Cervical smear is a well-known method in detecting cervical cancer. Oral smear on the other hand may be useful in microbiological diagnosis like candidal infection. Whether it can be used for diagnosing cancer is still controversial in comparison to histopathology. This may dictate certain pros and cons for the technique when used in the oral mucosa.
Hello Najla,, I personally feel that exfoliative cytology(EC) can play a very useful role in detecting Oral epithelial dysplastic (OED) lesions. We just need to remember that the oral epithelium is different from the lining of the cervix and behaves differently too . We often find keratinization without any dysplastic change in the oral lining and this makes the well known differential staining of Pap stain less useful . So greater level of training is required in identifying OEDs.
Field carcinogenesis and the possibility of multiple lesions, very large lesions and conditions that affect the entire mucosa such as OSMF, provide good support for the diagnostic usefulness of EC .In all these cases it is impossible to biopsy all areas /lesions thus it is best to use EC for identifying the most appropriate location for biopsy. Even in recall /follow up patients it would seem the best protocol would be to perform a EC of the site/lesion at each recall. Since there would be limitation to number of biopsies that can be performed.
EC smears have the additional advantage of identifying candidiasis which is known to play a role in dysplastic change and may also cause unrelated lesions that look premalignant . So EC is really useful for hastening diagnosis and appropriate treatment.
I believe the greatest pitfall in examining EC is because of similar changes often found as a result of inflammation. However if such a situation is found it can be expected to be seen in the biopsy as well.. so a good practice would be to deal with all obvious causes of inflammation and recheck after the standard 14 days.. this would probably help in avoiding inconclusive histology reports too.
Additionally we find that with practice it is possible to identify cytological dysplasia with great degree of accuracy.
Sorry .. this answer turned a lot longer than it was meant to....
Thank you Mandana for giving a nice outline on the indications of EC. Do you recommend using this technique for smokers who may be susceptible to scc? What changes you look for during cytological examination?
I personally feel and use EC only to examine existing lesions. Don't Know how effective it will be for screening.
We normally base our diagnosis on 1) Increased nuclear cytoplasmic ratio and one of the following , variations in cell shape, size and Nuclear pleomorphism.
Hi I agree with Mandana Maam. You can also look for micronuclei in smokers which are increased
Dear Mandana, can you control the sample size and should the sample be read by some one expert in EC?
Thank you Nandini, is there an association between smoking and histological findings on the nuclear level?
Not clear what sample size you are referring to. And yes a certain level of expertise is required before reporting the slides, we found it was best for beginners to examine the EC slides of cases where the incisional biopsy slides had subsequently become available for comparison, this is the best form of self learning to our experience ...
Thanks Mandana, I meant by the sample size the number of cells scraped.
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