51
|
Pei M, Han D, Kim KY, Kim DW, Nam W, Kim HJ, Cho ES, Kim HS, Cha IH, Zhang X. Risk Factors of Microscopically Tumor-Free Surgical Margins for Recurrence and Survival of Oral Squamous Cell Carcinoma Patients. Front Oncol 2022; 12:930988. [PMID: 35875099 PMCID: PMC9300840 DOI: 10.3389/fonc.2022.930988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives The concept of adequate surgical margins remains controversial in oral squamous cell carcinoma (OSCC) surgery. This study aimed to identify surgical margin-related indicators that might impact recurrence and survival of OSCC patients. Materials and Methods Histopathological examination was performed using hematoxylin-eosin-stained surgical margin tissue sections in 235 OSCC patients. Axin2 and Snail expression at the surgical margin was detected by immunohistochemistry. The impact of the Axin2-Snail cascade on tumorigenesis of the immortalized human oral keratinocyte (IHOK) line was investigated in vivo. Results The width and dysplasia of surgical margins were not significantly associated with the outcome of OSCC patients. In a multivariate analysis using variable clinicopathologic factors and with Axin2 and Snail expression as cofactors, higher age (hazard ratio [HR]:1.050; P=0.047), Axin2 (HR:6.883; P=0.014), and Snail abundance (HR:5.663; P=0.009) had independent impacts on worsened overall survival. Similarly, lesion site in retromolar trigone (HR:4.077; P=0.010), upper (HR:4.332; P=0.005) and lower gingiva (HR:3.545; P=0.012), presence of extranodal extension (HR:9.967; P<0.001), perineural invasion (HR:3.627; P=0.024), and Snail abundance (HR:3.587; P<0.001) had independent impacts on worsened recurrence-free survival. Furthermore, Axin2 knockdown induced decreased Snail expression and attenuated tumorigenesis in the IHOK line. Conclusion Histopathological examination of surgical margins may not be reliable to predict OSCC patient outcome. Molecular analysis may provide a more accurate risk assessment of surgical margins in OSCC. In particular, Axin2 and Snail are potential predictive biomarkers for the risk assessment of surgical margins in OSCC.
Collapse
Affiliation(s)
- Meiling Pei
- Department of Dermatology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Dawool Han
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ki-Yeol Kim
- BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
- Department of Dental Education, Yonsei University College of Dentistry, Seoul, South Korea
| | - Dong Wook Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Eunae Sandra Cho
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
- BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hyun Sil Kim
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
- *Correspondence: In-Ho Cha, ; Xianglan Zhang,
| | - Xianglan Zhang
- Department of Pathology, Yanbian University Hospital, Yanji, China
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, South Korea
- *Correspondence: In-Ho Cha, ; Xianglan Zhang,
| |
Collapse
|
52
|
Cheung VKY, Hulme K, Schifter M, Palme C, Low THH, Clark J, Gupta R. Oral Epithelial Dysplasia: A Review of Diagnostic Criteria for Anatomic Pathologists. Adv Anat Pathol 2022; 29:227-240. [PMID: 35435865 DOI: 10.1097/pap.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Oral epithelial dysplasia (OED) represents a spectrum of histologic changes in the oral cavity mucosa that has the potential to transform into oral squamous cell carcinoma. Predicting the risk of malignant transformation is predominantly based on clinicopathologic correlation, histologic examination and grading. OED often poses a diagnostic challenge, primarily due to its histologic mimics and a large number of terminologies used in the literature. The grading system for OED is also fraught with significant interobserver variability. This review summarizes the essential clinical and histopathologic features of OED and its mimics. Practical preanalytical, analytical, and postanalytical considerations for anatomic pathologists are discussed to improve the diagnostic accuracy and increase the reproducibility in the grading of OED.
