malignant oral lesions were included. Clinical diagnosis was leukoplakia (n = 36), lichen planus (n = 18), verruciform erythroplakia (n = 12), erythroleukoplakia (n = 9), erosion (n = 7) and induration (n = 6). Evaluation was conducted via histology, cytology and DNA-ICM.Results: Histological diagnosis revealed eight cases of squamous intraepithelial dysplasia (SIN 1 n = 6, SIN 2 n = 2), four cases of carcinoma-in situ and 25 cases of oral T1-cancer. Remaining cases were leukoplakia (n = 28), lichen planus (n = 15) and local inflammation (n = 8). Brush biopsy detected malignant lesions including SIN > 1 with a sensitivity of 55% and a specificity of 100%. DNA-ICM had a sensitivity of 70% and a specificity of 100%. The combination of both methods showed a sensitivity of 76% and a specificity of 100%. The predominant reason for false negative results were sampling errors with insufficient cells (86% in brush biopsy and 100% in DNA-ICM).Conclusion: DNA-ICM has the potential to substantially improve the sensitivity of a pure morphological interpretation of oral brush biopsies. Method inherent sampling errors may be accountable for a lower sensitivity compared to conventional histological diagnosis. Therefore, DNA-ICM should not be used to rule out malignancy, when lesions are already clinically suspicious for oral cancer. (C) 2012 Elsevier Ltd. All rights reserved.