RESUMO
Oral submucous fibrosis (OSMF) is a condition that was first described in the 1950s. It is caused as a result of addiction to harmful areca nut products with or without tobacco. The rationale of using exfoliative cytology in our study lies in the epithelial physiology where continuous exfoliation of epithelial cells is a part of physiological turnover. Deeper cells, which are strongly adhered in normal conditions, become loose in the case of malignancy and exfoliate along with superficial cells. Our aim in this study was to compare the cellular changes such as formation of micronuclei within the cell and cytomorphometric analysis of the buccal mucosal cells of OSMF patients with that of normal controls. We identified thirty three such cases of OSMF on the basis of oral inspection and examination. We used exfoliative cytology and liquid based cytogy to obtain buccal cells. The smear thus prepared was stained with feulgan fast green, acridine orange and papanicolou. Micronuclei were identified and cytomorphometric analysis was done using Adelta software. There was a change in the hue of Papanicolou from pink to purplish indicating the degree of keratinization from normal cells to cells affected by OSMF. Acridine orange gave a green emission at wavelength 480-490 to normal cells, while it gave a bright red fluorescence in cells undergoing apoptosis. Mean cellular diameter decreased from normalcells affected oral lesions. Mean nuclear cytoplasmic ratio increased from normal-cells to those affected by oral lesions. Frequency of micronuclei increased from normal to the cells affected by oral lesions. Buccal cell mutations in premalignant and malignant lesions can serve as a useful tool for the bio-monitoring of oral lesions. Exfoliative Cytology being minimally invasive and cost effective can help in mass screening programmes
RESUMO
Background: Tobacco comprises of one of the most common addiction in the society. All the forms of the tobacco are harmful, causing alterations in the cellular parameters of the oral mucosal cells. A number of techniques and methods are available along with chair side examination for supplementing the diagnosis of tobacco induced premalignant lesions. Exfoliative cytology is one such technique, which is non-invasive and can be used for mass screening. Therefore, we evaluated the cytological and cytomorphometric changes in the oral squames using brush biopsy from buccal mucosa of tobacco users. Methods: A total of 300 patients with age group of 25 to 60 years were included in the study. Detailed history of the patients were taken to known the method (smoking, smokeless or both) and frequency of tobacco intake. Scrapings from the buccal mucosal scrape were obtained, smeared on slides and were subsequently stained with Hematoxylin and Eosin staining. Observation and analyses of the smears was done under microscope followed by analysis in the computer using software Dewinter Biowizard version 3.0. various cellular parameters were assessed and compared in between different groups. Patients were divided into two major groups- Habituers and Nonhabituers. The habituers were again divided into: Tobacco smokers, Tobacco chewers and patients having combined habit. Independent-Samples T Test and One-Way ANOVA were used to assess the level of significance. Results: Significant results were obtained while comparing nuclear parameter, cellular area, cellular perimeter, cell contour and nucleo-cytoplasmic ratio in between lesional group and tobacco smoking group. While comparing between tobacco smoking group and Non habituers group, significant results were obtained in all the parameters except for cell contour and N/C ratio. Significant results were obtained while comparing between lesions and combined habit groups. While comparing between habituers and non- habituers group, except for cell contour significant results were obtained in all other cellular parameters. Conclusion: Early changes detection in clinically normal oral mucosa of tobacco users is possible by using non-invasive, painless procedures like oral brush biopsy and cytomorphometry. Further studies recommended.
