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Br J Ophthalmol 2009;93:209-214 doi:10.1136/bjo.2008.147710
  • Original Article
    • Clinical science

Predictive index to differentiate invasive squamous cell carcinoma from preinvasive ocular surface lesions by impression cytology

  1. J N Barros1,
  2. M S Lowen1,2,
  3. P L Ballalai1,
  4. V L D M Mascaro1,
  5. J Á P Gomes1,
  6. M C Martins1
  1. 1
    Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  2. 2
    Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
  1. Dr J N Barros, Doctor Penaforte Mendes Street, 86, São Paulo 01308-010, Brazil; jeisonbarros{at}hotmail.com
  • Accepted 26 October 2008
  • Published Online First 19 November 2008

Abstract

Background/aims: In the literature, no cytological features have been identified that reliably differentiate invasive squamous cell carcinoma (SCC) from preinvasive lesions in impression cytology (IC) samples. The aim was to identify cytological features related to malignancy and apply them in a quantitative model to determine an index score with the best predictive power to differentiate SCC from preinvasive ocular surface lesions by IC.

Methods: 39 patients with ocular surface epithelial lesions were enrolled. IC was obtained from all lesions before surgical excision. Specimens with atypical cells were evaluated regarding 11 cytological parameters based on the 2001 Bethesda system.

Results: Histopathological diagnosis was pterygium in one case, actinic keratosis in nine cases, intraepithelial neoplasia in nine cases and SCC in 20 cases. Analysis of the receiver operating characteristic curve revealed that a predictive index score (cut-off point) ≥4.25 presented the best relationship between sensitivity and specificity in identifying SCC (sensitivity of 95%, specificity of 93%, positive predictive value of 95% and negative predictive value of 93%).

Conclusion: The scoring system model presented is suitable for clinical practice in differentiating SCC from preinvasive ocular surface lesions by IC and can be better evaluated with prospective use.

Footnotes

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Medical Ethics Committee of the Federal University of São Paulo, Brazil.

  • Patient consent: Obtained.

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