Aplicação da citopatologia nos diagnósticos de malignidade e de carcinoma de células escamosas oral

Contém tabelas e ilustraçõesO número de casos de câncer tem aumentado de maneira significativa em todo omundo, configurando-se, na atualidade, como um dos mais importantes problemas de saúde pública. Consequentemente, a incidência de câncer de boca, também, tem aumentado mundialmente, sendo o carcinoma de células escamosas o maior representante de todos os tumores malignos que afetam a boca. O grande desafio é realizar o diagnóstico em fases iniciais, sendo uma condição importante para o prognóstico e tratamento efetivo destas lesões, o que pode ser facilitado pela utilização da citopatologia. Este é um método simples, não invasivo, relativamente indolor e de baixo custo, o que pode ser extremamente útil para o diagnóstico dessas lesões. No entanto, a literatura não é unânime sobre a precisão desse método. Este estudo objetivou avaliar a sensibilidade, especificidade, o valor preditivo positivo, valor preditivo negativo e acurácia do exame citopatológico no diagnóstico de malignidade e de carcinoma de células escamosas oral. A amostra constituiu-se de: a) estudo prospectivo a partir de esfregaços obtidos por raspagem de 39 lesões orais clinicamente suspeitas de malignidade, que simultaneamente foram submetidas à biópsia incisional para exame histopatológico, durante o ano de 2007; b) estudo retrospectivo a partir de lâminas (esfregaços e biópsias) de 61 pacientes que apresentaram lesões orais clinicamente suspeitas de malignidade entre os anos de 2002 e 2006, no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Antônio Pedro. Após o estabelecimento dos critérios citopatológicos, todos os esfregaços foram avaliados por três examinadores independentes, quanto à qualidade do esfregaço e classificados em negativo para malignidade, positivo para displasia epitelial, suspeito para malignidade, positivo para malignidade, positivo para carcinoma e positivo para carcinoma de células escamosas oral. A análise comparativa entre os aspectos cito e histopatológicos de positivo para malignidade e positivo para carcinoma de células escamosas oral revelou sensibilidade de 84,5% e 79,3%, especificidade de 100% e 100%, valores preditivos positivo de 100% e 100%, valor preditivo negativo de 55,2% e 51,4% e acurácia de 87% e 83%, respectivamente. Os resultados deste estudo indicam que a citopatologia pode ser utilizada rotineiramente como método diagnóstico de malignidade e de carcinoma de células escamosas oral. A utilização da citopatologia como procedimento diagnóstico de rotina, possibilitando a avaliação de maiores casuísticas e a padronização da técnica poderão definir a acurácia do método e provocar importantes mudanças na mortalidade e morbidade do câncer oralCancer is one of the most important problems in public health and its incidence has risen significantly worldwide. Accordingly, the incidence of oral cancer has also increased and 94% of the cases are caused by squamous cell carcinomas. A key factor in the lack of improvement in prognosis is dued of non-diagnosis or treatment in initial stage, in which the cytophatologic exam makes easier the early diagnostic. The cytopathology consists in a simple, non-aggressive, painless, and economical technique, an attractive option for the diagnosis of these lesions. However, based on literature, the effectiveness of this method is not unanimous. The objective of the present study is to evaluate the sensitivity, specificity, positive and negative predictive values and accuracy in cytopathological results in diagnosis of malignancy and oral squamous cell carcinoma. The sample consisted of: a) prospective study from swabs obtained by scraping of 39 oral lesions clinically suspected of malignancy, which were also submitted to incisional biopsy for histopathological examination, in the year 2007; b) retrospective study from the blades (smears and biopsies) of 61 patients who had oral lesions clinically suspected of malignancy between the years 2002 and 2006, in the file of the Office of Pathological Anatomy of the University Hospital Antonio Pedro. After the establishment of the cytopathologicals criteria, all swabs were evaluated by three independent examiners, on the quality of swabs and classified in negative for malignancy, positive for epithelial dysplasia, suspected for malignancy, positive for malignancy, positive for carcinoma and positive for carcinoma of squamous cells. A comparative analysis between the cytopathological and histopathological aspects of positivity for malignancy and for oral squamous cell carcinoma showed sensitivity of 84.5% and 79.3%, specificity of 100% and 100%, positive predictive values of 100% and 100 %, negative predictive value of 55,2% and 51,4%, and accuracy of 87% and 83%, respectively. Our findings demonstrate that the cytopathology was a reliable tool that may be used as a method of diagnosis of malignancy and oral squamous cell carcinoma. The use of cytophatology as a routine diagnostic procedure, enabling the evaluation of more number of cases and the standardization of the technique, may define the accuracy of the method and cause major changes in the mortality and morbidity of oral cancer.157 f

