Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

2021 ◽  
pp. 1-7
Author(s):  
Vasudha Singh ◽  
Mudita Bhargava ◽  
Kachnar Varma ◽  
Vatsala Misra ◽  
Richa Singh
Keyword(s):  
Tertiary Hospital ◽  
Accurate Diagnosis ◽  
Exfoliative Cytology ◽  
Visual Examination ◽  
Normal Cytology ◽  
Subjective Analysis ◽  
Oral Epithelial Dysplasia ◽  
Significant Difference ◽  
Potentially Malignant ◽  
Malignant Lesions

<b><i>Introduction:</i></b> Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. <b><i>Material and Methods:</i></b> This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. <b><i>Results:</i></b> On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (<i>p</i> value &#x3c;0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. <b><i>Conclusion:</i></b> In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

scholarly journals Evaluation of AgNORs in Oral Potentially Malignant Lesions

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Karin Berria Tomazelli ◽  
Filipe Modolo ◽  
Elena Riet Correa Rivero
Keyword(s):  
High Risk ◽  
Study Groups ◽  
Epithelial Dysplasia ◽  
Oral Epithelial Dysplasia ◽  
Cheap Method ◽  
Potentially Malignant ◽  
Mucosal Changes ◽  
Malignant Lesions ◽  
The Mean ◽  
The One

Oral squamous cell carcinoma (OSCC) is usually preceded by detectable mucosal changes, as leukoplakias and erythroplakia. Histologically, these lesions can range from hyperkeratosis and acanthosis to epithelial dysplasia and even OSCC. The aim of this study was to investigate the proliferative activity, using AgNORs quantification proteins, in low- and high-risk oral epithelial dysplasia, OSCC, and nondysplastic epithelium (inflammatory fibrous hyperplasia). The sample was divided into 4 groups: G1: 10 cases of inflammatory fibrous hyperplasia (IFH), G2: 11 cases of low-risk epithelial dysplasia (LD), G3: 10 cases of high-risk epithelial dysplasia (HD), and G4: 11 cases of OSCC. The quantitative analysis was performed using an image processing software in photomicrographs at 1000x magnification. The one-way ANOVA was used for comparison of the mean AgNORs counts between the study groups. The mean AgNORs count was significantly higherP≤0.01in OSCC when compared to IFH and the LD; however, it was not statistically different from HD. The mean number of LD was significantly lower than the HD and OSCC, with no difference related to IFH. AgNORs quantification can be an important and cheap method to help in the determination of the degree of epithelial dysplasia and, consequently, in the analysis of their potential for malignant transformation.

scholarly journals The effects of topical treatment with 5-fluorouracil on potentially malignant lesions of mice oral mucosa

2015 ◽  
Vol 32 (02) ◽  
pp. 082-088
Author(s):  
G. Costa ◽  
E. Almeida ◽  
F. Cavalcanti ◽  
J. Castro
Keyword(s):  
Oral Cavity ◽  
Patient Involvement ◽  
Antineoplastic Agent ◽  
Chemotherapeutic Drugs ◽  
Cure Rate ◽  
Lingual Mucosa ◽  
Significant Difference ◽  
Potentially Malignant ◽  
Malignant Lesions ◽  
Epithelial Lesions

Abstract Introduction: The 5-fluorouracil (5-FU) discloses a cure rate greater than 90 percent in potentially malignant lesions of skin. In the oral cavity, these lesions are treat in most cases with practice surgery, which reduces the number of patient involvement by malignant lesions, not being usual treatment with chemotherapeutic drugs. The aim of this study was to evaluate the effectiveness of the antineoplastic agent 5-fluorouracil in orabase® in potentially malignant lesions of the lingual mucosa in mice. Materials and Methods: Swiss albino mice (Mus musculus) were submitted to carcinogen 4-nitroquinoline-1-oxide (4NQO), 100 μg/ml in drinking water for 8 weeks, and on developing potentially malignant lesions on the tongue, were treated daily, with topical 5-FU in orabase® at concentrations of 0.5% and 5%, for 3 weeks. The tongues were processed for analysis by light microscopy. Results: Treatment with 5-FU in orabase® was shown to be effective in the histological degree of involution of the epithelial lesions of the tongue in the treated animals (p<0.05). However, when compared, there was no statistically significant difference between the two concentrations (p>0.05). Conclusions: The 5-FU in orabase® was shown to be a feasible therapy in potentially malignant lesions of the oral cavity.