Collapse
Affiliation(s)
- Veronica K Y Cheung
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
- Faculty of Medicine and Health, Sydney Medical School
| | - Katherine Hulme
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
| | - Mark Schifter
- Westmead Centre for Oral Health, Westmead Hospital, a Teaching Hospital of the Sydney Dental School, Faculty of Medicine and Health, University of Sydney
- The Skin Hospital, Darlinghurst (Sydney)
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
| | - Carsten Palme
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University
| | - Jonathan Clark
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
- Faculty of Medicine and Health, Sydney Medical School
| |
Collapse
|
53
|
Idrees M, Farah CS, Sloan P, Kujan O. Oral brush biopsy using liquid-based cytology is a reliable tool for oral cancer screening: A cost-utility analysis: Oral brush biopsy for oral cancer screening. Cancer Cytopathol 2022; 130:740-748. [PMID: 35704619 PMCID: PMC9544877 DOI: 10.1002/cncy.22599] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 01/13/2023]
Abstract
Background This study aimed to assess the diagnostic utility and associated cost of oral liquid‐based brush cytology (OLBC) in the diagnosis of oral cancer and oral potentially malignant disorders (OPMDs). Methods A total of 284 patients with oral mucosal lesions were included. OLBC samples were collected from all patients immediately before undergoing surgical biopsies. A liquid‐based cytology slide was prepared from each OLBC sample for cytological evaluation using the modified 2014 Bethesda cytology system. The results and the cost were compared with the histopathological outcomes. Results The level of agreement between the two approaches was very good (weighted kappa = 0.824). The accuracy of OLBC in differentiating between the different diagnostic groups was 91.69%, whereas the associated sensitivity and specificity were 79.23% and 94.81%, respectively. The estimated cost of each OLBC sample was at least 26% less than the cost of a single biopsy and more than 42% less in cases of multiple biopsied lesions. Conclusions The proposed modifications of the Bethesda system can be adopted as a standardized system for oral cytological assessment. Our findings support OLBC as a reliable adjunct to surgical biopsy in the diagnosis of OPMDs. This tool has potential for oral cancer–finding and surveillance programs. Oral brush liquid‐based cytology is a reliable adjunct to surgical biopsy in the diagnosis of oral potentially malignant disorders. It has potential for oral cancer‐finding and surveillance programs.
Collapse
Affiliation(s)
- Majdy Idrees
- University of Western Australia Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, Western Australia, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian Clinical Labs, Subiaco, Western Australia, Australia.,CQ University, Rockhampton, Queensland, Australia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Omar Kujan
- University of Western Australia Dental School, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
54
|
Use of the Fractal Dimension to Differentiate Epithelium and Connective Tissue in Oral Leukoplakias. Cancers (Basel) 2022; 14:cancers14112697. [PMID: 35681677 PMCID: PMC9179462 DOI: 10.3390/cancers14112697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oral leukoplakia (OL) is considered one of the most common potentially malignant oral disorders (OPMD), with a verified increased risk of developing oral cancer. The identification of the dysplasia grade (low-high) is the only consolidated factor used to evaluate this risk. The objective of this study was to verify the role of the fractal dimension (FD) in assessing this dysplasia. METHODS To begin, 29 OL and 10 normal oral mucosa (NOM) biopsies were retrieved for FD analysis of the epithelial (dime) and the connective (dimc) tissue. RESULTS In the OL group, the median value of dime is higher (1.67, IQR = 0.12) than for the NOM group (1.56, IQR = 0.08), with statistically significant differences (Wilcoxon test, p = 0.0031). There were no differences in relation to dimc. Significant differences were observed between the non-dysplasia vs. high-grade (p = 0.0156) and low-grade vs. high-grade (p = 0.0049) groups. No significant differences were identified in relation to dimc for the different degrees of dysplasia. For a cut-off point of 1.44 of dime, a specificity of 96.6% was obtained, a sensitivity of 100%, and an AUC = 0.819 (p = 0.003). CONCLUSIONS FD at the level of the epithelium may be used as a diagnostic tool in OL.
