Image-based DNA ploidy analysis aids prediction of malignant transformation in oral lichen planus

Marcelo Sperandio, Myriam F. Klinikowski, Amy L. Brown, Penelope J. Shirlaw, Stephen J. Challacombe, Peter R. Morgan, Saman Warnakulasuriya, Edward W. Odell

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AbstractObjectives To investigate the potential of image-based DNA ploidy analysis to predict malignant transformation in patients with oral lichen planus (OLP). Study design DNA ploidy analysis was performed on biopsy samples from 14 patients with OLP who underwent malignant transformation. As controls, 42 OLP lesions showing unusual clinical features suggesting a transformation risk and 68 samples of clinically and histologically typical OLP were included. Cases with dysplasia on initial biopsy were excluded. Eighty fibroepithelial polyps acted as methodological controls. Epithelial nuclei were isolated from formalin-fixed paraffin embedded biopsy samples and monolayers stained with Feulgen for automated image cytometry to establish DNA content. Ploidy status was correlated to outcome using Kaplan-Meier analysis and Log rank Mantel-Cox tests. Results All controls and typical OLP were diploid and none underwent malignant transformation in mean follow-up of 14 years (10–18 years). One unusual OLP developed carcinoma and all were diploid. The 14 patients with transformation developed 21 carcinomas. In the 11 patients who had a prior biopsy, 4 were aneuploid. Conclusion DNA ploidy analysis predicted malignant transformation in over one third (36.4%) of patients with OLP with a preceding biopsy (n=11). This premalignant nature could not have been diagnosed clinically or by histological dysplasia assessment.
Original languageEnglish
JournalOral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics
Early online date23 Feb 2016
Publication statusE-pub ahead of print - 23 Feb 2016


  • oral lichen planus
  • malignant transformation
  • oral cancer
  • DNA ploidy
  • image-based cytometry


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