Methods: Brush- and scalpel biopsies were obtained from 120 patients with suspicious oral lesions. In cases, in which EC revealed malignant or suspicious cells, nuclear DNA-contents were measured using a TV image analysis system. The final diagnoses were: squamous cell carcinoma: 15, leukoplakia: 28, erythroplakia: 3, lichen planus: 54, pemphigus vulgaris: 1, cicatricial pemphigoid: 7, linear IgA disease: 2, ulcers: 3, actinic keratosis: 1, idiopathic desquamative gingivitis: 3, asthma spray stomatitis: 1, aphthous ulcers: 2.
Results: Among 120 oral lesions both cytological and histological diagnoses showed no sign of malignancy or dysplasia in 96. In 24 cases cytology yielded tumor cell positive (15), suspicious (5) or doubtful (4) results. DNA-image-cytometry showed aneuploidy in 19 of these (squamous cell carcinoma: 15 , leukoplakia: 1 , erythroplakia: 3), suspicion of DNA-aneuploidy in one case (cicatricial pemhigoid) and DNA-polyploidy in four cases (lichen planus: 2, linear IgA disease: 1, actinic keratosis: 1). In one primarily seemingly false positive cytological diagnosis, a second scalpel biopsy revealed cancer fifteen months later. In a further seemingly false positive cytological diagnosis, histology was not negative, but revealed mild dysplasia. The comparison between cytological diagnosis combined with DNA-cytometry and biopsy-histology resulted in a sensitivity of 100% and a specificity of 98%.
Conclusion: Within the limits of the present study, it was concluded that cytology with DNA-image-cytometry is a highly sensitive, specific, inexpensive and non invasive method for the early diagnosis of oral epithelial neoplasia and for the postsurgical control of large mucosal lesions in order to diagnose recurrences in an early stage, showing excellent compliance among patients.