Exfoliative cytology for diagnosing basal cell carcinoma and other skin cancers in adults

Background: Early accurate detection of all skin cancer types is essential to guide appropriate management and to reduce morbidity and improve survival. Basal cell carcinoma (BCC) is usually localised to the skin with potential to infiltrate and damage surrounding tissue, while cutaneous squamous cell carcinoma (cSCC) and melanoma have a much higher potential to metastasise and ultimately lead to death. Exfoliative cytology is a non–invasive test that uses the Tzanck smear technique to identify disease by examining the structure of cells obtained from scraped samples. This simple procedure is a less invasive diagnostic test than a skin biopsy, and for BCC has the potential to provide an immediate diagnosis that avoids an additional visit to clinic to receive skin biopsy results. This may benefit patients scheduled for either Mohs micrographic surgery or non–surgical treatments such as radiotherapy. A cytology scrape can never give the same information as a skin biopsy, however, so it is important to know more about which skin cancer situations it may be helpful.Objectives: The primary objective was to determine the diagnostic accuracy of exfoliative cytology for the detection of basal cell carcinoma (BCC) in adults. Secondary objectives were to determine diagnostic accuracy for the detection of i) cutaneous squamous cell carcinoma, ii) invasive melanoma and atypical intraepidermal melanocytic variants, and iii) any skin cancer, including keratinocyte skin cancer, invasive melanoma and atypical intraepidermal melanocytic variants, or any other skin cancer.Search methods: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We also studied the reference lists of published systematic review articles.Selection criteria: Studies evaluating exfoliative cytology in adults with lesions suspicious for BCC, cSCC or melanoma, compared with a reference standard of histological confirmation.Data collection and analysis: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). Where possible we estimated summary sensitivities and specificities using the bivariate hierarchical model.Main results: This review reports on nine studies with a total of 1655 lesions including 1120 BCCs (14 datasets), 401 lesions with 44 cSCCs (two datasets), and 200 lesions with 10 melanomas (one dataset). Three of these datasets (one each for BCC, melanoma, and any malignant condition) were derived from one study which also performed a direct comparison with dermoscopy. Studies were of moderate to poor quality providing inadequate descriptions of participant selection, thresholds used to make cytological and histological diagnoses, and blinding. Reporting of patients’ prior referral pathways was particularly poor, as were descriptions of the cytodiagnostic criteria used to make diagnoses. No studies evaluated the use of exfoliative cytology as a primary diagnostic test for detecting BCC or other skin cancers in lesions suspicious for skin cancer. Pooled data from seven studies using standard cytomorphological criteria (but various stain methods) to detect BCC in patients with a high clinical suspicion of BCC estimated the sensitivity and specificity of exfoliative cytology as 97.5% (95% CI: 94.5 to 98.9%) and 90.1% (95% CI: 81.1 to 95.1%) respectively. When applied to a hypothetical population of 1000 clinically suspected BCC lesions with a median observed BCC prevalence of 86%, exfoliative cytology would miss 21 BCCs and would lead to 14 false positive diagnoses of BCC. No false positive cases were histologically confirmed to be melanoma. Insufficient data are available to make summary statements regarding the accuracy of exfoliative cytology to detect melanoma or cSCC, or its accuracy compared to dermoscopy.Authors' conclusions: The utility of exfoliative cytology for the primary diagnosis of skin cancer is unknown, as all included studies focused on the use of this technique for confirming strongly suspected clinical diagnoses. For the confirmation of BCC in lesions with a high clinical suspicion, there is evidence of high sensitivity and specificity for exfoliative cytology. Since decisions to treat low riskBCCs are unlikely in practice to require diagnostic confirmation given that clinical suspicion is already high, exfoliative cytology might be most useful for cases of BCC where the treatments being contemplated require a tissue diagnosis (e.g. radiotherapy). The small number of included studies, poor reporting and varying methodological quality means that no strong conclusions can currently be drawn to guide clinical practice. Despite insufficient data on the use of cytology for cSCC or melanoma, it is unlikely that cytology would be useful in these scenarios since preservation of the architecture of the whole lesion that would be available from a biopsy provides crucial diagnostic information. Given the paucity of good quality data, appropriately designed prospective comparative studies may be required to evaluate both the diagnostic value of exfoliative cytology by comparison to dermoscopy, and its confirmatory value in adequately reported populations with a high probability of BCC scheduled for further treatment requiring a tissue diagnosis