scholarly journals Evaluation of Diagnostic Value of Sediment Cytology in Oral Malignant and Oral Potentially Malignant Disorders

2021 ◽  
Author(s):  
Shreyas N Shah ◽  
Falguni H Patel ◽  
Niraj Patil ◽  
Uday Patel
Keyword(s):  
Indian Subcontinent ◽  
Diagnostic Value ◽  
Histopathological Study ◽  
Oral Potentially Malignant Disorders ◽  
Oral Epithelial Dysplasia ◽  
Study Results ◽  
Potentially Malignant Disorders ◽  
Potentially Malignant ◽  
Malignant Lesions ◽  
Oral Epithelial

Introduction: Globally, highest prevalence of oral cancer has been observed in Indian subcontinent due to exposure to carcinogens such as betel nut extracts, smoking and chewing form of tobacco. Usually, cancer develops through rising grades of oral epithelial dysplasia which can arise from Oral Potentially Malignant Disorders (OPMD) and lead to fatal invasive malignancy. Being rapid, simple, cheaper and easy, sediment cytology may provide early diagnostic value in such cases. Aim: To estimate the role of sediment cytology from biopsy specimen fixatives in early diagnosis of OPMDs and oral malignant lesions. Materials and Methods: Cytological smears from total 30 cases, 15 subjects had Oral Potentially Malignant Disorders and 15 subjects each of Oral Potentially Malignant Disorders and Oral Malignant lesions were prepared by centrifuging fixatives of the biopsy specimens from February 2015 to January 2016. Analyses of prepared cytological smears were done and obtained results were compared with histological diagnosis. Results: The study results revealed that, out of 15 oral malignant lesions, 12 lesions were properly diagnosed with one inconclusive result and only three out of 15 OPMDs were properly diagnosed, where as three cases were inconclusive. Thus, in case of sediment cytology, the overall diagnostic accuracy was 50% and specifically 80% in case of oral malignant lesions. Conclusion: The Biopsy sediment cytology procedure is rapid, simple and inexpensive and can be applied with possible benefit in any laboratory for preliminary diagnosis. Thus, it is a good compliment for histopathological study of oral biopsies.

Premalignant and Malignant Lesions of the Heterotopic Pancreas in the Esophagus: a Case Report and Review of the Literature

2015 ◽  
Vol 24 (2) ◽  
pp. 235-239 ◽  
Author(s):  
Jan Ulrych ◽  
Vladimir Fryba ◽  
Helena Skalova ◽  
Zdenek Krska ◽  
Tomas Krechler ◽  
...  
Keyword(s):  
Case Report ◽  
Gastrointestinal Tract ◽  
Unusual Case ◽  
Accurate Diagnosis ◽  
Heterotopic Pancreas ◽  
Premalignant Lesions ◽  
Resected Specimen ◽  
Review Of The Literature ◽  
Severe Dysphagia ◽  
Malignant Lesions

Heterotopic pancreas is a congenital pathology of the gastrointestinal tract, particularly rare in the esophagus. Both symptomatology and findings during preoperative examinations are non-specific and therefore do not often lead to an accurate diagnosis, which is usually revealed only by histopathological assessment of a resected specimen. We report an unusual case of a patient suffering from severe dysphagia caused by heterotopic pancreas in the distal esophagus with chronic inflammation and foci of premalignant changes. This article also reviews 14 adult cases of heterotopic pancreas in the esophagus previously reported in the literature, with the aim of determining the clinical features of this disease and possible complications including rare premalignant lesions and malignant transformation. Especially with regard to those complications, we suggest that both symptomatic and incidentally found asymptomatic lesions should be resected.