Collapse
|
55
|
Barba-Montero C, Lorenzo-Pouso AI, Gándara-Vila P, Blanco-Carrión A, Marichalar-Mendía X, García-García A, Pérez-Sayáns M. Lichenoid areas may arise in early stages of proliferative verrucous leukoplakia: A long-term study of 34 patients. J Oral Pathol Med 2022; 51:573-581. [PMID: 35596256 PMCID: PMC9541998 DOI: 10.1111/jop.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/07/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Proliferative verrucous leukoplakia is considered an uncommon oral potentially malignant disorder with a high malignant transformation rate. The objective of this paper was to define its cancer incidence and related risk factors. Methods A retrospective audit of 34 patients diagnosed with proliferative verrucous leukoplakia from a university‐based unit, during the period from 1995 to 2019 was performed. The mean number of visits was 23 ± 18.6. The follow‐up was divided into four‐time intervals to evaluate the clinical presentation, number of lesions, dysplasia grade, and malignant transformation rate. Results The majority of patients were females 29 (85.3%), with verrucous component (77.8%), with a gingival presentation (31.8%), and with a preceding lichenoid area (44.1%). Eleven patients (32.4%) were affected by oral cancer during the follow‐up, developing a total of 15 carcinomas. The mean age of malignant transformation was 67.2 ± 12.9 years, particularly 8 ± 8.5 from the onset of the lesions. Warty forms presented a higher mean estimate for malignant transformation (15.2 years, 95% confidence interval 4.4–26 years) than nodular forms (1.9 years, 95% confidence interval 1.9–1.9) (p = 0.019). Patients with an initial proliferative verrucous leukoplakia diagnosis suffered a higher risk of malignancy, particularly 15.55 times (95% confidence interval 1.69–143.17; p = 0.015) than those who did present a preceding area with lichenoid morphology. Conclusion Proliferative verrucous leukoplakia presented a high malignant transformation rate and sometimes displayed preceding oral lichenoid areas in early stages. Further studies are needed to understand the impact of these lichenoid areas in proliferative verrucous leukoplakia progression.
Collapse
Affiliation(s)
- Catalina Barba-Montero
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain
| | - Alejandro Ismael Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain
| | - Pilar Gándara-Vila
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Andrés Blanco-Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Xabier Marichalar-Mendía
- Department of Nursing, Faculty of Medicine and Nursing, University of Basque Country, Leioa, Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Santiago, Spain.,ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago, Spain
| |
Collapse
|
56
|
Nevanpää TT, Terävä AE, Laine HK, Rautava J. Malignant transformation of oral epithelial dysplasia in Southwest Finland. Sci Rep 2022; 12:8261. [PMID: 35585112 PMCID: PMC9117212 DOI: 10.1038/s41598-022-12441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
Oral epithelial dysplasia (OED) is considered a risk for oral squamous cell carcinoma (OSCC). A meta-analysis estimated a mean malignant transformation rate of 12.1% (95% CI 8.1-17.9). The main target of this study was to define how many OED patients develop OSCC in the hospital district of Southwest Finland. A total of 571 patients diagnosed with OED were identified. Their potential subsequent diagnosis of OSCC was derived from the Finnish Cancer Registry. The risk of OSCC development in OED patients was compared with that of the general population without OED. During a mean follow-up of 5.5 (range 0.1-29.0) years 10.9% of OED patients developed OSCC. OED patients had a 44.7-fold higher risk (95% CI 34.4-56.7) of developing OSCC than the general population. The risk was at its highest within two years of OED diagnosis. OED patients in Southwest Finland have a significantly increased risk of developing OSCC relative to the general population, especially within the first two years of dysplasia diagnosis.
Collapse
Affiliation(s)
- Toni T Nevanpää
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Antti E Terävä
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna K Laine
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland.
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland.
| | - Jaana Rautava
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland
- Department of Pathology, Medicum, Faculty of Medicine, University of Helsinki and HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
57
|
Idrees M, Shearston K, Farah CS, Kujan O. Immunoexpression of oral brush biopsy enhances the accuracy of diagnosis for oral lichen planus and lichenoid lesions. J Oral Pathol Med 2022; 51:563-572. [PMID: 35460123 PMCID: PMC9542982 DOI: 10.1111/jop.13301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022]
Abstract
Background This study assessed the efficacy of using oral liquid‐based brush cytology (OLBC) coupled with immunostained cytology‐derived cell‐blocks, quantified using machine‐learning, in the diagnosis of oral lichen planus (OLP). Methods Eighty‐two patients diagnosed clinically with either OLP or oral lichenoid lesion (OLL) were included. OLBC samples were obtained from all patients before undergoing surgical biopsy. Liquid‐based cytology slides and cell‐blocks were prepared and assessed by cytomorphology and immunocytochemistry for four antibodies (Ki‐67, BAX, NF‐κB‐p65, and AMACR). For comparison purposes, a sub‐group of 31 matched surgical biopsy samples were selected randomly and assessed by immunohistochemistry. Patients were categorized according to their definitive diagnoses into OLP, OLL, and clinically lichenoid, but histopathologically dysplastic lesions (OEDL). Machine‐learning was utilized to provide automated quantification of positively stained protein expression. Results Cytomorphological assessment was associated with an accuracy of 77.27% in the distinction between OLP/OLL and OEDL. A strong concordance of 92.5% (κ = 0.84) of immunostaining patterns was evident between cell‐blocks and tissue sections using machine‐learning. A diagnostic index using a Ki‐67‐based model was 100% accurate in detecting lichenoid cases with epithelial dysplasia. A BAX‐based model demonstrated an accuracy of 92.16%. The accuracy of cytomorphological assessment was greatly improved when it was combined with BAX immunoreactivity (95%). Conclusions Cell‐blocks prepared from OLBC are reliable and minimally‐invasive alternatives to surgical biopsies to diagnose OLLs with epithelial dysplasia when combined with Ki‐67 immunostaining. Machine‐learning has a promising role in the automated quantification of immunostained protein expression.
