Abstract
While the Bethesda system represents one of the great success stories in cervical cytology, there has been little appetite for the adoption of a universal grading system for oral cytology. This could be explained by the general lack of interest in oral cytology due to a high percentage of false negative diagnoses, a great variation in technical quality and cellularity of oral smears as well as the use of inadequate sampling procedures. The lack of a standardized method for reporting oral cytology adversely affects proper management of patients with oral lesions. The emergence of Liquid-Based Cytology (LBC) with dramatic improvements in technical quality and cellularity of the cytology specimens has provoked a new interest in using this diagnostic modality for suspicious oral mucosal lesions. This chapter describes the adequacy criteria and minimum cellularity specifications of oral cytologic specimens, and proposes an oral cytologic grading system analogous to the Bethesda System for reporting cervical cytology based on LBC techniques. Using this classification, the terminology for reporting results obtained by oral cytology examination of class I and class II oral mucosal lesions is discussed with ample illustrations of the morphologic criteria and diagnostic categories. These include normal, reactive changes, changes including probably atypical reactive/low-grade lesions, low-grade squamous intraepithelial lesions, atypical probably high-grade changes, high-grade squamous intraepithelial lesion and invasive squamous carcinoma. While still at its infancy, this grading system provides a standardised and uniform method of reporting for the practising pathologist. To further validate the newly proposed classification scheme and discover the best cut-off value for distinguishing reactive/low grade lesions from high grade/squamous cell carcinoma, a simple and easy scoring method based on nine cytologic characteristics is proposed. This may well increase the specificity of the oral cytology test in a manner similar to that of the robust Papanicolaou test.
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References
Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Obstet Gynecol. 1941;42:193–206.
National Cancer Institute Workshop. The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnoses. JAMA. 1989;262:931–4.
Reagan JW, Seidemann IL, Saracusa Y. The cellular morphology of carcinoma in situ and dysplasia or atypical hyperplasia of the uterine cervix. Cancer. 1953;6:224–35.
Koss LG. Diagnostic cytology and its histopathologic bases. 4th ed. Philadelphia: J.B. Lipincott Co; 1992.
Richart RM. Natural history of cervical intraepithelial neoplasia. Clin Obstet Gynecol. 1967;10:748–84.
The Bethesda System for reporting cervical/vaginal cytologic diagnoses: report of the 1991 Bethesda Workshop. JAMA. 1992; 267: 1892.
Solomon D, Davey DD, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114–9.
Nichols ML, Quinn FB, Schnadig VJ, Zaharopoulos P, Hokanson JA, Des Jardins L, et al. Interobserver variability in the interpretation of brush cytologic studies from head and neck lesions. Arch Otolaryngol Head Neck Surg. 1991;117:1350–5.
Kaugars GE, Silverman S, Ray AK, Page DG, Abbey LM, Burns JC, et al. The use of exfoliative cytology for the early diagnosis of oral cancers: is there a role for it in education and private practice? J Cancer Educ. 1998;13:85–9.
Feldman PS, Kaplan MJ, Johns ME, Cantrell RW. Fine-needle aspiration in squamous cell carcinoma of the head and neck. Arch Otolaryngol. 1983;109:735–42.
Scher RL, Oostingh PE, Levine PA, Cantrell R, Feldman PS. Role of fine needle aspiration in the diagnosis of lesions of the oral cavity, oropharynx, and nasopharynx. Cancer. 1988;62:2602–6.
Sciubba JJ. Improving detection of precancerous and cancerous oral lesions: computer-assisted analysis of the oral brush biopsy. J Am Dent Assoc. 1999;130:1445–57.
Hayama FH, Motta AC, Silva AG, Migliari DA. Liquid-based preparations versus conventional cytology: specimen adequacy and diagnostic agreement in oral lesions. Med Oral Patol Oral Cir Bucal. 2005;10:115–22.
