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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
Touch Imprint Cytology in Oral Cancer Diagnosis: A Narrative Review
Correspondence Address :
Dr. Sumiran Sinha,
Harshringar Block C, Room No. 608, Sri Aurobindo Institute of Medical Sciences, Indore-453555, Madhya Pradesh, India.
E-mail: sinha.sumirann@gmail.com
Touch Imprint Cytology (TIC) is a simple, economical, and cost-effective method that can be used as a rapid tool for tissue diagnosis. It has been used for the intraoperative diagnosis of cancer, evaluation of surgical cut margins, evaluation of sentinel lymph nodes, diagnosis of head and neck lesions, and postmortem diagnosis. Intraoperative diagnosis includes both frozen section and TIC, which provide rapid pathological consultation. Brush biopsy can also be used for cytological diagnosis and acts as an adjunct to histopathological and TIC diagnosis. It has been found that TIC yields satisfactory and adequate material for diagnosis, allowing early counselling and preparation of the patient for further processes without having to wait for the results of histopathology. As technology continues to evolve, ongoing research aims to enhance the utility and accuracy of TIC in oral cancer diagnosis. Advancements in imaging techniques, such as confocal microscopy and molecular analysis of TIC samples, hold promise for improving diagnostic sensitivity and specificity.
Frozen section, Histopathological technique, Papanicolaou stain
The most common type of cancer encountered in India is oral cancer, and among these, oral squamous cell carcinoma is the most common histological type. Biopsy is the most relied-upon option for the diagnosis of such cancers. However, the entire procedure of taking a biopsy, processing it, and obtaining a diagnosis requires a time span of 3 to 7 days, depending on the resources available, which is quite long (1). Advancements in diagnostic techniques have introduced less time-consuming methods like TIC, which have shown promising results in the detection and diagnosis of oral cancer. TIC is a process similar to cytology that can be used intraoperatively to reach a definitive diagnosis in a short time period, as it conserves tissue without the need to freeze or process it. Conventional cytology techniques involve scraping the surface, i.e., exfoliative cytology, or Fine Needle Aspiration Cytology (FNAC) for deep-seated cystic lesions where fluid is withdrawn. In contrast, TIC involves the removal of the entire lesion, which is then imprinted on a glass slide prior to processing.
TIC was first introduced by Tribe in 1973 (2) and involves gently cleaning the cut surface of the biopsy specimen with dry gauze to remove any excess blood or saline. The freshly cut surface of the specimen is then gently touched on the glass slide, avoiding a gliding movement. The pressure applied for imprinting varies with the consistency of the specimen. Smears are then quickly fixed in 95% alcohol to avoid air-drying artifacts and are usually stained with a variant of Papanicolaou’s stain. The major difference between TIC and other cytological techniques is that exfoliative cytology uses exfoliated cells or scraped superficial cells from the lesion for diagnosis, while FNAC uses a wide-bore needle to draw out fluid for diagnosis. In contrast, TIC utilises the cut tissue surface of a biopsy specimen for cell yield and diagnosis. Hence, TIC has a distinct advantage over exfoliative cytology in that the chances of visualising dysplastic cells are greater in TIC compared to exfoliative cytology and FNAC (3).
Several studies have been performed to depict the reliability of the TIC technique in reaching a diagnosis (4). A study performed by Tanabe N et al., on TIC for the diagnosis of PitNET surgical margins showed that TIC has an accuracy of 75% in margin evaluation (4). Another study conducted by Randive R et al., on TIC of lymph nodes and their histopathological correlation revealed a sensitivity of 60% and specificity of 100% in diagnosing malignant lesions, along with a 100% positive predictive value in diagnosing non neoplastic lesions (5). Additionally, Naveed H et al., carried out a study on the diagnostic accuracy of touch imprint for head and neck malignancies (upper aerodigestive tract), which demonstrated a sensitivity of 96% and specificity of 100% (6). Thus, these studies have sparked interest among clinicians in exploring this technique and its utility as a rapid screening tool to provide a general guideline for mentally preparing a patient prior to receiving the histopathological report of a biopsy. Therefore, this review paper aims to provide a concise overview of the TIC process, covering its various aspects, advantages, limitations, and future scope.
Principle
The TIC is the microscopic examination of tissue cellular material for the diagnosis of diseases, particularly cancer. It is used as an adjunct to histological diagnosis, which relies on the architecture of the tissue to help determine the disease process. In contrast, cytological diagnosis relies on the examination of individual cells and their morphology to provide clues about the cell’s health and activity (6).
Uses
The TIC has been extensively used, and many researchers have found it useful in determining the surgical resection margins of tumours (7), diagnosing malignant and benign tumours (8), diagnosing skin lesions like basal cell carcinomas and tumours like meningiomas and gliomas (9),(10),(11), diagnosing metastatic tumours, and assessing salivary gland tumours like pleomorphic adenomas and mucoepidermoid carcinomas (12),(13).
