Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
general dental practitioners, who, although experts in their own
field, had no specialist training in oncology nor specific competence
in the sector of Oral Medicine and Pathology. The training
session lasted about 90 minutes and included the use of visual
aids, such as photographs and a video, so as to provide them with
the notions necessary to carry out the sampling correctly. At the
end of the session, each dentist was given a detailed leaflet with
a description of the sampling technique and 5 kits. The kits contained
all the material required to carry out the sampling, which
was to be done on the first five consecutive patients with oral cavity
lesions of the mucosa during their routine practise. Each kit
had: 1 disposable dermatological curette, 7mm in diametre, (Acu-
Dispo Curette®, Acuderm Inc., Ft. Lauderdale, FL, USA); 1 fixing
vial with Thin Prep® (Cytic Corporation, Marlborough, MA,
USA); 1 form with patient details e.g. anagraphic data, medical
anamnesis including the use of alcohol and/or tobacco, the site,
colour dimension and symptomatology of the lesions, the time
of onset, whether or not anaesthesia had been used for sampling
and diagnostic suspicion. The operative protocol recommended
that sampling be carried out only in the presence of lesions of
epithelial origin i.e. patches, papules, plaques, verrucous lesions,
erosions and ulcers.
The dentist was taught to hold the curette tangential to the lesion
surface so as to avoid cutting rather than scraping and to continue
scraping until such times as an adequate amount of tissue fragments
had been obtained, with visible uniform slight bleeding on
the whole surface area of the lesion being sampled. The curette
was then to be placed into the fixing vial and shaken to free
the fragments. As a rule, no local anaesthesia, topical sprays,
or emulsions/creams should be used to avoid lubrication of the
lesion surface, which would reduce scraping efficacy when collecting
fragments, except in particularly symptomatic cases, or on
patient request. The micro-biopsies are then embedded in paraffin,
cut with a microtome, stained with haematoxylin-eosin and
subjected to histological examination by an expert pathologist.
The sample is classified on the basis of the histological evaluation:
ADEQUATE in the presence of a representative strip of
epithelium (at least 100 non-superficial cells), or INADEQUATE
when only horny material is present (anucleated cells).
Results. A total of 50/75 dentists, who took part in the training
session, took part in the study. Between February 2009 and September
2011, 152 micro-biopsies were sent for evaluation, from
sampling carried out on a total of 132 patients, 72 males and 60
females (M:F = 1.2:1) average age 53.6 years (25-88).
There were 140/152 adequate samples (92.1%) and 110/140
(78.5%) had a visible basal membrane (110/140). Whilst 12/152
(7.9%) were inadequate. The data obtained in this study showed
that the number of adequate samples obtained in non-expert
hands were superimposable on those obtained by personnel
expert in the field i.e. 92.1% and 96.3% respectively; p = 0.167.
The inadequate samples showed no statistically significant difference
on the basis of the type of lesion (p = 0.320), or the
lesion site (p = 0.740). The first-level micro-biopsy examination
355
result was confirmed in all cases that were referred for a 2 nd
level diagnostic test (scalpel biopsy). A histological diagnosis of
dysplasia was made in 10/140 micro-biopsy samples (7.1%) and
one carcinoma (0.7%). There were no relevant complications and
anaesthesia was used in 18.4% of cases.
Conclusions/Summary. We demonstrated that the micro-biopsy
technique in expert hands is minimally invasive with a high sensitivity
(97.65%) and high negative predictive value (97.33%)
(Navone et al., 2008). Therefore, we hypothesized its use as a
first level diagnostic test for dentists on the field. The innovative
research reported herein aimed at evaluating the feasibility of
such a hypothesis and demonstrated that a brief training session
sufficed to enable dentists who, although experts in their own
field, had no specific oncological training, to provide adequate
samples for histological examination through an economical,
user-friendly and well accepted first level test. Moreover, to
the best of our knowledge, for the first time, this study obtained
valuable information as to the number and type of oral mucosal
lesions that put the dentist into difficulty when making a differential
diagnosis in everyday practise. The most common lesions
sampled were patches, papules, plaques, rather than erosions/
ulcers, most likely due to the fact that the latter heal quickly once
the source of the problem has been identified and modified e.g.
ill-fitting prosthesis or other factors tied to dental issues. Taken
as a whole, the lesions sampled and referred for histology had
relevant oncological characteristics with 7.8% having a definite
diagnosis of dysplasia or carcinoma, absolutely not to be underestimated.
Indeed, these data have demonstrated for the first time
how important the dentist’s role can be in providing early data on
these types of potentially fatal lesions. Last, but not least, these
data show how the first level micro-biopsy diagnostic test is able
to select a small group of patients to be sent for further evaluation
allowing professionals working in an important health-care sector
to treat their patients with state-of-the-art technology. Moreover,
thanks to the follow-up of all the negative cases, future data will
provide information as to the presence of any false-negative cases
at the 1 st level test. The adoption of this strategy could, hopefully,
make a contribution in reducing the percentage of late diagnosis
in oral mucosal squamous cell carcinoma.
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Navone R, Pentenero M, Gandolfo S. Liquid-based cytology in oral cavity
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Navone R, Pentenero M, Rostan I, et al. Oral potentially malignant lesions:
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