Concordance between cytopathology and incisional biopsy in the diagnosis of oral squamous cell carcinoma

Oral cytopathology is a simple, non-invasive technique that could be used for early detection of oral premalignant and malignant lesions, but the effectiveness of this diagnostic approach remains controversial. The aim of this study was to evaluate the sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology for diagnosing oral squamous cell carcinoma (OSCC) and the diagnostic concordance between cytopathological and histopathological diagnoses. The study enrolled 172 patients at outpatient clinics who presented with oral lesions suspicious of malignancy. All patients underwent oral cytological scrapes followed by an incisional biopsy. Of 148 cases that were histopathologically diagnosed with OSCC, the cytopathological method diagnosed 123 positive cases and resulted in a suspicion of OSCC in 16 patients. Based on these data, the sensitivity was 83.1%, the specificity was 100.0%, the positive predictive value was 100.0%, the negative predictive value was 49.0%, and the accuracy was 85.5%. The diagnostic concordance between histopathological and cytopathological examinations was 83.1% for OSCC and 85.7% for non-neoplastic lesions. The results indicate that cytopathological diagnosis had good concordance with histopathological diagnosis and showed high sensitivity, specificity, positive predictive value, and accuracy. We conclude that the sensitivity of oral cytopathology is sufficient to justify its use as a diagnostic screening test and to confirm the malignant nature of epithelial cells, mainly for the classification of OSCC. Therefore, cytopathology may be a reliable method for referring patients who require diagnosis of suspected oral cancer for starting treatment

Evaluation of sclerotherapy with different dilutions of ethanolamine oleate in the treatment of oral varicose veins

ABSTRACT Objective: This study aim to evaluate the effectiveness of sclerotherapy protocols with different dilutions of ethanolamine oleate in the treatment of oral varicose veins. Methods: Clinical data and images of 14 cases treated with sclerotherapy were analyzed and descriptive analyses were performed. Results: Females (58%) and white skin color (83%) prevailed. Age varied between 14 and 79 years, with 47 years on mean (SD = 19 years). The most common anatomical locations were the buccal mucosa and lower lip. The final volume of the sclerosing agent (Ethamolin®) ranged from 0.4 to 4.3ml and the concentration ranged from 5% to 100%. The number of sessions ranged from 1 to 12 and the number of points per application was 1 to 7 points. Pain and edema were seen in 43% and 29% of patients, respectively. Conclusion: Sclerotherapy with monoethanolamine oleate diluted in anesthetic is a safe and effective option for the treatment of this lesion, regardless of concentration. However, edema and pain seem to be directly associated with increased drug concentration

Usefulness of tissue autofluorescence imaging in actinic cheilitis diagnosis

Actinic cheilitis (AC) is a potentially malignant disorder of the lips. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. The purpose of this study was to evaluate the usefulness of tissue autofluorescence in AC diagnosis. The system was composed of a 405-nm light-emitting diode, sent to the sample by a dichroic, that allows the fluorescence signal to reach a camera directly plugged in the system. Fifty-seven patients with clinical diagnosis of AC and 45 normal volunteers were selected. According to clinical and fluorescence features, one or more areas were selected for biopsies in the AC group and epithelial dysplasia (ED) grades were established. The autofluorescence images were processed by a clustering algorithm for AC automated diagnosis. The tissue autofluorescence image revealed a heterogeneous pattern of loss and increase of fluorescence in patients with AC. ED was found in 93% of the cases, and most of the areas graded as moderate or severe ED were chosen with the aid of autofluorescence. The processed autofluorescence images from AC patients showed a higher number of spots in an irregular pattern. Tissue autofluorescence image system is a useful technique in association with clinical examination for AC diagnosis.FAPERJFAPESPCNP