Advantages
Unlike biopsies that require tissue removal, TIC involves only the collection of superficial cells from the lesion, minimising patient discomfort and reducing the risk of complications. TIC provides rapid preliminary results, allowing for immediate on-site evaluation by a pathologist. This quick turnaround time can expedite the diagnostic process and facilitate the prompt initiation of treatment. TIC is a cost-effective diagnostic tool compared to traditional biopsies, as it requires minimal equipment and can be performed in outpatient settings without the need for anaesthesia or surgical facilities. TIC can be performed in various clinical settings, including primary care offices, dental clinics, and community health centres, making it accessible to a broader population, especially in underserved areas where access to specialised diagnostic facilities may be limited (12),(13),(14).
Pitfalls
One of the major pitfalls of using this technique is that superficial biopsies can result in false negative results. Focal tumour extensions may lead to false negatives if the area of focal extension has been missed by the operator. In well-differentiated tumours, loss of cohesion is less evident, and there is also less cellularity seen at the margins, which can lead to a failure of tumour cell adhesion to the glass slides and result in a negative diagnosis. TIC provides only a superficial assessment of cellular material, which may not always capture deeper tissue changes or architectural abnormalities present in certain lesions. The interpretation of TIC slides relies heavily on the expertise of the examining pathologist, and there may be subjective variations in diagnostic interpretation among different observers. The invasion of the tumour cannot be assessed, as it only shows the presence or absence of dysplastic cells (14).
TIC vs Frozen Section
The TIC is an excellent tool for rapid intraoperative diagnosis, alongside frozen section analysis. In comparison, frozen sections have shown some operative complications, like freezing artifacts, low cost-effectiveness, and the requirement for expertise in operating the cryostat machine. TIC, on the other hand, is a very simple, inexpensive, and easy-to-perform procedure that requires a pathologist’s expertise in cytology interpretation (14),(15). A study performed by Scucchi LF et al., on 2,250 samples found that the sensitivity and specificity for frozen section were 89.9% and 97.95%, respectively, while for TIC, they were 94.9% and 96.8% (16). A similar study by Guarda LA reported an accuracy of 98.4% for TIC and 99.2% for frozen section (17). Touch cytology provides better cellular details and fewer artifacts. The diagnostic accuracy in distinguishing between benign and malignant lesions when combining TIC and frozen section was 100%. Touch imprints prepared from fresh surgical specimens yield excellent cytological clarity and, when used intraoperatively, can provide valuable information where frozen section interpretation is equally important (18),(19),(20).
TIC versus Histopathological Technique
Histopathology is the gold standard for diagnosing any lesion. However, touch imprint preparation has been used as an adjunct technique to histopathology for the diagnosis of various cancers. Studies have found that cytological preparations play an important role in the perioperative assessment of malignant lesions and can be used for screening and diagnostic purposes. The commonly used cytological preparations for diagnostic analysis include touch imprint, scrape, squash, and fine needle aspirates. TIC has the advantage of relative ease in performing the procedure; it is a rapid procedure that does not alter tissue or produce undesirable artifacts, providing excellent cytological clarity (Table/Fig 1). Histopathology can be time-consuming and may not be useful in intraoperative consultations where quick decisions are required. The use of frozen sections for intraoperative consultation is widely adopted; however, it employs expensive equipment. TIC preparation does not affect normal histopathological processing since fresh surgical specimens are first used to make cytological preparations before the tissue is processed into paraffin-embedded sections. It is possible to assess tumour cells using touch imprint preparation, as tumour cells are generally characterised by reduced cohesiveness, which allows them to be present in tissue fluid more readily. Thus, the tissue surface may be selectively enriched with detached tumour groups, providing a unique source of cytological information (20),(21),(22),(23).
Limitation(s)
Despite the numerous advantages, touch imprint has certain limitations as well. Oral cancer is one of the most common cancers affecting the oral cavity. However, this technique cannot be used for the diagnosis of oral cancer, as a superficial biopsy or one that has not been taken from a representative site will result in a zero yield of tumour cells (23),(24). Another drawback is that the technique only identifies dysplastic cells and not tumour architecture; hence, differentiating between epithelial dysplasia and cancer is not possible using this technique (25),(26),(27).
TIC represents a valuable adjunctive tool in the diagnosis and management of oral cancer. Its simplicity, cost-effectiveness, and accessibility make it an attractive option for clinicians involved in oral cancer screening and diagnosis. However, further studies are required to optimise its performance and integration into routine clinical practice, ultimately improving outcomes for patients with oral cancer.
DOI: 10.7860/JCDR/2024/71335.20288
Date of Submission: Apr 17, 2024
Date of Peer Review: May 08, 2024
Date of Acceptance: Sep 17, 2024
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 17, 2024
• Manual Googling: May 07, 2024
• iThenticate Software: Sep 16, 2024 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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