Modern methods of surgical treatment of cysts of jaws

Навчальний посібник присвячений актуальній проблемі сучасної хірургічної стоматології та щелепно-лицьовій хірургії – діагностиці та лікуванню кіст щелеп. В посібник увійшли питання класифікації, особливостей клініки та діагностики, лікування кіст щелеп. Кісти щелеп є дуже розповсюдженою патологією в щелепно-лицевій ділянці. Ця пухлиноподібна патологія нерідко призводить до серйозних наслідків. Для її діагностики і лікування потрібний комплексний підхід, з урахуванням усього різноманіття кістоутворення в щелепних кістках. Зміст посібника орієнтований на вимоги ОКХ та ОПП з фаху «стоматологія», що до набуття практичних навичок з діагностики та лікування хворих з кістами щелеп. Посібник призначений для студентів стоматологічних факультетів, лікарів-інтернів, магістрів, клінічних ординаторів, хірургів-стоматологів; Учебное пособие посвящено актуальной проблеме современной хирургической стоматологии и челюстно-лицевой хирургии - диагностике и лечению кист челюстей. В пособие вошли вопросы классификации, особенностей клиники и диагностики, лечения кист челюстей. Кисты челюстей очень распространенная патология в челюстно-лицевой области. Эта опухолеподобная патология нередко приводит к серьезным последствиям. Для ее диагностики и лечения требуется комплексный подход, с учетом всего многообразия кистообразования в челюстных костях. Содержание пособия ориентировано на требования ОКХ и ОПП по специальности «стоматология», что в приобретение практических навыков по диагностике и лечению больных с костями челюстей. Пособие предназначено для студентов стоматологических факультетов, врачей-интернов, магистров, клинических ординаторов, хирургов-стоматологов; he manual is devoted to the actual problem of modern surgical stomatology and maxillofacial surgery - diagnosis and treatment of jaw cysts. The manual includes issues of classification, clinical features and diagnosis, treatment of jaw cysts. Jawbones are a very common pathology in the maxillofacial area. This tumor-like pathology often leads to serious consequences. For its diagnosis and treatment, an integrated approach is required, taking into account the diversity of cyst formation in the maxillary bones. The content of the manual is oriented on the requirements of the OCh and OPP for the specialty "Dentistry", which, before acquiring practical skills in the diagnosis and treatment of patients with jaw cysts. The manual is intended for students of stomatological departments, interns, masters, clinical residents, surgeons, dentists

Clinical and molecular investigation of rare genetic overgrowth disorders

Genetic overgrowth disorders are a group of rare conditions characterised by generalised and/or regional overgrowth. They are associated with a wide spectrum of clinical features including intellectual disability, developmental disorders, congenital anomalies, and other medical problems. In recent years several novel overgrowth genes have been identified but the clinical phenotypes and natural history of these emerging conditions are not yet fully understood. The Phenotyping of Overgrowth Disorders (POD) study was established to investigate the clinical and molecular features of rare genetic overgrowth disorders. Comprehensive clinical phenotyping data was collected from 100 participants and entered in an electronic data capture system. Genomic testing was performed on a custom targeted next generation sequencing panel of overgrowth genes. Additional molecular investigation with whole exome sequencing was performed in selected participants and trios. This work identified a molecular genetic diagnosis in over 40% of the study cohort, confirmed the genetic heterogeneity of overgrowth disorders, and identified phenotypic overlap between overgrowth disorders and other rare genetic disorders. Knowledge of the clinical phenotypes of rare genetic overgrowth disorders has been expanded, including the clinically significant discovery of vascular complications in PDGFRB-related disorders that may be amenable to targeted molecular therapy

SIPMO 2019

The biennial Congress of the Italian Society of Oral Pathology and Medicine (SIPMO) is an International meeting dedicated to the growing diagnostic challenges in the oral pathology and medicine field. The III International and XV National edition will be a chance to discuss clinical conditions which are unusual, rare, or difficult to define. Many consolidated national and international research groups will be involved in the debate and discussion through special guest lecturers, academic dissertations, single clinical case presentations, posters, and degree thesis discussions. The SIPMO Congress took place from the 17th to the 19th of October 2019 in Bari (Italy), and the enclosed copy of Proceedings is a non-exhaustive collection of abstracts from the SIPMO 2019 contributions

Depth data improves non-melanoma skin lesion segmentation and diagnosis

Examining surface shape appearance by touching and observing a lesion from different points of view is a part of the clinical process for skin lesion diagnosis. Motivated by this, we hypothesise that surface shape embodies important information that serves to represent lesion identity and status. A new sensor, Dense Stereo Imaging System (DSIS) allows us to capture 1:1 aligned 3D surface data and 2D colour images simultaneously. This thesis investigates whether the extra surface shape appearance information, represented by features derived from the captured 3D data benefits skin lesion analysis, particularly on the tasks of segmentation and classification. In order to validate the contribution of 3D data to lesion identification, we compare the segmentations resulting from various combinations of images cues (e.g., colour, depth and texture) embedded in a region-based level set segmentation method. The experiments indicate that depth is complementary to colour. Adding the 3D information reduces the error rate from 7:8% to 6:6%. For the purpose of evaluating the segmentation results, we propose a novel ground truth estimation approach that incorporates a prior pattern analysis of a set of manual segmentations. The experiments on both synthetic and real data show that this method performs favourably compared to the state of the art approach STAPLE [1] on ground truth estimation. Finally, we explore the usefulness of 3D information to non-melanoma lesion diagnosis by tests on both human and computer based classifications of five lesion types. The results provide evidence for the benefit of the additional 3D information, i.e., adding the 3D-based features gives a significantly improved classification rate of 80:7% compared to only using colour features (75:3%). The three main contributions of the thesis are improved methods for lesion segmentation, non-melanoma lesion classification and lesion boundary ground-truth estimation