Use of impression cytology for the detection of unsuspected ocular
               surface squamous neoplasia cells in pterygia

Barros, Jeison de Nadai; Lowen, Marcia Serva; Moraes-Filho, Milton Nunes de; Martins, Maria Cristina

doi:10.5935/0004-2749.20140077

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Original Articles • Arq. Bras. Oftalmol. 77 (5) • Oct 2014 • https://doi.org/10.5935/0004-2749.20140077 copy

Use of impression cytology for the detection of unsuspected ocular surface squamous neoplasia cells in pterygia

Uso da citologia de impressão para a detecção de células de neoplasia escamosa da superfície ocular insuspeita em pterígios

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose:

To evaluate the agreement between the methodologies of impression cytology (IC) and histopathology regarding epithelial lesions clinically diagnosed as pterygium and also regarding the detection of unsuspected and associated ocular surface squamous neoplasia (OSSN).

Methods:

Thirty-two Brazilian patients were included and IC was performed on all pterygia before excision. Histopathogical examination was considered the gold standard and was performed by two experienced ocular pathologists in which consensus existed regarding pterygia diagnosis. IC accuracy was assessed by sensitivity and specificity with a 95% confidence interval.

Results:

From the 32 primary lesions studied, histopathological examination confirmed the diagnosis of pterygium without atypical cells in 19 cases (60%) and showed unsuspected and associated OSSN cells in 13 cases (40%). IC demonstrated one false-negative and one false-positive result for atypia. Statistical analysis showed an estimated sensitivity of 92%, specificity of 94%, positive predictive value of 92%, and negative predictive value of 94%.

Conclusion:

IC demonstrated high agreement with histopathological analysis in the detection of atypical epithelial cells in unsuspected OSSN in Brazilian pterygia patients.

Pterygium; Conjunctiva; Cornea; Limbus corneae; Ocular surface; Eye neoplasms; Cytological techniques

References	Publication year	Study population	Sample size	Associated ocular disease	%
Sevel and Sealy⁽⁶6 Sevel D, Sealy R. Pterygia and carcinoma of the conjunctiva. Trans Ophthalmol Soc U K. 1969;88:567-78.⁾	1969	Cape Town	n=100	OSSN	29.0
Clear et al.⁽ ⁷7 Clear AS, Chirambo MC, Hutt MSR. Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi. Br J Ophthalmol. 1979;63(2):102-9.⁾	1979	Malawi	n=234	OSSN	~30
Perra et al.⁽⁸8 Perra MT, Colombari R, Maxia C, Zucca I, Piras F, Corbu A, et al. Finding of conjunctival melanocytic pigmented lesions within pterygium. Histopathology. 2006;48(4):387-93.⁾	2006	Ecuador	n=80	PAM with atypia	2.5
Hirst et al.⁽⁹9 Hirst LW, Axelsen RA, Schwab I. Pterygium and associated ocular surface squamous neoplasia. Arch Ophthalmol. 2009;127(1):31-2.⁾	2009	Brisbane	n=533	OSSN	9.8
Chui et al.⁽¹⁰10 Chui J, Coroneo MT, Tat LT, Crouch R, Wakefield D, Di Girolamo N. Ophthalmic pterygium: a stem cell disorder with premalignant features. Am J Pathol. 2011;178(2): 817-27.⁾	2011	Sydney	n=100	OSSN	5.0
				PAM with atypia	1
Yeung et al.⁽¹¹11 Yeung SN, Kim P, Lichtinger A, Amiran MD, Cote E, Teitel S, et al. Incidence of ocular surface squamous neoplasia in pterygium specimens: and 8-year survey. Br J Ophthalmol. 2011;95(4):592.⁾	2011	Toronto	n=1127	OSSN	0
Leite⁽¹²12 Leite A de O. Incidência de neoplasia intraepitelial conjuntival em pterígio [tese]. Mato Grosso do Sul: Universidade Federal do Mato Grosso do Sul; 2011.⁾	2011	Campo Grande	n=43	OSSN	39.5
Galor et al.⁽¹³13 Galor A, Karp CL, Oellers P, Kao AA, Abdelaziz A, Feuer W, et al. Predictors of ocular surface squamous neoplasia recurrence after excisional surgery. Ophthalmology. 2012; 119(10):1974-81.⁾	2012	Florida	n=384	OSSN	4.1
Oellers et al.⁽¹⁴14 Oellers P, Karp CL, Sheth A, Kao AA, Abdelaziz A, Mattthews JL, et al. Prevalence, treatment, and outcomes of coexistent ocular surface squamous neoplasia and pterygium. Ophthalmology. 2013;120(3):445-50.⁾	2013	Florida	n=2005	OSSN	1.7
Artornsombudh et al.⁽¹⁵15 Artornsombudh P, Sanpavat A, Tinnungwattana U, Tongkhomsai V, Sansopha L, Tulvatana W. Prevalence and clinicopathologic findings of conjunctival epithelial neoplasia in pterygia. Ophthalmology. 2013;120(7):1337-40.⁾	2013	Bangkok	n=498	OSSN	1.8

