|Year : 2019 | Volume
| Issue : 1 | Page : 52-56
Diagnostic accuracy of the mean platelet volume in oral lichen planus
Mai Zakaria BDS, MDS, PhD 1, Ola Khashaba2
1 Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
2 Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
|Date of Submission||26-Apr-2019|
|Date of Acceptance||09-May-2019|
|Date of Web Publication||27-Jun-2019|
Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, 11 El Saraya Street, El Manial, Cairo 11562
Source of Support: None, Conflict of Interest: None
Background/aim Oral lichen planus (OLP) is an inflammatory disorder influencing oral mucosa characterized by chronicity. Mean platelet volume (MPV) has been shown as an inflammatory indicator. The present research study attempted to assess the diagnostic accuracy of MPV in patients with OLP.
Patients and methods A total of 70 patients suspected to have symptomatic OLP were included from the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University. From all patients, blood samples were taken for complete blood count to measure MPV, and biopsies were taken for histopathological evaluation as a gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy tests were done. A receiver operating characteristics curve was made.
Results Histopathological evaluation revealed 66 of the patients with positive OLP and four patients with negative OLP results. The mean level of MPV in all the patients was 10.29±0.8 fl in comparison with the reference range of 7.4–10.4 fl. The sensitivity and specificity of MPV level are 80.3% and 50%, respectively.
Conclusion The MPV level may be a feasible and cost-effective indicator in the diagnosis of OLP.
Keywords: diagnosis, mean platelet volume, oral lichen planus
|How to cite this article:|
Zakaria M, Khashaba O. Diagnostic accuracy of the mean platelet volume in oral lichen planus. J Arab Soc Med Res 2019;14:52-6
| Introduction|| |
Oral lichen planus (OLP) is an inflammatory disorder influencing the oral mucous membrane with different clinical forms, comprising reticular, papular, plaque-like, atrophic, and ulcerative sores, characterized by chronicity. OLP influences 0.1–4% of the population worldwide . The WHO considered it to be a potentially malignant lesion ,.
Among OLP-associated symptoms, the most frequent complaint of the patients is burning perception and pain after consumption or drinking hot or spiced diet that influences their personal satisfaction. Commonly, OLP is supposed to be an immunological disorder that is mediated by T cell; however, its exact etiology is as yet indistinct. Several cytokines have been accounted in pathogenesis of OLP, for instance, tumor necrosis factor-alpha and interferon-gamma discharged from OLP lesions .
Histopathologically, it is described through (a) basal epithelial cells destruction, (b) basement membrane separation, and (c) invasion of T-helper and T-cytotoxic lymphocytes subepithelially . However, until now, the exact cause is unknown, and pathogenesis and pathways of malignant change of OLP are not obvious. Regular challenges in the investigation of OLP are identified with the similarity between highlights of OLP and other disorders that involve oral mucous membrane, to the extremely inconstant use of indicative standards, and the potential presence of further disorders that are inflammatory in origin yet not related to OLP in the similar patients .
Mean platelet volume (MPV) is a parameter of platelet diameter, produced by complete analysis of routinely done complete blood count. MPV is frequently ignored by physicians . MPV significantly corresponds with the role and activity of the platelet and has been revealed to indicate the process of inflammation and ability to monitor activity in numerous diseases . Moreover, increased MPV has been associated with autoimmune diseases, thrombocytopenia, type B and C hepatitis, congestive heart failure, and acute pulmonary emboli. However, decreased MPV was detected in patients with anemia, chronic renal failure, and ulcerative colitis ,.
Accordingly, this study was accomplished to assess the diagnostic accuracy of MPV in patients with OLP compared with biopsy as a gold standard.
| Patients and methods|| |
This study was done according to the ethical guidelines of the World Medical Association (Declaration of Helsinki, 1978, as revised in 2008) for studies involving human participants, and the study protocol was approved by the Ethical Committee of the Faculty of Dentistry, Cairo University and registered in code no 18 7 64. In addition, the study was registered with NCT03687437 in ClinicalTrials.gov. Before beginning of the study, all the patients signed informed consent after detailed clarification of the study procedures to them.
Sample size calculation
The sample size was calculated according to the result of a previous study carried out by An et al.  using G* power software to determine the necessary sample size, where an alpha was 0.05 and a power was 0.80, with a large effect size (f=0.62). Based on the aforementioned assumptions, the anticipated sample size was 66 patients, which was increased to 70 patients to avoid any decrease that may occur owing to patient withdrawal.
