Tobacco-induced alterations in exfoliated oral epithelial cells: A comparative image analysis study

Background: Squamous cell carcinoma is the most prevalent neoplasm of the oral cavity. A strong relationship exists between tobacco smoking and development of oral squamous cell carcinoma. The mortality rate associated with head and neck cancers remains high, and thus detection techniques are important. Oral exfoliative cytology is a simple, noninvasive method that involves microscopic analysis of cells collected from the surface of oral mucosa which can reveal various cellular and nuclear alterations in squamous cell carcinoma. Aims: This study aims to analyze the cytomorphometric changes in smokers and nonsmokers and to compare and evaluate the efficacy of different stains, that is, Papanicolaou, Methyl green-pyronin, and Feulgen stains in assessing the oral smears. Patients and Methods: Study sample consists of 72 healthy individuals of 30-40 years including two groups (36 smokers and 36 nonsmokers) who had no clinically apparent oral mucosal lesions. Three smears were obtained from each subject with oral cytobrush and were then stained separately with Papanicolaou, Methyl green-pyronin, and Feulgen stains. Smears were observed and assessed for cytoplasmic diameter, nuclear diameter, and nuclear color intensity. Results: All three stains in our study showed significant variations in all three parameters between smokers and nonsmokers (P < 0.05). Out of all the three stains, Methyl green-pyronin Y stain proved to give better results. Conclusion: This study contributed to the fact that exfoliative cytology is a simple, noninvasive diagnostic technique for identifying cancerous changes in oral mucosa at an early stage for early intervention.