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Category: Volume 07 Issue 07 July 2019
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Title: Morphometric approach to decipher the Verrucous Carcinoma - oral squamous cell carcinoma enigma using fractal geometry

Authors: Dr Nivedita N. Kaorey, Dr Mandakini S Mandale, Dr Jyoti D. Bhavthankar, Dr Jayanti G Humbe, Dr Vaishali A. Nandkhedkar, Dr Suhani S. Khundia

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.171

Abstract

Introduction: The entire continuum of Oral potentially malignant- malignant disorders is dogged with numerous uncertainties during their diagnosis. Particularly affected by these indecisions and predicaments are verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma.

Substantial and objective studies are required in order to better define the biologic behavior and prognosis of these lesions and to distinguish closely resembling lesions from one another.

Aim: To evaluate and compare nuclear fractal dimensions (nFD) & fractal dimensions of epithelial connective tissue interface (eFD) for -Leukoplakia histopathologically diagnosed as Oral Epithelial Dysplasia (OED), Oral Verrucous Carcinoma (VC) and Oral Squamous Cell Carcinoma (OSCC).

Materials & Method: 60 archived paraffin embedded tissue sections stained with H&E which were segregated into 3 groups – OED (20), VC (20), OSCC (20). Five fields each at low power (10x) and high power (40x) were captured for each section using Magnus Image-Pro System. Histo-morphometric  analysis  of  nucleus  and  ECTI  was  carried  out  with  the  help of  Computer  aided image  analysis  software -   Image ProPremier 9.1.

Results: The nuclear fractal dimensions for OED= 1.1151, VC=1.2012, OSCC= 1.2493 were detected. Analogous trend of increasing fractal dimensions was observed with respect to the ECTI of OED=1.0962, VC=1.1266, OSCC= 1.1357. The statistical analysis was done using one-way ANOVA and the p value in both the groups was found to be <0.005 (statistically significant).

Conclusion: Fractal dimensions may be used as a single digital marker to asses nuclear abnormalities and the abnormalities of the ECTI in order to solve ambiguities in diagnosis of OED, VC and OSCC and also to predict their biologic behavior. 

Keywords: Fractal diamensions, digital imaging, epithelial-connective tissue interface, nuclear morphometry

Key Messages: The fractal dimensions of the nucleus of the neoplastic cells and the changes occurring at the Epithelial- connective tissue interface of OED, VC and OSCC were computed and correlated to their pathobiology. The purpose of this study was to use morphometry in order to point towards a substantial diagnosis whenever histopathology is insufficient to rule out ambiguous presentation. A similar study with a larger sample size should be undertaken to reinforce the findings obtained in the current study.

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Corresponding Author

Dr Nivedita N. Kaorey

Post-graduate student, Dept of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad