Usefulness of Five-Parameter System Reconfirmed for Cytopathology of Oral Squamous Cell Carcinoma regardless of Differentiation Degree
Usefulness of Five-Parameter System Reconfirmed for Cytopathology of Oral Squamous Cell Carcinoma regardless of Differentiation Degree
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DOI：
10.1159/000521835
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发表时间：
2022-02-11
期刊：
影响因子：
1.8
通讯作者：
Saku，Takashi
中科院分区：
文献类型：
--
作者：
Hara，Hitoshi;Misawa，Tsunemi;Saku，Takashi
背景我们之前介绍了五参数系统（FPS），它专门评估角化细胞的发现，用于口腔高分化鳞状细胞癌（SCC）和原位癌（CIS）标本的细胞学检查，因为它们偶尔缺乏核异型性并且可能难以通过贝塞斯达系统（TBS）进行分类。本研究旨在确定即使在具有明显核异型性的口腔 SCC/CIS 标本中是否也可检测 FPS 参数。总结口腔细胞学标本与活检组织样本一起获得。它们取自使用 TBS 诊断的 59 例恶性（HSIL 和 SCC）和 29 例非明确恶性（NILM 至 ASC-H）标本。在重新确认原始 TBS 分类后，使用 FPS 重新评估样本。在检查的 70 份恶性样本中，有 69 份记录了一项或多项 FPS 参数，其中 11 份已被 TBS 诊断为非明确恶性。其余 1 例恶性标本被诊断为鳞状细胞癌 (SCC)，仅伴有 TBS。 FPS参数#1（同心排列）、#2（大量细胞）、#3（形状怪异的细胞）、#4（角膜球）和#5（不均匀的丝状细胞质）仅在恶性病例中观察到，而在非明确恶性标本中未发现。最后，辅以 FPS 的 TBS 实现了 100% 的敏感性、特异性、准确性、阳性预测值和阴性预测值。 关键信息 FPS 参数包含在大多数口腔细胞学标本检查中。因此，无论分化程度如何，强烈推荐FPS用于口腔SCC的细胞学检查，以确认基于TBS这一强制性标准的判断，并弥补其主要评估核异型性的局限性。 FPS 被认为是口腔细胞学的重要诊断工具，特别是在分诊病例中，这对于 TBS 来说是具有挑战性的。细胞病理学不应仅限于核发现，而应基于全细胞形态。
BackgroundWe previously introduced the Five-Parameter System (FPS), which exclusively evaluates keratinized cellular findings, for use in cytology examinations of oral well-differentiated squamous cell carcinoma (SCC) and carcinoma in situ (CIS) specimens, as they occasionally lack nuclear atypia and can be challenging for categorization by The Bethesda System (TBS). This study was conducted to determine whether FPS parameters are detectable even in oral SCC/CIS specimens with apparent nuclear atypia.SummaryOral cytology specimens were obtained together with biopsy tissue samples. They were obtained from 59 malignant (HSIL and SCC) and 29 not-definitely malignant (NILM to ASC-H) specimens diagnosed using TBS. Following re-confirmation of the original TBS categorization, the specimens were re-evaluated using FPS. One or more of the FPS parameters were noted in 69 of 70 malignant specimens examined, of which 11 had been diagnosed by TBS as not-definitely malignant. The remaining one malignant specimen was diagnosed as SCC with only TBS. FPS parameters# 1 (concentric arrangement),# 2 (large cell number),# 3 (bizarre-shaped cells),# 4 (keratoglobules), and# 5 (uneven filamentous cytoplasm) were observed only in malignant cases, while none were revealed in not-definitely malignant specimens. Finally, TBS supplemented with FPS achieved sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 100%.Key MessagesFPS parameters are included in most examinations of oral cytology specimens. Thus, FPS is highly recommended for use in cytology examinations of oral SCC regardless of differentiation degree to confirm judgment based on TBS, a mandatory standard, as well as to cover its limitation of mainly evaluating nuclear atypia. FPS is considered to be an important diagnostic tool for oral cytology, especially in triage cases, which are challenging for TBS. Cytopathology should not be limited to only nuclear findings but be based on whole-cell morphology.