Cytodiagnosis of oral lesions in chronic tobacco users

Background: In the country like India where oral cancer with its associated tobacco chewing habit exists in epidemic proportions, constitutes a major public health hazard. The high percentage of oral cancer if not preventable is curable only if detected in its early stage which require large scale screening of the population at risk carried out repeatedly from time to time. Exfoliative cytology plays important role in this. Aim: To study age and sex wise incidence of oral lesion, to study the clinical presentations, to study the role of tobacco chewing, gutkha, pan with areca nut and smoking in benign, premalignant and malignant lesions of oral cavity, to study the cytomorphological changes in oral cavity of different clinico- pathological lesions of chronic tobacco users, to corelate oral cytology with histopathology where ever possible. Materials and methods: A prospective study was carried out in total 135 chronic tobacco users. Patients above 15 years age who presented with oral lesion and with history of tobacco use in any form for more than 1 year were included in the study. Samples were obtained by scrape method using wooden spatula. All the smears were stained by Papanicolaou stain. Results: In the present study of 135 chronic tobacco users 73.33% were male and 26.67% were females. Male to female ratio was 2.75:1. Maximum 34.07% chronic tobacco users were in the age group of 31-40 year.30 cases of oral submucous fibrosis, 5 cases of leukoplakia and 59 cases of clinically suspected malignancy seen. Most common presenting symptom were ulceration in oral cavity in 51.11%. Commonest site of lesion was buccal mucosa in 56.30% cases. Cytological examination of smear showed dysplasia in 58.52% cases, smears positive / suspicious for malignancy in 37.04% cases and inflammatory smears in 3.70% cases. Clinically suspected malignant lesions were seen maximum (40 cases) in age group of 41-60 years which were using tobacco+lime, kharra, gutkha and tobacco smoking as habits. Incidence of malignancy was seen increasing with increased duration and frequency of tobacco use. Maximum 24 cases of malignancy (40.68%) were seen with use of tobacco for more than 25 years, affecting males commonly. Squamous cell carcinoma was the only histological type seen in all the cases. Percentage accuracy of cytologic diagnosis in oral cancer when compared with histopathological diagnosis was 84.75%. Conclusion: Cytology is a reliable method for diagnosis of oral cancer but histological examination remains the gold standard.