Seventy patients with suspicious symptomatic OLP who presented to the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, and the outpatient clinic of the Skin and Venereal Diseases Department, Faculty of Medicine, Cairo University, were recruited for this study.
Inclusion and exclusion criteria
Inclusion criteria were patients with suspected OLP, atrophic and bullous erosive forms, whose age ranged from 18 to 60 years, and provided signed written informed consent.
Exclusion criteria were pregnancy, lactation, hypertension, congestive heart failure, ischemic heart disease, hyperlipidemia, peripheral arterial disease, hematologic disorders, malignancies, and hepatic, renal and pulmonary diseases. Moreover, patients having diabetes mellitus, peripheral and cerebral vascular disease, Cohn’s disease, ulcerative colitis, and autoimmune, infectious, and inflammatory diseases were not included in the study. None of the study contributors had used anticoagulant medications, lichenoid reaction-inducing drugs, NSAIDs, and oral contraceptive drugs. In addition, patients having amalgam-filled adjacent lesions were also not involved.
The provisional diagnosis of OLP was established according to the modified WHO criteria  after conventional clinical examination under incandescent projected light.
For all participants, the blood samples were collected between 08:00 and 09:00 am, after a fasting period of 12 h, and analysis were done within 2 h of the sampling. The MPV and other hematologic parameters were measured in a blood sample that was collected in tubes containing EDTA. Complete blood cell analysis was done using XN1000, SA01, Sysmex, in hematology laboratory, New Kasr Al-Aini Teaching Hospital, Faculty of Medicine, Cairo University. For consistent measurement of the MPV, the time delay between sampling and analysis was standardized to be less than 2 h for all patients. The reference range of MPV is 7.4–10.4 fl.
The surgical biopsies were made for histopathological assessment as a gold standard for all patients. The clinically recognized lesions underwent biopsies where specimens were placed in 10% buffered formalin for fixation. Using microtome, the paraffin-embedded material was cut into 4-µm-thick sections and was stained with hematoxylin+eosin, and then subjected to histopathological evaluation by a senior oral pathologist blinded to the clinical findings in Oral Pathology Department, Faculty of Dentistry, Cairo University, using light microscopy transferred to the monitor of the image analyzer computer system (Leica Quin 500 Microsystems, Switzerland).
Statistical analysis was done with IBM SPSS Version 21.0. (Statistical Package for the Social Sciences; IBM Corp., Armonk, New York, USA). Descriptive statistics included mean and standard deviation (SD) values and percentage (%). The sensitivity, specificity, positive predictive value, and negative predictive value, accuracy, and the P value were assessed. A receiver operating characteristic curve (ROC) was made to measure the significance of the MPV in the diagnosis of OLP. The significance level was set at P value less than 0.05.
| Results|| |
The current study was conducted on 70 patients (35 males and 35 females), with age between 18 and 60 years (mean, 45.8±8.3 years), suspected to have symptomatic OLP who continued the study without dropping out. Regarding the marital status, the percentages of single, married, and widowed patients were 11.4, 80, and 8.6%, respectively. The distribution of the lesions was bilateral buccal mucosa (61.4%), bilateral buccal mucosa and tongue (15.7%), bilateral buccal mucosa and labial mucosa (14.2%), unilateral buccal mucosa and tongue (7.1%), and unilateral buccal mucosa with alveolar ridge (1.4%), as detailed in [Table 1].
Assessment of biopsy and mean platelet volume
The result of histopathological evaluation was positive OLP in 66 (94.3%) of the patients and negative OLP in four (5.7%) patients. [Figure 1] showed the positive biopsy of OLP stained with H&E staining. Regarding the level of MPV in all study patients, it was abnormal in 55 (78.6%) of the patients and normal in 15 (21.4%) of the patients, considering that any increase or decrease in the level of MPV than the reference range (7.4–10.4 fl) was read as abnormal. The mean level of MPV in all the patients was 10.29±0.8 fl, as shown in [Table 2].
|Figure 1 Photomicrograph showing a histopathologically positive OLP biopsy. It shows hyperkeratosis with apparent hydropic degeneration of the basal cell layer (arrows). A condensed band-like infiltrate of chronic inflammatory cells (arrow heads) is shown at the junction of epithelium-stroma and the upper part of the connective tissue (hematoxylin–eosin stain, ×100). OLP, oral lichen planus.|
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Correlation between biopsy and mean platelet volume
It has been shown that within the 66 patients with positive biopsy, 53 patients had abnormal MPV level and 13 patients had normal level of MPV. However, in the four patients with negative biopsy, two patients had abnormal level of MPV and two patients had normal one ([Table 3]).
|Table 3 Association between biopsy and mean platelet volume in the study patients|
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According to these revealed data, the sensitivity and specificity are 80.3 and 50%, respectively. The positive predictive value and negative predictive value are 96.4 and 13.3%, respectively. The accuracy of the test result is 65.1%.
