Oral cGVHD screening tests in the diagnosis of systemic chronic graft-versus-host disease |
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Authors: | Renata Gonçalves Resende Jeane de Fátima Correia-Silva Telma Cristina Arão João Artur Ricieri Brito Henrique Bittencourt Ricardo Santiago Gomez Mauro Henrique Nogueira Guimarães Abreu |
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Institution: | 1.Department of Oral Surgery and Pathology,School of Dentistry, Universidade Federal de Minas Gerais,Belo Horizonte,Brazil;2.Department of Community and Preventive Dentistry,School of Dentistry, Universidade Federal de Minas Gerais,Belo Horizonte,Brazil;3.Stem Cell Transplant Unit, Hospital das Clínicas,Universidade Federal de Minas Gerais,Belo Horizonte,Brazil;4.Faculdade de Odontologia, Universidade Federal de Minas Gerais,Belo Horizonte,Brazil |
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Abstract: | To determine the diagnostic properties of oral manifestations and histological features of graft-versus-host disease (GVHD)
screening tests in the diagnosis of systemic chronic graft-versus-host disease (cGVHD). Sixty patients having undergone allogeneic
haematopoietic stem cell transplantation were selected. The patients were submitted to a clinical oral examination to assess
symptoms and clinical changes in the oral mucosa. Histopathologic analysis of the lower lip oral mucosa (LLOM) and salivary
glands (SG) was also performed. Systemic cGVHD was used for a comparison to oral cGVHD. The accuracy of oral cGVHD tests was
low for all methods (58.4% and 52.6% for white lesions and white/red lesions, respectively, in the clinical analysis; 50.4%
for the presence of oral pain; and 66.8% and 55.1% for LLOM and SG histopathologic tests, respectively). However, the presence
of oral pain had good diagnostic properties specificity: 100.0, 95% confidence interval (CI): 88.0–100.0; positive predictive
value (PPV): 100.0, 95% CI: 94.4–100.0; and negative predictive value (NPV): 72.0, 95% CI: 57.3–83.3]. Moreover, SG alterations
revealed by the histopathological analysis also exhibited good diagnostic properties (sensitivity: 98.6, 95% CI: 81.5–99.8;
PPV: 71.1, 95% CI: 62.1–79.7; NPV: 85.9 95% CI: 32.9–99.4). The clinical severity of oral lesions and histophatological changes
in the LLOM did not exhibit adequate diagnostic properties, whereas both oral pain and SG histopathological analysis exhibited
adequate properties for the diagnosis of systemic cGVHD. Histological changes in lip oral mucosa and salivary glands together
with a clinical manifestation of the disease in the oral mucosa can be useful to determining the systemic cGVHD. |
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