An evaluation of the role of nuclear cytoplasmic ratios and nuclear volume densities as diagnostic indicators in metaplastic, dysplastic and neoplastic lesions of the human cheek.

The increase in nuclear cytoplasmic (N/C) ratio is one of the features of cellular atypia which is used in the histopathological assessment of premalignant lesions of the oral mucosa. Since this feature is readily quantifiable using morphometry, we have analysed both N/C and nuclear volume densities in basal and spinous cells from human cheek lesions with and without malignant potential in order to ascertain the validity of this parameter as a predictor. Using a strictly standardised sampling procedure, measurements of cellular and nuclear areas of basal and spinous cells from normal and pathological human cheek mucosa were made on haematoxylin and eosin-stained sections using a VIDAS image analyser. Cases examined comprised fibrous hyperplasia (FH), traumatic inflammation (IF), benign hyperkeratosis (HK), lichen planus (LI), leukoplakia with dysplasia (DYS), squamous cell papilloma (PP), dysplastic epithelium from the edges adjacent to invasive carcinoma (CE) and islands from invasive squamous cell carcinoma (CI). In basal cells, N/C ratios and nuclear volume densities were lower than values obtained for the normal controls. In spinous cells, these parameters were elevated in the potentially premalignant lesions (DYS, CE) as well as in CI but values were similarly elevated in FH, IF, HK and PP, lesions which appear to have no malignant potential. The N/C ratio is of no value as a predictor of malignant potential in basal or spinous cells from cheek lesions. The putative increase in N/C which has been previously described qualitatively is probably due to increased nuclear hyperchromatism, which may provide an illusory increase in relative nuclear size at the expense of the cytoplasm.