The result of receiver operating characteristics curve showed that the area under the curve was 0.9, with 95% confidence interval of 0.97–1, and P value is significant, as presented in [Figure 2].
|Figure 2 Receiver operator characteristic (ROC) curve analysis for biopsy and mean platelet volume (MPV) level.|
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| Discussion|| |
Lichen planus (LP) is an inflammatory disease of chronic nature that affects the skin, mucous membranes, or both. It is characterized by remission and exacerbation episodes. It is the most common dermatological disease that affects the oral mucosa . The prevalence of OLP ranges approximately between 0.2 and 5% worldwide. The exact etiology of OLP still uncertain .
Platelets are discoid-shaped cells with a typical length of 1–2 µm and 8–10 days as usual life span. In addition to hemostasis, platelets have an essential participation in angiogenesis, inflammatory process, allergic responses, repair and regeneration of tissues, and production of chemokine and cytokines that yield a powerful inflammatory reaction ,.
The MPV is a feasible indicator demonstrating the role and activity of platelet, which could be detected through complete blood count without extra charge. It has been shown that MPV is an indicator of inflammatory reaction, disorder progress, and effectiveness of treatment with anti-inflammatory drugs in numerous inflammatory diseases associated with chronicity . Inflammatory conditions with high-grade intensity are frequently linked with the passage of principally platelets that are small sized with decreased MPV. However, similarly in the periods of remission, they are linked with large sized platelets in the circulation. These were revealed in patients with rheumatoid arthritis , as well as those with inflammatory bowel disease , in addition to familial Mediterranean fever episodes . These findings were attributed to the depletion of dynamic platelets with larger size in the area of inflammation. On the contrary, it has been shown that increased MPV is linked to inflammatory conditions of low-grade intensity , for instance, patients with recurrent aphthous stomatitis and Behçet disease , psoriasis , and chronic hepatitis B . These investigations showed that MPV measures were directly related to the inflammatory grade .
Although the information apparently indicates the necessity for additional investigations on OLP, any beneficial researches must be established on a precise diagnosis. Conversely, a dependable diagnosis of OLP has demonstrated to be challenging. Accordingly, the present work was conducted to investigate the diagnostic accuracy of the MPV in the patients with OLP compared with biopsy as a gold standard.
The result of this study showed that 66 of the patients had positive biopsy of OLP and four patients had negative one. The level of MPV was abnormal in 55 of the patients and normal in 15 of the patients, considering that any increase or decrease in the level of MPV than the reference range was read as abnormal. The MPV level has higher sensitivity compared with its specificity.
To the best of authors’ knowledge, this is the first study to assess the level of MPV in patients with OLP in a diagnostic accuracy study. The previous study which was conducted by An et al.  found that the level of MPV in patients with LP was significantly increased than normal healthy controls but with the absence of significant linkage between MPV and nail-oral mucosa association. This was in agreement with the results revealed by the present research. The outcome of the previous trail carried out by Ozlu et al. , showed that patients with LP had decreased level of MPV compared with healthy controls where this was against the results revealed by the current work. The explanation may be owing to the difference between the collection times, the method of sample storing, and the type of anticoagulant utilized . These variables were organized in the present study to be standardized in all study participants.
Numerous hormonal and immunological mediators affect the development of thrombopoietic cells and release of platelets into the circulatory system. The essential ones of them are interleukin (IL)-1, tumor necrosis factor-alpha, and IL-6 . According to the results of a previous research conducted by Rhodusa et al. , it was revealed that in the different kinds of oral fluids, a significant increase of these cytokines levels was identified in patients with OLP than in healthy controls. Regarding the influence of these mediators on platelet maturation and release, it may be an explanation of high MPV level identified in patients with symptomatic OLP revealed by the present research.
| Conclusion|| |
The MPV level has a high sensitivity, which may make it useful as a feasible and cost-effective indicator in the diagnosis of OLP. Furthermore, it may be helpful in exclusion of OLP from other disorders. Additional researches are needed to evaluate the MPV level in the disease activity and response to treatment in OLP.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]