title: Diagnostic accuracy of oral cancer cytology in a pilot study.
abstract: BACKGROUND
  Recently, cytology has been applied to the diagnosis of oral lesions. We aimed to explore the diagnostic accuracy of oral cytology based on the histological diagnosis.
  
  
  METHODS
  Histological diagnoses of 327 cases were classified as Negative, Borderline lesion -, Borderline lesion +, oral intraepithelial neoplasia/carcinoma in situ (OIN/CIS), or Positive. Cytological diagnoses were classified as NILM (negative for intraepithelial lesion or malignancy), LSIL (low-grade squamous intraepithelial lesion), HSIL (high-grade squamous intraepithelial lesion), or SCC (squamous cell carcinoma). The cytology slides were evaluated by 10 raters and the results were compared with the histology results.
  
  
  RESULTS
  In 142 cases that were histologically negative, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 77 (54.2%), 47 (34.3%), 8 (5.6%), and 10 (7.0%), respectively. Among 32 cases of Borderline lesion -, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 11 (34.3%), 11 (34.3%), 9 (28.1%), and 1 (3.1%), respectively. Also, in 4 cases of Borderline lesion +, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 2 (50.0%), 0 (0.0%), 0 (0.0%), 2 (50.0%), respectively. Among 12 cases of OIN/CIS, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 1 (8.3%), 2 (16.7%), 4 (33.3%), and 5 cases (41.7%), respectively. Among 137 cases with a histological diagnosis of Positive, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 7 (5.1%), 22 (16.1%), 19 (13.9%), and 89 (65.0%), respectively. Sensitivity, specificity, and positive predictive and negative predictive values were 93.5, 50.6, 62.4, and 89.8%, respectively, when the cytological diagnosis of Negative was assumed to be NILM; they were 77.8, 83.9, 81.0 and 81.1%, respectively, if the cytological diagnosis of Negative was assumed to be NILM and LSIL. The number of false-positive and false-negative diagnosis affected cases with LSIL and HSIL may indicate the difficulty in the cytological diagnosis of borderline lesions. While the negative predictive value was relatively high (89.8%) when cytological Negative was assumed to be NILM only.
  
  
  CONCLUSIONS
  Histopathological examination should be recommended in cases with cytological diagnoses of LSIL, HSIL, and SCC.
authors.affiliation: Japanese Society of Clinical Cytology, Tokyo, Japan. georges@med.shimane-u.ac.jp.|Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan. georges@med.shimane-u.ac.jp.
authors.forename: Joji
authors.identifier: http://orcid.org/0000-0001-5573-3461
authors.initials: J
authors.lastname: Sekine
authors.affiliation: Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakatani
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hideshima
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Iwahashi
authors.affiliation: Japanese Society of Clinical Cytology, Tokyo, Japan.|Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
mesh_terms: D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D057189:Checklist; D003581:Cytodiagnosis / Q000379:methods*; D006801:Humans; D007564:Japan; D009062:Mouth Neoplasms / Q000473:pathology*; D060787:Neoplasm Grading; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Accuracy; Cytology; Diagnosis; Oral cancer; Pathology