RESUMO
CONTEXT: Early detection of oral premalignancy and malignancy using simple screening aids play a promising role in curbing the disease. AIM: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
RESUMO
Background: Tobacco is mostly regarded as one of the primary etiologic factor in causing oral cancer. Literature quotes studies have depicted the alteration of nuclear (NA) and cytoplasmic area (CA) induced by tobacco smoking and chewing. Also some authors have stressed on quantifying the role of cytomorphometric analysis in analysing these cellular alterations. Therefore, we evaluated the cytological and cytomorphometric changes in the oral squames using brush biopsy from buccal mucosa of tobacco users. Materials and methods: 200 patients of age group of 40-65 years attending the hospital OPD with history of smoking were included in the study. The patients were broadly divided into two groups; Shetty R, Mukherjee S, Dutta N, Bhagat DK, Sushma K N, Pandey V. Cytomorphometric analysis of oral squames Tobacco Smoker’s using oral brush biopsy: An exfoliative cytological study. IAIM, 2016; 3(5): 14-19. Page 15 smokers (n=150) and Non-smokers (n=50). The cytological samples were taken from clinically normal appearing oral mucosa, stained and analysed using Image analysing software. IndependentSamples T Test and One-Way ANOVA were used to assess the level of significance. Results: significant increase in Mean NA was observed in smokers as compared to non-smokers. Also, Mean CA decreased in smoker’s group as compared to non-smokers. Likewise, N/C ratio was found to be significantly elevated in smokers group. Cytomorphometric parameter changes showed significant alteration with increasing duration of smoking. Conclusion: Cytomorhometric analysis can be used to analyse the alterations occurring in cellular and nuclear level.
RESUMO
La detección temprana de lesiones bucales promete aumentar sobrevivencia y reducir la morbilidad de los pacientes que sufren esta condición. Un método alternativo para el examen de lesiones en la cavidad bucal, es la citología. Objetivo: valorar las relaciones del tamaño núcleo/citoplasma de células de mucosa bucal sana, de lesiones bucales potencialmente malignas y de cáncer bucal, obtenidas con citología exfoliativa utilizando citomorfometría. Material y método: Se realizó citología a 22 pacientes, de ambos sexos, con edades entre 23 y 81 años utilizando cytobrush. Las muestras se dividieron en tres grupos: 1) citologías de pacientes con lesiones de cáncer bucal (n=7); 2) citologías de pacientes con desórdenes bucales potencialmente malignos (leucoplasia y líquen) (n=15); 3) citologías del lado sano de pacientes con lesiones de cáncer y desórdenes bucales potencialmente malignos (grupo control) (n=15). Se seleccionaron 30 células de cada paciente y se midió el área nuclear (AN), la citoplasmática (AC) y se calculó la relación AN/AN. Se utilizó el Test de Kruskal Wallis y el Sofware estadístico Infostat. Resultados: No se encontraron diferencias significativas entre los tres grupos estudiados al valorar la relación AN/AC. Teniendo en cuenta el género, se observó que en las mujeres se diferenciaron significativamente las células del grupo control de las de los grupos de lesiones. En el género masculino se observaron diferencias significativas entre los tres grupos celulares. No hubo diferencias significativas entre los diferentes grupos etarios .Discusión: A pesar de las diferencias significativas entre los géneros, no es posible hacer una buena separación de los tres grupos de estudio, utilizando solamente citología exfoliativa.
Early detection of bucal lesions promises to increase survival and to reduce morbidity in patients suffering from this condition. An alternative method for examining lesions in the bucal cavity is cytology. Objective: To assess by cytomorphometry the relationship of size nucleus / cytoplasm of superficial cells from healthy bucal mucosa, from potentially malignant bucal disordes lesions and bucal cancer using exfoliative cytology. Material and methods: PAP smear was performed in 22 patients of both gender, aged between 23 and 81. Cytobrush was used. The samples were divided into three study groups: 1) smears of patients with bucal cancer lesions (n = 7), 2) smears of patients with potentially malignant bucal disordes lesions (n = 15), lesions considered were leukoplakia and lichens ; 3) (control group) (n=15): smears of the healthy side of patients with cancer and potentially malignant bucal disordes lesions.Thirty cells were selected for each patient and the nuclear area (NA), cytoplasmic area (CA) were measured and the ratio NA / CA was calculated. We used Kruskal Wallis and Statistical Software InfoStat. Results: No significant differences were found between the three groups studied the relationship NA / CA was assesed . When comparing cells from each of the three groups considering the gender of the patients separately, we found that in women differ significantly from the control group cells and groups of injuries, we could not discriminate between cells obtained from potentially malignant bucal disordes lesions and cancer lesions . In the male gender differences were significant among the three cell groups. Discusion: Despite the significant gender differences, we could not difference the three study groups using only exfoliative cytology.