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Orale Zytologie

Historische Entwicklung, aktueller Stand und Ausblick

Oral cytology

Historical development, current status, and perspectives

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Zusammenfassung

Die orale Zytologie erfährt eine Renaissance, die durch die Einführung der Bürste als Entnahmeträger und durch die Anwendung zusätzlicher moderner Verfahren bedingt ist. Die Bürste kann tiefe Schichten der oralen Mukosa erfassen, in denen die squamöse intraepitheliale Neoplasie (SIN) beginnt. Zusätzliche Verfahren zur Bewertung der biologischen Potenz der gewonnenen oralen Epithelzellen sind: die computerunterstützte Bildanalyse (OralCDx®), die DNA-Zytometrie, die Immunzytochemie, die Dünnschichtzytologie und molekularbiologische Analysen. Alle genannten Verfahren sind geeignet, die Sensitivität (bis zu 100%) und Spezifität (bis zu 100%) der oralen Zytologie zu erhöhen. Dennoch gibt es Berichte über orale Plattenepithelkarzinome, die mithilfe der Bürstenbiopsie nicht erkannt wurden. Die Wertigkeit der einzelnen Verfahren kann aktuell aufgrund fehlender vergleichender Studien nicht abschließend beurteilt werden. Die Immunzytochemie mit kommerziellen Antikörpern gegen Laminin 5 ist allseits verfügbar und methodisch einfach.

Das nichtinvasive diagnostische Verfahren der methodisch unterstützten oralen Bürstenbiopsie kann einen Beitrag zur frühen Erkennung ausgewählter Mundschleimhautläsionen leisten. Ein positiver Befund oder eine Progression der Läsion bei negativem Befund sind Indikationen zur Überweisung des Patienten an Fachkliniken und zur dort durchgeführten Skalpellbiopsie mit histopathologischer Untersuchung. Die histopathologische Begutachtung bleibt der Goldstandard in der definitiven Diagnostik maligner oraler Läsionen.

Abstract

Oral cytology has aroused new interest caused by introduction of the cytobrush as a sampling device and the use of additional analytical methods. By brushing it is possible to reach deeper layers of the oral mucosa where squamous intraepithelial neoplasia (SIN) begins. The biological potential of the oral epithelial cells obtained can be evaluated by the following additional methods: computer-assisted image analysis (OralCDx®), DNA cytometry, immunohistochemistry, monolayer cytology, and molecular biological analysis. All of those methods can increase sensitivity (up to 100%) and specificity (up to 100%) of oral brush biopsy. Nevertheless, there are reports that oral epithelial carcinomas were not identified. No comparative study exists allowing conclusions to be drawn about the value of the single methods. Immunocytochemistry with commercial antibodies against laminin-5 is generally available and methodologically easy.

Oral brush biopsy as a non invasive diagnostic method can be useful for the early detection of oral mucosal lesions. Positive findings or progression of the lesion despite negative findings are indications to refer the patient to a specialized clinic where a surgical biopsy should be performed, followed by histopathological analysis. Histopathology remains the gold standard for the definitive diagnosis of oral malignant lesions.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    M. Hullmann, T. E. Reichert & O. Driemel

  2. Institut für Pathologie, HELIOS Klinikum Erfurt, Erfurt, Germany

    R. Dahse & H. Kosmehl

  3. Core Unit Chip-Application, Institut für Humangenetik und Anthropologie, Friedrich-Schiller-Universität Jena, Jena, Germany

    F. von Eggeling

  4. Klinik für Mund-, Kiefer- und Gesichtschirurgie/Plastische Operationen, HELIOS Klinikum Erfurt, Erfurt, Germany

    H. Pistner

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  1. M. Hullmann
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  3. R. Dahse
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  4. F. von Eggeling
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Glossar

Akridinorange

Fluorochrom zur Anfärbung der DNA

DNA-Ploidie

charakterisiert den DNA-Gehalt einer Zelle

Imagezytometrie

Verfahren zur Bestimmung des DNA-Gehalts einzelner Zellkerne und von DNA-Histogrammen ganzer Zellpopulationen

Laminin 5

extrazelluläres Matrixprotein, verantwortlich für die Zellhaftung an der Basalmembran

Mikrosatelliten

nicht proteinkodierende Abschnitte der DNA

Negativer Vorhersagewert

statistischer Parameter, der beschreibt, ob bei einem negativen Testwert die Person nicht erkrankt ist

p53

Dieses Gen reguliert den automatisierten Zelltod bei genetischen Defekten einer Zelle. Ist es selbst defekt, können schadhafte Zellen immortalisiert werden.

Positiver Vorhersagewert

statistischer Parameter, der beschreibt, ob bei einem positiven Testwert die Person tatsächlich erkrankt ist

Sensitivität

statistischer Parameter, der beschreibt, ob eine erkrankte Person ein positives Testergebnis erhält

Spezifität

statistischer Parameter, der beschreibt, ob eine gesunde Person ein negatives Testergebnis erhält

Tenascin C

extrazelluläres Glykoprotein, verantwortlich für Zellbindung und Zellwanderung

Transformationszone

Epidermisierungszone im Bereich des äußeren Muttermundes, an dem Zylinderepithel der Portio auf Plattenepithel trifft

Zytokeratin

ist über die Bildung intermediärer Filamente an der Ausbildung des zellulären Verbundes beteiligt

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Hullmann, M., Reichert, T.E., Dahse, R. et al. Orale Zytologie. Mund Kiefer GesichtsChir 11, 1–9 (2007). https://doi.org/10.1007/s10006-006-0041-5

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