Increse of newly - detected in situ cancers in non-palpable breast lesions

2006 ◽  
Vol 53 (1) ◽  
pp. 73-75
Author(s):  
N. Miletic ◽  
D. Stojiljkovic ◽  
M. Inic ◽  
M. Prekajski ◽  
A. Celebic ◽  
...  
Keyword(s):  
Breast Tissue ◽  
Malignant Disease ◽  
Clinical Stage ◽  
Diagnostic Procedures ◽  
Basal Membrane ◽  
Needle Aspiration ◽  
Screening Mammography ◽  
Significant Difference ◽  
Malignant Lesions

Great importance in detecting cancer in the phase of in situ lays in the fact that the epithelial layer is deprived of blood and lymph vessels, so metastases may develop only when basal membrane has been broken. This paper includes 46 operated women in whom it preoperatively had been verified suspect non-palpable lesion. The preoperative diagnostics included use of high- resolution mammography, aimed mammography, palpatory examination, as well as fine-needle aspiration (FNA), biopsy and cytologic analysis of the sample. The methodology of this work implies the use of stereotaxic marking, specimen mammography and ex-tempore pathohistology analysis. Out of 46 investigated patients in clinical stage T0N0M0, in whom there were no signs of malignant disease, and according to suspect lesion of initial screening mammography, malignant lesions of breast tissue were diagnosed in 19 patients (41%) intraoperatively. Three of these lesions (15,8%) were histopathologically verified as in situ. Comparing our results with data of the Institute of oncology and radiology of Serbia hospital registry (IORS) for the year 2001, from 1173 patients registered with malignant lesions, only 16 ones (1,4%) had in situ cancer, operated on the basis of the suspect mammography of clinical stage T0N0M0. Statistically significant difference was found related to the number of detected cancers in this early phase of the breast malignant disease. This limits surgical intervention to tumorectomy, with preservation of the remaining breast tissue, what brings to healing, justifying in that way, screening examinations and routine application of the most contemporary diagnostic procedures.

scholarly journals Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

2019 ◽  
Vol 10 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Tristan B. Weir ◽  
Neil Sardesai ◽  
Julio J. Jauregui ◽  
Ehsan Jazini ◽  
Michael J. Sokolow ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Linear Regression Analysis ◽  
Degenerative Spondylolisthesis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Hospitals ◽  
Single Level ◽  
Significant Difference ◽  
Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

scholarly journals Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040361
Author(s):  
Amanda Klinger ◽  
Ariel Mueller ◽  
Tori Sutherland ◽  
Christophe Mpirimbanyi ◽  
Elie Nziyomaze ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Predictive Capacity ◽  
Suspected Infection ◽  
Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

scholarly journals Diagnostic Accuracy of Oral Cancer and Suspicious Malignant Mucosal Changes among Future Dentists

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 263
Author(s):  
Kamis Gaballah ◽  
Asmaa Faden ◽  
Fatima Jassem Fakih ◽  
Anfal Yousuf Alsaadi ◽  
Nadeen Faiz Noshi ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Dental Students ◽  
Benign Tumors ◽  
Dental Practitioners ◽  
Significant Difference ◽  
Potentially Malignant Disorders ◽  
Potentially Malignant ◽  
Recent Graduates ◽  
Mucosal Changes ◽  
Oral Abnormalities

This study aimed to assess the ability of dental students and recent graduates to detect and recognize mucosal changes that are suggestive of oral cancer and potentially malignant disorders. In this cross-sectional study, a questionnaire was administered to dental students and recent graduates of Ajman University (n = 132). Completed questionnaires were received from 84 (63.6%) females and 48 (36.4%) males which included fifth-year students (n = 80), interns (n = 39), and dental practitioners (n = 13). This questionnaire was designed to assess the respondent’s ability to detect and recognize different types of oral lesions, as well as their knowledge of oral cancer appearance and malignancy potential. The overall accuracy of diagnosis was 46%. The participants correctly identified normal variations, benign tumors, malignant tumors, and premalignant lesions at rates of 60.3%, 31.0%, 55.7%, and 33.4%, respectively. There was no significant difference between the two genders in their ability to recognize and detect correct answers (females, 48.3%; males, 47.2%). According to education level, interns provided the highest percentage of correct answers (52.5%), followed by newly dental practitioners (51.9%) and fifth-year students (44.1%). Conclusion: The respondents of this survey did not exhibit a satisfactory diagnostic capability in recognizing mucosal changes consistent with the clinical presentation of oral cancer. Thus, a need exists for improved and updated educational methods for undergraduate students regarding oral cancer and potentially malignant disorders. Meanwhile, practitioners should look for oral abnormalities to provide better diagnosis and management. Practitioners should also stay up to date on the oral malignancy topic by attending workshops and clinicopathological conferences.

Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

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