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An official publication of the Middle-Eastern Association for Cancer Research
Clinical Cancer Investigation Journal
ISSN Print: 2278-1668, Online: 2278-0513
ARTICLE
Year: 2022   |   Volume: 11   |   Issue: 4   |   Page: 25-32     View issue

The Application of the Bethesda System for Reporting Cervical Cytology to Oral Cytology: An Institutional Study

Anubhuti Sood1, Deepika Mishra1*, Rahul Yadav2, Krushna Bhatt2, Harsh Priya3

1Division of Oral Pathology and Microbiology, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi. 2Division of Oral and Maxillofacial Surgery, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi. 3Division of Public Health Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi.


Abstract

Classification of oral cytology remains controversial under the Papanicolaou system. A uniform classification system would reduce inter-observer variability and also establish well-defined thresholds for management. This study evaluated the diagnostic accuracy of Bethesda (2014) system for dysplasia and malignancy in comparison to the Pap classification system and histopathological gold standard.
806 patients presenting with oral lesions were subjected to cytological diagnosis at our institution from 2017 to 2019. 100 of these patients
underwent simultaneous biopsy for these lesions (subjects of this study). PAP-stained cytological smears from these patients were classified according to PAP and Bethesda 2014 systems and compared with their histopathological diagnosis. Bethesda classification showed 52.9% sensitivity, 86.7% specificity, PPV of 90.2% and NPV of 44.1% for detecting malignant/pre-malignant oral lesions. Sensitivity, specificity, PPV and NPV of the PAP system was 70%, 80%, 89.1% and 46.6% respectively. Statistically significant association was found between histopathological diagnosis and Bethesda classification: Spearman’s correlation coefficient being 0.537 (p<0.001). The Bethesda classification system uses well-defined criteria. Our study suggests that it renders cytopathological diagnosis of oral lesions more rigorous and reproducible. Oral scrape cytology reported under the Bethesda system can present clinicians with more interpretable, objective and actionable reports

Keywords: Oral cytology, Papanicolaou classification, Bethesda classification, Squamous intraepithelial lesion, Squamous cell carcinoma


 

References

1.        Papanicolaou GN. A general survey of the vaginal smear and its use in research and diagnosis. Am J Obstet Gynecol. 1946;51(3):316-28.

2.        Kazanowska K, Hałoń A, Radwan-Oczko M. The role and application of exfoliative cytology in the diagnosis of oral mucosa pathology - contemporary knowledge with review of the literature. Adv Clin Exp Med Off Organ Wroclaw Med Univ. 2014;23(2):299-305.

3.        Mehrotra R, editor. Oral Cytology: A Concise Guide [Internet]. New York: Springer-Verlag; 2013 [cited 2019 Mar 16]. Available from: https://www.springer.com/de/book/9781461452201

4.        Montgomery PW, Von Haam E. A study of the exfoliative cytology in patients with carcinoma of the oral mucosa. J Dent Res. 1951;30(3):308-13.

5.        Verma R, Singh A, Badni M, Chandra A, Gupta S, Verma R. Evaluation of exfoliative cytology in the diagnosis of oral premalignant and malignant lesions: A cytomorphometric analysis. Dent Res J. 2015;12(1):83-8.

6.        Brunotto M, Zárate AM, Cismondi A, Fernández M del C, Noher de Halac RI. Valuation of exfoliative cytology as prediction factor in oral mucosa lesions. Med Oral Patol Oral Cirugia Bucal. 2005;10 Suppl 2:E92-102.

7.        Powers CN. Diagnosis of infectious diseases: a cytopathologist’s perspective. Clin Microbiol Rev. 1998;11(2):341-65.

8.        Sukegawa S, Ono S, Nakano K, Takabatake K, Kawai H, Nagatsuka H, et al. Clinical study on primary screening of oral cancer and precancerous lesions by oral cytology. Diagn Pathol. 2020;15(1):1-6.

9.        Swailes AL, Hossler CE, Kesterson JP. Pathway to the Papanicolaou smear: The development of cervical cytology in twentieth-century America and implications in the present day. Gynecol Oncol. 2019;154(1):3-7. doi:10.1016/j.ygyno.2019.04.004

10.      Mehrotra R, Hullmann M, Smeets R, Reichert TE, Driemel O. Oral cytology revisited. JOral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol. 2009;38(2):161-6.

11.      Chandrasekhar V, Krishnamurti C. George Papanicolaou (1883-1962): Discoverer of the Pap Smear. J Obstet Gynaecol India. 2018;68(3):232-5. doi:10.1007/s13224-018-1102-z

12.      Afrogheh A, Hille J, Mehrotra R. The development of a novel oral cytologic grading system. In Oral Cytology 2013 (pp. 73-90). Springer, New York, NY.