Collapse
Affiliation(s)
- Majdy Idrees
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kate Shearston
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, Western Australia, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Anatomical Pathology, Australian Clinical Labs, Subiaco, Western Australia, Australia.,CQ University, Rockhampton, Queensland, Australia
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
58
|
Monteiro L, do Amaral B, Delgado L, Garcês F, Salazar F, Pacheco JJ, Lopes C, Warnakulasuriya S. Podoplanin Expression Independently and Jointly with Oral Epithelial Dysplasia Grade Acts as a Potential Biomarker of Malignant Transformation in Oral Leukoplakia. Biomolecules 2022; 12:biom12050606. [PMID: 35625534 PMCID: PMC9138639 DOI: 10.3390/biom12050606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/16/2022] Open
Abstract
Our aim was to evaluate the expression of biomarkers, CD44v6, CD147, EGFR, p53, p63, p73, p16, and podoplanin in oral leukoplakias (OL) and to assess their potential for prediction of malignant transformation (MT). We analyzed the expression of CD44v6, CD147, EGFR, p53, p63, p73, p16, and podoplanin by immunohistochemistry in 52 OL, comprised of 41 low-grade (LG) dysplasia and 11 high-grade (HG) cases. Twelve healthy normal tissues (NT) were also included. Univariate and multivariate analysis were performed to evaluate any association with MT. Variable expression among the studied markers was observed, with a significant increase of high expression from NT to LG and HG cases in CD44v6 (p = 0.002), P53 (p = 0.002), P73 (p = 0.043), and podoplanin (p < 0.001). In multivariate analysis, cases with high podoplanin score showed a significant increased risk of MT (HR of 10.148 (95% CI of 1.503−68.532; p = 0.017). Furthermore, podoplanin combined with binary dysplasia grade obtained a HR of 10.238 (95% CI of 2.06−50.889; p = 0.004). To conclude, CD44v6, p53, p73, and podoplanin showed an increasing expression along the natural history of oral carcinogenesis. Podoplanin expression independently or combined with dysplasia grade could be useful predictive markers of MT in OL.
Collapse
Affiliation(s)
- Luís Monteiro
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (B.d.A.); (F.S.); (J.J.P.)
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
- Correspondence: ; Tel.: +351-224157168
| | - Barbas do Amaral
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (B.d.A.); (F.S.); (J.J.P.)
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
- Stomatology Department, Hospital de Santo António, Centro Hospitalar do Porto, 4099-001 Porto, Portugal
| | - Leonor Delgado
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
| | - Fernanda Garcês
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
| | - Filomena Salazar
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (B.d.A.); (F.S.); (J.J.P.)
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
| | - José Júlio Pacheco
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (B.d.A.); (F.S.); (J.J.P.)
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
| | - Carlos Lopes
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), 4585-116 Gandra, Portugal; (L.D.); (F.G.); (C.L.)