Case	Gender	Race	Age	Atypical cells on IC	Atypical cells on histology
1	M	W	50	Y	Y
2	M	B	38	N	N
3	F	B	51	N	N
4	M	B	51	Y	Y
5	F	B	42	N	N
6	M	W	58	N	N
7	M	W	47	Y	Y
8	F	W	50	Y	Y
9	M	W	28	N	N
10	M	W	30	Y	N
11	M	B	33	Y	Y
12	F	B	32	Y	Y
13	F	W	59	Y	Y
14	M	B	56	Y	Y
15	M	B	34	N	N
16	M	W	52	Y	Y
17	F	B	47	N	N
18	M	W	67	N	N
19	M	W	48	N	N
20	F	B	60	N	N
21	F	W	51	N	Y
22	F	W	46	N	N
23	M	W	37	Y	Y
24	F	W	81	N	N
25	F	W	55	N	N
26	M	W	39	N	N
27	F	W	61	N	N
28	F	W	41	N	N
29	M	W	66	N	N
30	F	W	55	N	N
31	F	W	62	Y	Y
32	M	W	48	Y	Y

			Confidence interval (95%)
Parameters	Estimated values	Standard error	Inferior limit	Superior limit
Specificity	0.947	0.051	0.740	0.999
Sensibility	0.923	0.074	0.640	0.998
Positive predictive value	0.923	0.074	0.640	0.998
Negative predictive value	0.947	0.051	0.740	0.999
Prevalence	0.406	0.087	0.237	0.594

Conselho Brasileiro de Oftalmologia Rua Casa do Ator, 1117 - cj.21, 04546-004 São Paulo SP Brazil, Tel: 55 11 - 3266-4000, Fax: 55 11- 3171-0953 - São Paulo - SP - Brazil
E-mail: abo@cbo.com.br

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[1] Corresponding author: Jeison de Nadai Barros, Al. Gabriel Monteiro da Silva, 1.000, São Paulo, SP, 01442-000, Brazil. E-mail: jeisonbarros@hotmail.com

Case	Gender	Race	Age	Atypical cells on IC	Atypical cells on histology
1	M	W	50	Y	Y
2	M	B	38	N	N
3	F	B	51	N	N
4	M	B	51	Y	Y
5	F	B	42	N	N
6	M	W	58	N	N
7	M	W	47	Y	Y
8	F	W	50	Y	Y
9	M	W	28	N	N
10	M	W	30	Y	N
11	M	B	33	Y	Y
12	F	B	32	Y	Y
13	F	W	59	Y	Y
14	M	B	56	Y	Y
15	M	B	34	N	N
16	M	W	52	Y	Y
17	F	B	47	N	N
18	M	W	67	N	N
19	M	W	48	N	N
20	F	B	60	N	N
21	F	W	51	N	Y
22	F	W	46	N	N
23	M	W	37	Y	Y
24	F	W	81	N	N
25	F	W	55	N	N
26	M	W	39	N	N
27	F	W	61	N	N
28	F	W	41	N	N
29	M	W	66	N	N
30	F	W	55	N	N
31	F	W	62	Y	Y
32	M	W	48	Y	Y

Case	Gender	Race	Age	Atypical cells on IC	Atypical cells on histology
1	M	W	50	Y	Y
2	M	B	38	N	N
3	F	B	51	N	N
4	M	B	51	Y	Y
5	F	B	42	N	N
6	M	W	58	N	N
7	M	W	47	Y	Y
8	F	W	50	Y	Y
9	M	W	28	N	N
10	M	W	30	Y	N
11	M	B	33	Y	Y
12	F	B	32	Y	Y
13	F	W	59	Y	Y
14	M	B	56	Y	Y
15	M	B	34	N	N
16	M	W	52	Y	Y
17	F	B	47	N	N
18	M	W	67	N	N
19	M	W	48	N	N
20	F	B	60	N	N
21	F	W	51	N	Y
22	F	W	46	N	N
23	M	W	37	Y	Y
24	F	W	81	N	N
25	F	W	55	N	N
26	M	W	39	N	N
27	F	W	61	N	N
28	F	W	41	N	N
29	M	W	66	N	N
30	F	W	55	N	N
31	F	W	62	Y	Y
32	M	W	48	Y	Y

Case	Gender	Race	Age	Atypical cells on IC	Atypical cells on histology
1	M	W	50	Y	Y
2	M	B	38	N	N
3	F	B	51	N	N
4	M	B	51	Y	Y
5	F	B	42	N	N
6	M	W	58	N	N
7	M	W	47	Y	Y
8	F	W	50	Y	Y
9	M	W	28	N	N
10	M	W	30	Y	N
11	M	B	33	Y	Y
12	F	B	32	Y	Y
13	F	W	59	Y	Y
14	M	B	56	Y	Y
15	M	B	34	N	N
16	M	W	52	Y	Y
17	F	B	47	N	N
18	M	W	67	N	N
19	M	W	48	N	N
20	F	B	60	N	N
21	F	W	51	N	Y
22	F	W	46	N	N
23	M	W	37	Y	Y
24	F	W	81	N	N
25	F	W	55	N	N
26	M	W	39	N	N
27	F	W	61	N	N
28	F	W	41	N	N
29	M	W	66	N	N
30	F	W	55	N	N
31	F	W	62	Y	Y
32	M	W	48	Y	Y