Evaluation of diagnostic accuracy of PAP (papanicolaou) and AgNOR (argyrophilic nucleolar organizer regions) staining in exfoliative cytology of oral mucosa in smokers and non-smokers

Background: A strong causal relationship exists between cigarette smoking and the development of oral cancer. Most of the cases of oral cancer are diagnosed at advanced stage that results in an unfavorable prognosis and high mortality rate. In such cases certain noninvasive procedures such as Exfoliative Cytology plays an important role in the detection and monitoring of initial alteration and for the establishment of adequate treatment. The purpose of this study is to compare exfoliative cytology from oral mucosa of smokers and non smokers, with evaluation of proliferative activity by PAP (Papanicolaou) and AgNOR. Materials and method: The study was conducted in the department of Oral Pathology and Microbiology between 2011-2013 in Eastern Uttar Pradesh, India. The detailed information of each patient was noted in a pretested Performa. Exfoliative cytology specimens were obtained from clinical normal mucosa from the lateral border of the tongue in 60 nonsmokers and 60 smokers ranging from 30 to 50 years of age using cigarettes for at least 10 years. The cytologic specimens were evaluated by Papanicolaou staining and AgNOR quantification.The data collected was analyzed using IBM SPSS statistics version 22 (Armonk,NY:IBM corp).P value <0.05 was considered as statistically significant. Statistical analysis of chi- square (χ2) test, Student t-test and One way ANOVA by running post hoc test were applied. Result and observation: Statistically significant increases in mean number of AgNOR /nucleus were found in smoker and non smoker patient according to cytologic evaluation. Cytologic specimens evaluated by PAP also showed the presence of inflammation, dysplasia, keratinisation and higher proliferative activity in smokers than non smokers. Conclusion: AgNOR quantification increases sensitivity and specificity by reduces the chances of false negative or positive and can be used as an adjunct diagnostic tool over routine PAP staining in cytopathology to assess cellular chnages in oral mucosa.