Analysis of false-negatives in exfoliative cytology in oral potentially malignant disorders: A retrospective cohort study

• Published in: Journal of stomatology, oral and maxillofacial surgery Vol. 123; no. 5; pp. e390 - e395
• Main Authors: Ishii, Shigeru, Sakaguchi, Wakako, Sugai, Masafune, Nagumo, Tatsuhito, Koeda, Satoko, Ozawa, Manami, Kitamura, Toru, Yamamura, Makiko, Akiyama, Hiroki, Tsukinoki, Keiichi, Nakamura, Atsushi
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-10-2022
• Subjects: Diagnosis; Epithelial dysplasia; Exfoliative cytology; Oral cytology; Oral leucoplakia; Squamous cell carcinoma; Exfoliative cytology; Epithelial dysplasia; Squamous cell carcinoma; Oral cytology; Diagnosis; Oral leucoplakia
• ISSN: 2468-7855; 2468-7855
• DOI: 10.1016/j.jormas.2022.02.001

•False-negatives were associated with leukoplakia, age ≤64, and tongue lesions.•Misdiagnosis in oral exfoliative cytology may be due to inadequate cell collection.•The development of inexpensive instruments dedicated to oral cytology is required.•The best method of diagnosis should be determined by considering the age and site.
Keratinized lesions have been a conceivable false-negative (FN) factor in oral exfoliative cytology (OEC); however, other factors are poorly analyzed. In this study, we aimed to identify the factors influencing the accuracy of OEC and FNs focusing on the lesion characteristics, patient background, and surgeon factors in oral potentially malignant disorders (OPMD).
We retrospectively studied 44 patients who underwent both OEC and histopathological diagnosis. Sensitivity, specificity, FN rate, false-positive (FP) rate, and prevalence of both methods were compared. Similarly, accuracy indices were compared among clinical diagnosis groups (leukoplakia vs. other diagnosis). The association between patient and surgeon-related factors influencing FN OEC results were investigated using Fisher's exact test and a multiple logistic regression analysis.
Overall, the sensitivity; specificity; and FN, FP, and prevalence rates of OEC were 31.8%, 82.1%, and 68.8%, 17.9%, and 36.4%, respectively. Leukoplakia was significantly more common in clinical diagnosis (P = 0.007) with sensitivity, specificity, and FN rates of 20.0%, 95.2%, and 80.0%, respectively. Contrarily, non-keratinized lesions had sensitivity, specificity, and FN of 83.3%, 85.7%, and 16.7%, respectively. In the prevalent group, leukoplakia and anucleate squamous cells were significantly associated with FN cases (P = 0.013, P = 0.050). On multivariate analysis in OEC negative patients, age ≤64 (P = 0.050) and location on the tongue (P = 0.047) was independently associated with FNs.
FN of OEC was conceivable to be due to poor deep-seated cell sampling, which was associated with leukoplakia, age, and location. Therefore, these factors may be considered in the evaluation of OEC results.