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Analytical Cellular Pathology
Volume 25, Issue 3, Pages 139-146

Diagnostic Value of Nucleolar Organizer Regions (AgNORs) in Brush Biopsies of Suspicious Lesions of the Oral Cavity

Torsten W. Remmerbach,1 Horst Weidenbach,2 Conrad Müller,1 Alexander Hemprich,1 Natalja Pomjanski,3 Birgit Buckstegge,3 and Alfred Böcking3

1Department of Oral, Maxillofacial and Facial Plastic Surgery, University of Leipzig, Nürnberger Straße 57, D‐04103 Leipzig, Germany
2Institute of Pathology, University of Leipzig, Liebigstraße 26, D‐04103 Leipzig, Germany
3Institute of Cytopathology, Heinrich Heine University, Moorenstraße 5, D‐40225 Düsseldorf, Germany

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: The aim of this retrospective study was to report on the diagnostic accuracy of AgNOR‐analysis as an adjunctive diagnostic tool of conventional oral exfoliative cytology taken from suspicious lesions in our clinic. Study design: Cytological diagnoses obtained from brush biopsies of macroscopically suspicious lesions of the oral mucosa from 75 patients (final diagnoses: 53 histologically proven squamous cell carcinomas, 11 leukoplakias and other inflammatory oral lesions) and from 11 patients with normal mucosa as a negative control group were compared with histological and/or clinical follow‐ups. Five smears were doubtful and seven suspicious for tumor cells in the cytologic report. Number of AgNOR's were counted in 100 squamous epithelial cell‐nuclei per slide after silver‐restaining. Results: Sensitivity of our cytological diagnosis alone on oral smears for the detection of squamous carcinomas was 92.5%, specificity 100%, positive predictive value was 100% and negative 84.6%. The best cut‐off value of the mean number of AgNOR dots per nucleus distinguishing benign from malignant cells was 4.8. The percentage of nuclei with more than three AgNORs had a cut‐off level of 70%. Applying these methods to twelve doubtful or suspicious cytological diagnoses we were able to correctly establish the diagnosis of malignancy in ten cases of histologically proven cancers and to reveal benignity in two histologically proven cases. Thus we achieved a positive and negative predictive value of 100% each. Conclusions: Smears from brushings of visible oral lesions, if clinically considered as suspicious for cancer, are an easily practicable, non‐invasive, painless, safe and accurate screening method for detection of oral cancerous lesions. We conclude that AgNOR‐analysis may be a useful adjunct to other methods in routine cytological diagnosis of oral cancer that can help to solve cytologically suspicious or doubtful cases. Colour figures can be viewed on‐3/remmerbach.htm.