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McRae MP, Kerr AR, Janal MN, Thornhill MH, Redding SW, Vigneswaran N, Kang SK, Niederman R, Christodoulides NJ, Trochesset DA, Murdoch C, Dapkins I, Bouquot J, Modak SS, Simmons GW, McDevitt JT. Nuclear F-actin Cytology in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma. J Dent Res 2020; 100:479-486. [PMID: 33179547 DOI: 10.1177/0022034520973162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Oral cavity cancer has a low 5-y survival rate, but outcomes improve when the disease is detected early. Cytology is a less invasive method to assess oral potentially malignant disorders relative to the gold-standard scalpel biopsy and histopathology. In this report, we aimed to determine the utility of cytological signatures, including nuclear F-actin cell phenotypes, for classifying the entire spectrum of oral epithelial dysplasia and oral squamous cell carcinoma. We enrolled subjects with oral potentially malignant disorders, subjects with previously diagnosed malignant lesions, and healthy volunteers without lesions and obtained brush cytology specimens and matched scalpel biopsies from 486 subjects. Histopathological assessment of the scalpel biopsy specimens classified lesions into 6 categories. Brush cytology specimens were analyzed by machine learning classifiers trained to identify relevant cytological features. Multimodal diagnostic models were developed using cytology results, lesion characteristics, and risk factors. Squamous cells with nuclear F-actin staining were associated with early disease (i.e., lower proportions in benign lesions than in more severe lesions), whereas small round parabasal-like cells and leukocytes were associated with late disease (i.e., higher proportions in severe dysplasia and carcinoma than in less severe lesions). Lesions with the impression of oral lichen planus were unlikely to be either dysplastic or malignant. Cytological features substantially improved upon lesion appearance and risk factors in predicting squamous cell carcinoma. Diagnostic models accurately discriminated early and late disease with AUCs (95% CI) of 0.82 (0.77 to 0.87) and 0.93 (0.88 to 0.97), respectively. The cytological features identified here have the potential to improve screening and surveillance of the entire spectrum of oral potentially malignant disorders in multiple care settings.
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Affiliation(s)
- M P McRae
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentsitry, New York, NY, USA
| | - A R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
| | - M N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - M H Thornhill
- Department of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - S W Redding
- Department of Comprehensive Dentistry and Mays Cancer Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - N Vigneswaran
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S K Kang
- Departments of Radiology, Population Health New York University School of Medicine, New York, NY, USA
| | - R Niederman
- Department of Epidemiology and Health Promotion, New York University, New York, NY, USA
| | - N J Christodoulides
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentsitry, New York, NY, USA
| | - D A Trochesset
- Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
| | - C Murdoch
- Department of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - I Dapkins
- Departments of Population Health and Medicine, New York University School of Medicine, New York, NY, USA
| | - J Bouquot
- Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston, Houston, TX, USA
| | - S S Modak
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentsitry, New York, NY, USA
| | - G W Simmons
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentsitry, New York, NY, USA
| | - J T McDevitt
- Department of Biomaterials, Bioengineering Institute, New York University College of Dentsitry, New York, NY, USA
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