Diagnostic value of cytology in oral ulcer and comparison with histopathology and direct immunofluorescence

Abstract

Rapid diagnosis of pemphigus vulgaris (PV) is an important task in patient's prognosis and treatment. Although PV is routinely diagnosed through investigation of pathology specimens and direct immunofluorescence assays, Tzanck smear can be used as rapid, inexpensive, and easily used test to confirm its clinical diagnosis. This study aimed to determine the diagnostic value of Tzanck smear in erosive oral lesions of PV and also determine its sensitivity and specificity for diagnostic purposes. A total of 68 patients with erosive/ulcerated oral lesions were included in this study and divided into PV (case group) vs other causes of erosive oral lesions (control group). From all participants, two Tzanck smears were prepared for both Giemsa and hematoxylin-eosin (H&E) staining. For definite diagnosis, histopathology and direct immunofluorescence evaluations were performed based on clinical findings. The sensitivity of acantholytic cells in Tzanck smear of erosive oral lesions of PV cases was 80.5% (for both Giemsa and H&E staining), whereas specificity values of Giemsa and H&E staining were 84.6% and 96.3%, respectively. Based on our findings, the Tzanck smear of erosive oral lesions is a simple, quick, and inexpensive test for screening and primary diagnosis of PV.

Liquid‐based cytology for differentiating two cases of pemphigus vulgaris from oral squamous cell carcinoma

“…It is suggested that the lack of deep cell collection could be a possible differentiating factor. Regarding the incidence of acantholytic cells, 80.5% (33/41) of the oral erosive lesions in PV cases were found to be acantholytic, while in the control group, Lichen planus, the incidence was 0% (0/12) in H&E‐stained smears and 18.1% (2/11) in Giemsa‐stained smears 2 . The sensitivity of acantholytic cells in Tzanck smear of erosive oral lesions of PV cases was 80.5% (for both Giemsa and H&E staining), whereas specificity values of Giemsa and H&E staining were 84.6% and 96.3%, respectively 2 .…”

“…Regarding the incidence of acantholytic cells, 80.5% (33/41) of the oral erosive lesions in PV cases were found to be acantholytic, while in the control group, Lichen planus, the incidence was 0% (0/12) in H&E‐stained smears and 18.1% (2/11) in Giemsa‐stained smears 2 . The sensitivity of acantholytic cells in Tzanck smear of erosive oral lesions of PV cases was 80.5% (for both Giemsa and H&E staining), whereas specificity values of Giemsa and H&E staining were 84.6% and 96.3%, respectively 2 . However, Papanicolaou stain is usually used for cytological evaluation in oral mucosal diseases because it is useful in differentiating squamous cell lesions due to its color tone that reflects the degree of squamous cell differentiation, and we used Papanicolaou stain again for this evaluation.…”

“…Cell smear of erosive oral lesions is a sensitive and highly specific method for rapid diagnosis of PV. 2 Fine chromatin patterns and smooth nuclear films seem to be easier to assess in liquidbased PV smears. 3 However, it is sometimes difficult to differentiate Tzanck cells from the atypical parabasal/basal cells that appear in high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC), and it is important to differentiate Tzanck cells from neoplastic lesions of the oral mucosal epithelium for appropriate diagnosis.…”

“…Oral PV is characterized by the formation of the bullous lesion followed by thrush and cytological findings of acantholytic cells, also called Tzanck cells. Cell smear of erosive oral lesions is a sensitive and highly specific method for rapid diagnosis of PV 2 . Fine chromatin patterns and smooth nuclear films seem to be easier to assess in liquid‐based PV smears 3 .…”

A blade-free approach to the Tzanck smear

“…Although histopathology and direct immunofluorescence are the gold standard for pemphigus group of disorders, Tzanck smear is a cost-effective tool in resource-poor settings, with a sensitivity of 80.5% and specificity of 84.6% for oral pemphigus. 1 However, the standard procedure in dermatology literature involves scraping the erosion with the blunt end of a surgical blade, often causing patient apprehension, pain, and bleeding. Moreover, lesions on the posterior part of buccal mucosa or palate are inaccessible by this method (Supplementary Fig 1, available via Mendeley at https://data.mendeley.com/datasets/ks2gwtckh3/1 ).…”