Diagnostic Utility of Cytology in Assessment of Ploidy Status in Potentially Malignant Oral Disorders

Document Type: Research Articles

Authors

Department of Oral and Maxillofacial Pathology, SRM Dental College and Hospitals, SRM Institute of Science and Technology, Ramapuram, Chennai, India.

Abstract

Introduction: Oral leukoplakia, the most common potentially malignant oral disorder (PMOD) may progress to
oral squamous cell carcinoma (OSCC). Although, the current standard of care for assessing its malignant potential
remains histological examination and assessing the severity of dysplasia, DNA ploidy analysis has been suggested as a
surrogate marker to predict the behaviour of PMODs. Objectives: To detect aneuploidy and to correlate ploidy status
with different grades of dysplasia in both tissue and cytology samples to predict the behaviour of these potentially
malignant disorders and to assess the diagnostic utility of cytology samples for ploidy analysis. Methodology: After
obtaining ethical clearance and consent, tissue and cytology samples of leukoplakia were collected and grouped
based on the dysplastic findings into low-risk (n=20) and high-risk (n=20). DNA ploidy analysis was done using high
resolution flow cytometry and its diagnostic utility was assessed. Results: Diagnostic utility was expressed in terms of
sensitivity, specificity, PPV and NPV. On comparing the ploidy status of individual cases between tissue and cytology
samples, cytology was able to accurately determine the ploidy status in majority of the cases. In the low-risk group,
cytology had a sensitivity and specificity of 100% and a PPV and NPV of 100% with an overall diagnostic accuracy of
100%. Among the high-risk group, cytology had a sensitivity of 80% and specificity of 100% with a PPV of 100% and
NPV of 83.33% and had an overall diagnostic accuracy of 90%. Combining both groups together, it had a sensitivity
of 85.71% and specificity of 100% with a PPV of 100% and NPV of 92.31% and had an overall diagnostic accuracy
of 94.74%. Conclusion: Overall, this study showed a positive correlation between cytology and tissue samples and
ploidy and grade of dysplasia and cytology proved to be a simple and efficient with a reasonable diagnostic value.

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