Cytopathological quantification of NORs using artificial intelligence to oral cancer screening

Abstract Oral squamous cell carcinoma (OSCC) remains the most prevalent neoplasm of the head and neck. In recent decades, the incidence and prevalence of OSCC have not significantly changed, highlighting the critical need to develop and implement new risk assessment measures. The present study aimed...

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Main Authors: Tatiana Wannmacher LEPPER, Luara Nascimento do AMARAL, Ana Laura Ferrares ESPINOSA, Igor Cavalcante GUEDES, Maikel Maciel RÖNNAU, Natália Batista DAROIT, Alex Nogueira HAAS, Fernanda VISIOLI, Manuel Menezes de OLIVEIRA NETO, Pantelis Varvaki RADOS
Format: Article
Language:English
Published: Sociedade Brasileira de Pesquisa Odontológica 2025-05-01
Series:Brazilian Oral Research
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Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242025000101051&lng=en&tlng=en
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author Tatiana Wannmacher LEPPER
Luara Nascimento do AMARAL
Ana Laura Ferrares ESPINOSA
Igor Cavalcante GUEDES
Maikel Maciel RÖNNAU
Natália Batista DAROIT
Alex Nogueira HAAS
Fernanda VISIOLI
Manuel Menezes de OLIVEIRA NETO
Pantelis Varvaki RADOS
author_facet Tatiana Wannmacher LEPPER
Luara Nascimento do AMARAL
Ana Laura Ferrares ESPINOSA
Igor Cavalcante GUEDES
Maikel Maciel RÖNNAU
Natália Batista DAROIT
Alex Nogueira HAAS
Fernanda VISIOLI
Manuel Menezes de OLIVEIRA NETO
Pantelis Varvaki RADOS
author_sort Tatiana Wannmacher LEPPER
collection DOAJ
description Abstract Oral squamous cell carcinoma (OSCC) remains the most prevalent neoplasm of the head and neck. In recent decades, the incidence and prevalence of OSCC have not significantly changed, highlighting the critical need to develop and implement new risk assessment measures. The present study aimed to define argyrophilic proteins of the nucleolar organizer region (AgNOR) cut-off risk points by oral exfoliative cytological smears comparing specialized humans with a convolutional neural network (CNN) system AgNOR Slide-Image Examiner. This study included four experimental groups: control, exposure to carcinogens (alcohol and tobacco), oral potentially malignant disorders, and OSCC. In the first phase, 50 cells were used for AgNOR quantification. In the second phase, AgNOR quantification was established in an automated manner using an AgNOR System – Slide Examiner (captured – bounding-boxed – CNN analysis). In phase 1, the cut-off point for considering a smear as suspicious was established at 3.69 AgNORs/nucleus with sensitivity of 86%, specificity of 93%, and accuracy of 90%. In phase 2, the analysis of the intraclass correlation coefficient of AgNORs attributed to the system and human was 0.896 (95% confidence interval = 0.875–0.915; p < 0.0001), and this quantification with the CNN was 20 min compared to 67 h, considering human analysis. The AgNOR Slide-Image Examiner successfully differentiated the nuclei and accurately quantified the number of NORs in oral cytological smears. The cut-off risk point of 3.69 AgNOR/nucleus indicates a suspicious sample may contribute to improvements in oral cancer screening.
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spelling doaj-art-2bfb9b9363fc4ae09d5cc98c8a8f66672025-08-20T01:54:02ZengSociedade Brasileira de Pesquisa OdontológicaBrazilian Oral Research1807-31072025-05-013910.1590/1807-3107bor-2025.vol39.056Cytopathological quantification of NORs using artificial intelligence to oral cancer screeningTatiana Wannmacher LEPPERhttps://orcid.org/0000-0001-7905-0737Luara Nascimento do AMARALhttps://orcid.org/0000-0001-7767-5047Ana Laura Ferrares ESPINOSAhttps://orcid.org/0000-0003-0891-7043Igor Cavalcante GUEDEShttps://orcid.org/0000-0003-4073-4159Maikel Maciel RÖNNAUhttps://orcid.org/0000-0003-3924-7329Natália Batista DAROIThttps://orcid.org/0000-0002-0764-8999Alex Nogueira HAAShttps://orcid.org/0000-0003-0531-6234Fernanda VISIOLIhttps://orcid.org/0000-0002-4033-8431Manuel Menezes de OLIVEIRA NETOhttps://orcid.org/0000-0003-4957-9984Pantelis Varvaki RADOShttps://orcid.org/0000-0001-9307-1980Abstract Oral squamous cell carcinoma (OSCC) remains the most prevalent neoplasm of the head and neck. In recent decades, the incidence and prevalence of OSCC have not significantly changed, highlighting the critical need to develop and implement new risk assessment measures. The present study aimed to define argyrophilic proteins of the nucleolar organizer region (AgNOR) cut-off risk points by oral exfoliative cytological smears comparing specialized humans with a convolutional neural network (CNN) system AgNOR Slide-Image Examiner. This study included four experimental groups: control, exposure to carcinogens (alcohol and tobacco), oral potentially malignant disorders, and OSCC. In the first phase, 50 cells were used for AgNOR quantification. In the second phase, AgNOR quantification was established in an automated manner using an AgNOR System – Slide Examiner (captured – bounding-boxed – CNN analysis). In phase 1, the cut-off point for considering a smear as suspicious was established at 3.69 AgNORs/nucleus with sensitivity of 86%, specificity of 93%, and accuracy of 90%. In phase 2, the analysis of the intraclass correlation coefficient of AgNORs attributed to the system and human was 0.896 (95% confidence interval = 0.875–0.915; p < 0.0001), and this quantification with the CNN was 20 min compared to 67 h, considering human analysis. The AgNOR Slide-Image Examiner successfully differentiated the nuclei and accurately quantified the number of NORs in oral cytological smears. The cut-off risk point of 3.69 AgNOR/nucleus indicates a suspicious sample may contribute to improvements in oral cancer screening.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242025000101051&lng=en&tlng=enMouth NeoplasmsEarly Detection of CancerCytologyArtificial Intelligence
spellingShingle Tatiana Wannmacher LEPPER
Luara Nascimento do AMARAL
Ana Laura Ferrares ESPINOSA
Igor Cavalcante GUEDES
Maikel Maciel RÖNNAU
Natália Batista DAROIT
Alex Nogueira HAAS
Fernanda VISIOLI
Manuel Menezes de OLIVEIRA NETO
Pantelis Varvaki RADOS
Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
Brazilian Oral Research
Mouth Neoplasms
Early Detection of Cancer
Cytology
Artificial Intelligence
title Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
title_full Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
title_fullStr Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
title_full_unstemmed Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
title_short Cytopathological quantification of NORs using artificial intelligence to oral cancer screening
title_sort cytopathological quantification of nors using artificial intelligence to oral cancer screening
topic Mouth Neoplasms
Early Detection of Cancer
Cytology
Artificial Intelligence
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242025000101051&lng=en&tlng=en
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