Cytomorphometric analysis of squames obtained from normal mucosa, leukoplakia and oral squamous cell carcinoma

Exfoliative cytology is becoming increasingly important in the early diagnosis of oral cancers, as a procedure for obtaining cell samples, which can be analyzed by sophisticated diagnostic techniques. Quantitative techniques, based on the evaluation of parameters such as nucleus area, cytoplasm area and nucleus-to-cytoplasm area ratio, may increase the sensitivity of exfoliative cytology for early diagnosis of oral cancers, since these techniques are precise, objective and reproducible.

This study was undertaken to employ the cytomorphometric quantitative techniques to determine the value of exfoliative cytology and to assess this method to analyze the effectiveness in providing additional diagnostic test for the detection of early oral malignancy.

The study consisted of three groups. The experimental group comprised of 20 subjects with oral leukoplakia and 20 subjects with oral squamous cell carcinoma of the buccal mucosa. The control group comprised of 10 apparently healthy subjects. They were subjected to clinical examination and cytosmear of the buccal mucosa. A standard wooden tongue spatula/metal spatula moistened with normal saline was used to obtain scrapings of buccal mucosa. The scrapings were spread on plain glass slides and immediately fixed in Biofix spray, followed by staining with the Papanicolaou technique. Then, the microscopic pictures were captured onto a computer and are cytomorphometrically analyzed using an image analyzer. Since this study involved multiple groups, one-way analysis of variance (ANOVA) was used for comparing the parameters for multiple groups. Where significant difference was seen, the ANOVA test was followed by Mann-Whitney test, for pairwise comparison.

The mean count of nuclear area and nuclear diameter showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of cell area and cell diameter showed a decrease from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of nuclear/cytoplasm area ratio showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant.

With the advancements in the field of quantitative exfoliative cytology, interest in oral cytology has once again emerged in the diagnosis of oral premalignancy and malignancy. Computer-aided analysis with the sophisticated software increases the speed and accuracy of cytological measurements, which are repeatable. These versatile systems facilitate quantitative oral cytological assessments, which may become a viable procedure for the early detection of oral premalignancy and malignancy.