ABSTRACT
PURPOSE: To test the hypothesis that cigarette smokers develop oral potentially malignant disorders or carcinomas in preferential anatomical subsites. METHODS: The association of smoking habit with the presence of oral lesions in specific anatomical subsites was assessed in 123 patients using the odds ratio analysis. RESULTS: When compared to all the other subsites, the relative frequency of smokers with lesions was higher in the buccal mucosa and in the floor of the mouth (FOM) (P=0.002 and P=0.005), while it was lower in the tongue (P<0.0005). Smokers were about 7 years younger than non-smokers (P=0.008). CONCLUSIONS: The association of smoking and age suggests that smoking may contribute to generate a field of injury that leads to lesions in shorter periods than other causes. The stronger relationship of smoking with lesions in the buccal mucosa and FOM than in the tongue suggests that tissue characteristics mediate the effects of tobacco.
Subject(s)
Carcinoma, Squamous Cell/etiology , Mouth Neoplasms/etiology , Precancerous Conditions/etiology , Smoking/adverse effects , Age Factors , Aged , Carcinoma, Squamous Cell/pathology , Cheek/pathology , Disease Susceptibility , Erythroplasia/etiology , Erythroplasia/pathology , Female , Gingival Neoplasms/etiology , Gingival Neoplasms/pathology , Humans , Leukoplakia, Oral/etiology , Leukoplakia, Oral/pathology , Lip Neoplasms/etiology , Lip Neoplasms/pathology , Male , Middle Aged , Mouth Floor/pathology , Mouth Mucosa/pathology , Mouth Neoplasms/pathology , Palatal Neoplasms/etiology , Palatal Neoplasms/pathology , Precancerous Conditions/pathology , Sex Factors , Smoking/pathology , Tongue Neoplasms/etiology , Tongue Neoplasms/pathologyABSTRACT
To date there are still no reliable biomarkers for oral potentially malignant disorders (PMDs) to predict the risk of progression to squamous cell carcinoma (SCC). Within a prospective clinical trial of patients with PMDs, DNA content flow cytometry (DNA FCM) was evaluated for 60 PMDs using fresh samples obtained by a dermatological curette. There were 6/42 PMDs without dysplasia, but with DNA aneuploidy, versus 8/18 with both dysplasia and aneuploidy (p=0.02). When the tongue and the buccal mucosa, the two most common sites in the present series of cases were compared, dysplastic PMDs were mainly located on the tongue (p=0.01). Tobacco smokers, who preferentially developed PMDs in the buccal mucosa at a younger age than non-smokers (p=0.002), had fewer dysplastic PMDs than did non-smokers (p=0.01). Dysplasia was significantly linked to DNA aneuploidy (p=0.03) in smokers. The present data suggest that aneuploidy is an early event in oral carcinogenesis and that the influence of tobacco varies according to subsite and patient age. When DNA FCM of PMD samples are obtained by curette scraping, extensive areas can be covered with a minimally invasive, rapid, inexpensive procedure. Moreover DNA FCM of these samples appears easy amenable to routine analysis. Further research on larger numbers of PMDs should be carried out to determine whether DNA FCM plays a role in the prediction of risk of PMD transformation.
Subject(s)
Aneuploidy , Carcinoma, Squamous Cell/pathology , Mouth Neoplasms/pathology , Precancerous Conditions/pathology , Smoking/adverse effects , Age Factors , Aged , Carcinoma, Squamous Cell/genetics , Female , Flow Cytometry , Genetic Markers , Humans , Male , Middle Aged , Mouth Mucosa/pathology , Mouth Neoplasms/genetics , Precancerous Conditions/genetics , Prospective Studies , Smoking/genetics , Tongue/pathologyABSTRACT
BACKGROUND: Scalpel biopsy may under-diagnose oral dysplasia/carcinoma in potentially malignant lesions (PMLs) because samples represent only one or a few sites. It is possible that small tissue specimens obtained from over the whole area of PMLs, by scraping with a dermatological curette, could be treated histologically and used as 'micro' biopsies. This study values the accuracy of micro-biopsies in the detection of dysplasia/carcinoma in oral PMLs. METHODS: A prospective study was carried out on 164 patients with PMLs, with both scalpel and micro-biopsies, for the presence of dysplasia/carcinoma. The most severe diagnosis (obtained by either method) was used as the reference standard. The presence/absence of the basement membrane zone (BMZ) in the micro-biopsy specimens correlated with the site, the clinical features of the PMLs and the operator. RESULTS: Micro-biopsy gave six of 164 (3.66%) inadequate specimens. Of 158 of 164 adequate samples, dysplasia/carcinoma was diagnosed in 85 of 158 cases; micro-biopsy diagnosis was in agreement with scalpel biopsy in 144 of 158 (91.14%) cases and showed a better sensitivity than did scalpel biopsy (97.65% vs. 85.88%), corresponding to two of 158 false-negative cases by micro-biopsy vs. 12 of 158 by scalpel biopsy. The BMZ was observed in 110 of 158 (69.62%) of all micro-biopsies and had no relationship with the sampling site, the clinical features of the PMLs or the operator. CONCLUSIONS: The negative predictive value (97.33%) suggests that micro-biopsy may well be an effective first-level diagnostic procedure for PMLs (especially in follow-ups and multiple lesions); moreover, in carcinoma (17% of cases) a definitive diagnosis could be made without further investigation.
