While oral lesions that macroscopically are highly suspicious for cancer shall be submitted to scalpel-biopsy and histologic evaluation, the majority of facultatively precancerous lesions, such as leuko- and erythroplakias or even persistent lichen planus lesions, may be assessed by brush-biopsy and cytology. As this non-invasive procedure is well tolerated by patients, more lesions may be screened and thus more oral cancers may be found in early, curable stages. Oral brush-biopsies can easily be performed by dentists, dental surgeons and general practitioners. While sensitivity of exfoliative cytology alone is about 4 % lower than bioptic histology, the combination of the latter with DNA-image-cytometry reaches the same diagnostic accuracy as the former (sensitivity 97.8–100 %, specificity, 97.4–100 %). As clonal chromosomal- and DNA-aneuploidy mostly precede cytological and histological evidence of malignancy in the squamous epithelium, its detection allows the diagnosis of oral squamous cell carcinomas up to 2 years earlier. Moreover, the additional use of DNA-image cytometry is a reasonable tool for the assessment of the resection margins of squamous cell carcinomas. DNA-image-cytometry could help to find the appropriate treatment option for patients and thus might improve their prognosis. Diagnostic DNA-image-cytometry is an objective method and has internationally been standardized.
Here for the first time we describe the performance of a device for automated screening of oral brush-biopsy-smears, based on a cascaded diagnostic strategy: (1) Automated selection of morphologically suspicious nuclei, (2) Interactive control and correction of these on digital image galleries, (3) DNA-measurements on these only, (4) Final diagnosis on DNA-histograms and nuclear morphology.
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