Kujan O, Desai M, Sargent A, Bailey A, Turner A, Sloan P, et al. Potential applications of oral brush cytology with liquid-based technology: results from a cohort of normal oral mucosa. Oral Oncol. 2006;42:810–8.
Navone R, Burlo P, Pich A, Pentenero M, Broccoletti R, Marsico A, et al. The impact of liquid-based oral cytology on the diagnosis of oral squamous dysplasia and carcinoma. Cytopathology. 2007;18:356–60.
Jones AC, Pink FE, Sandow PL, Stewart CM, Migliorati CA, et al. The Cytobrush Plus cell collector in oral cytology. Oral Surg Oral Med Oral Pathol. 1994;77:101–4.
Driemel O, Dashe R, Hakim G, Tsioutsias T, Pistner H, Reichert TE, Kosmehl H. Laminin-5 immunocytochemistry: a new tool for identifying dysplastic cells in oral brush biopsies. Cytopathology. 2007;18:348–55.
Hutchinson ML, Isenstein LM, Goodman A, Hurley AA, Douglass KL, Mui KK, et al. Homogeneous sampling accounts for the increased diagnostic accuracy using the Thin Prep processor. Am J Clin Pathol. 1994;101:215–9.
Afrogheh A, Wright CA, Sellars SL, Pelsar A, Wetter J, Schubert PT, Hille J. An evaluation of the Shandon PapSpin liquid based oral test utilizing a novel cytologic scoring system. Oral Surg Oral Med Oral Pathol. 2012;113:799–807.
Solomon D, Nayar R, editors. The Bethesda system for reporting cervical cytology. 2nd ed. New York: Springer; 2004.
Christian DC. Computer-assisted of oral brush biopsies at and oral cancer screening program. J Am Dent Assoc. 2002;133:357–62.
Drinnan AJ. Screening for oral cancer and precancer – a valuable new technique. Gen Dent. 2000;48:656–60.
Ogden GR, Cowpe JG, Green MW. Effect of radiotherapy on oral mucosa assessed by quantitative exfoliative cytology. J Clin Pathol. 1989;42:940–3.
Bhattathiri NV, Bharathykkutty C, Prathapan R, et al. Prediction of radiosensitivity of oral cancers by serial cytological assay of nuclear changes. Radiother Oncol. 1998;49:61–5.
Bhattathiri N, Bindu L, Remani P, et al. Radiation induced acute immediate nuclear abnormalities in oral cancer cells: serial cytologic evaluation. Acta Cytol. 1998;42:1084–90.
Mehrotra R, Madhu R, Singh M. Serial scrape smear cytology of radiation response in normal and malignant cells of oral cavity. Indian J Pathol Microbiol. 2004;47:497–502.
Koss LG. Cytologic diagnosis of oral, esophageal, and peripheral lung cancer. J Cell Biochem. 1993;17F(Suppl):66–81.
Van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol. 2009;45:317–23.
Hirshberg A, Yarom N, Amariglio N, et al. Detection of non-diploid cells in premalignant and malignant oral lesions using combined morphological and FISH analysis-a new method for early detection of suspicious oral lesions. Cancer Lett. 2007;253:282–90.
Torres-Rendon A, Stewart R, Craig CT, Wells M, Speight PM. DNA ploidy analysis by image cytometry helps to identify oral epithelial dysplasias with high risk of malignant progression. Oral Oncol. 2009;45:468–73.
Acknowledgements
Prof CA Wright, Dr PT Schubert and Mrs G Neethling, Cytology unit, Division of Anatomical Pathology, University of Stellenbosch and NHLS Tygerberg, Cape Town, South Africa.
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Afrogheh, A., Hille, J., Mehrotra, R. (2013). The Development of a Novel Oral Cytologic Grading System. In: Mehrotra, R. (eds) Oral Cytology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5221-8_6
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DOI: https://doi.org/10.1007/978-1-4614-5221-8_6
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