13.      Sekine J, Nakatani E, Hideshima K, Iwahashi T, Sasaki H. Diagnostic accuracy of oral cancer cytology in a pilot study. Diagn Pathol. 2017;12(1):27.

14.      Diamantis A, Magiorkinis E, Koutselini H. 50 years after the death of George Nicholas Papanicolaou (1883-1962): evaluation of his scientific work. Acta Medico-Hist Adriat AMHA. 2014;12(1):181-8.

15.      IARC Working Group. Cervix cancer screening. IARC handbooks of cancer prevention, International Agency for Research on Cancer. World Health Organization. IARC Press. 2005.

16.      Broso PR, Buffetti G. The Papanicolaou classification in the Bethesda system (National Cancer Institute, Bethesda, Maryland). Minerva Ginecol. 1993;45(11):557-63.

17.      Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid Off J Am Thyroid Assoc. 2017;27(11):1341-6.

18.      Idrees M, Farah CS, Sloan P, Kujan O. Oral brush biopsy using liquid-based cytology is a reliable tool for oral cancer screening: A cost-utility analysis: Oral brush biopsy for oral cancer screening. Cancer Cytopathol. 2022;130(9):740-8. doi:10.1002/cncy.22599

19.      Zarif HA, Ghandurah SE, Al-Garni MA, Binmahfooz SK, Alsaywid BS, Satti MB. Thyroid Nodules Cytopathology Applying the Bethesda System with Histopathological Correlation. Saudi J Med Med Sci. 2018;6(3):143-8.

20.      Acar Y, Doğan L, Güven HE, Aksel B, Karaman N, Özaslan C, et al. Bethesda Made It Clearer: A Review of 542 Patients in a Single Institution. Oncol Res Treat. 2017;40(5):277-80.

21.      Sood A, Mishra D, Yadav R, Bhatt K, Priya H, Kaur H. Establishing the accuracy of a new and cheaper sample collection tool: Oral cytology versus oral histopathology. J Oral Maxillofac Pathol. 2020;24(1):52-6. doi:10.4103/jomfp.JOMFP27319

22.      Cawson RA. The cytological diagnosis of oral cancer. Brit Dent J. 1960;108:294.

23.      Nayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. Springer; 2015. 342 p.

24.      Al-Abbadi MA. Basics of cytology. Avicenna J Med. 2011;1(1):18-28.

25.      Sivapathasundharam B, Kalasagar M. Yet another article on exfoliative cytology. J Oral Maxillofac Pathol. 2004;8(2):54.

26.      Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. “The reports of my demise have been greatly exaggerated.” (after a quotation from Mark Twain). Acta Cytol. 2015;59(2):121-32.

27.      Melo-Uribe MA, Sanabria Á, Romero-Rojas A, Pérez G, Vargas EJ, Abaúnza MC, et al. The Bethesda system for reporting thyroid cytopathology in Colombia: Correlation with histopathological diagnoses in oncology and non-oncology institutions. J Cytol Indian Acad Cytol. 2015;32(1):12-6.

28.      Jain V, Vyas A. Cervical Neoplasia-Cyto-Histological Correlation (Bethesda System) A Study of 276 Cases. J Cytol Histol. 2010;01(02). Available from: https://www.omicsonline.org/cervical-neoplasia-cyto-histological-correlation-bethesda-system-a-study-of-276-cases-2157-7099.1000106.php?aid=1035

29.      Naz S, Hashmi AA, Khurshid A, Faridi N, Edhi MM, Kamal A, et al. Diagnostic accuracy of Bethesda system for reporting thyroid cytopathology: an institutional perspective. Int Arch Med. 2014;7(1):46.

30.      Christensen JT, Grønhøj C, Zamani M, Brask J, Kjær EK, Lajer H, et al. Association between oropharyngeal cancers with known HPV and p16 status and cervical intraepithelial neoplasia: a Danish population-based study. Acta Oncol. 2019;58(3):267-72. doi:10.1080/0284186X.2018.1546059

31.      Alsarraf A, Kujan O, Farah CS. Liquid-based oral brush cytology in the diagnosis of oral leukoplakia using a modified Bethesda Cytology system. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol. 2018;47(9):887-94.

32.      Macey R, Walsh T, Brocklehurst P, Kerr AR, Liu JLY, Lingen MW, et al. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst Rev. 2015;(5):CD010276.

33.      Brocklehurst PR, Speight PM. Screening for mouth cancer: the pros and cons of a national programme. Br Dent J. 2018;225:815-9.

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ISSN Print: 2278-1668, Online: 2278-0513