- Molecular Pathology and Immunology Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), Porto University, 4099-001 Porto, Portugal
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, The WHO Collaborating Centre for Oral Cancer, London SE1 9RT, UK;
| |
Collapse
|
59
|
Behl I, Calado G, Vishwakarma A, Traynor D, Flint S, Galvin S, Healy CM, Pimentel ML, Malkin A, Byrne HJ, Lyng FM. Classification of cytological samples from oral potentially malignant lesions through Raman spectroscopy: A pilot study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 266:120437. [PMID: 34627019 DOI: 10.1016/j.saa.2021.120437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
The potential of Raman microspectroscopy of exfoliated cells has been demonstrated for oral cancer diagnosis. In this study, brush biopsies were collected from the buccal mucosa/tongue of healthy donors (n = 31) and from oral mucosal dysplastic lesions (n = 31 patients). Raman spectra were acquired and subjected to partial least squares-discriminant analysis (PLS-DA). The patient samples could be differentiated from healthy donor samples with 96% sensitivity and 95% specificity. Furthermore, PLS-DA models were developed based on cytopathological and histopathological assessment. Low and high grade dysplasia could be discriminated with 64% sensitivity and 65% specificity based on cytopathological assessment, while 81% sensitivity and 86% specificity could be achieved when histopathological assessment was within six months of the brush biopsy sampling. Therefore, this explorative study has successfully demonstrated that Raman spectroscopy may have a role in monitoring patients with dysplasia and may reduce the need for multiple biopsies.
Collapse
Affiliation(s)
- Isha Behl
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland.
| | - Genecy Calado
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Anika Vishwakarma
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Damien Traynor
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Stephen Flint
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Sheila Galvin
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Claire M Healy
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Marina Leite Pimentel
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Alison Malkin
- School of Biological and Health Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Hugh J Byrne
- FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland
| | - Fiona M Lyng
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| |
Collapse
|
60
|
de Farias Morais HG, de Morais EF, Carlan LM, de Pontes Santos HB, da Silveira ÉJD, de Almeida Freitas R. Epithelial-mesenchymal transition modulates lower lip carcinogenesis and promotes cancer progression. Arch Oral Biol 2022; 136:105387. [DOI: 10.1016/j.archoralbio.2022.105387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
|
61
|
Khoury ZH, Sultan M, Sultan AS. Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis. Int J Surg Pathol 2022; 30:499-511. [PMID: 34994584 DOI: 10.1177/10668969211070171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^2 statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.
Collapse
Affiliation(s)
- Zaid H Khoury
- Meharry Medical College, School of Dentistry, Department of Oral Diagnostic Sciences & Research, Nashville, TN, USA
| | - Mohamed Sultan
- Western Vascular Institute, University College Hospital, Galway, Ireland
| | - Ahmed S Sultan
- 12265University of Maryland School of Dentistry, Baltimore, MD, USA.,12265University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA
| |
Collapse
|
62
|
Li Y, Cha SB, Park Y, Gong BH, Jeong IY, Kim HS, Kang MS, Kim YS, Han CH, Lee HK, Song SW, Park CG, Kang BH. Evaluation of Caspase-3 and Ki-67 expression in squamous cell hyperplasia of the stomach induced by Platycodi radix water extract in Sprague–Dawley rats. J Toxicol Pathol 2022; 35:45-52. [PMID: 35221495 PMCID: PMC8828602 DOI: 10.1293/tox.2021-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/16/2021] [Indexed: 12/25/2022] Open
Abstract
Platycodi radix is widely used in traditional herbal medicine for the
treatment of bronchitis, asthma, pulmonary tuberculosis, hypertension, hyperlipidemia, and
diabetes. This study aimed to investigate cell proliferation (Ki-67) and apoptosis
(Caspase-3) potential in squamous cell hyperplasia of the stomach induced by a
Platycodi radix water extract in a subchronic toxicity study. One
hundred formalin-fixed, paraffin-embedded stomach tissues of rats treated with
Platycodi radix at doses of 0, 500, 1,000, and 3,000 mg/kg body
weight/day were used for the analysis. They were conventionally stained using hematoxylin
and eosin (H&E) and immunohistochemically (IHC) stained using caspase-3 and Ki-67
antibodies. The incidence of squamous cell hyperplasia was significantly increased in the
3,000 mg/kg b.w./day treatment group in both sexes (p<0.01). However, the hyperplastic
change was completely repaired after 4 weeks of recovery period. Ki-67 expression was
similar in all groups, with no statistically significant differences among the groups.
Caspase-3 expression was significantly increased in both sexes in the 3,000 mg/kg b.w./day
treatment group (p<0.01), compared with the vehicle control groups, and then reduced to
normal levels in the recovery groups in both sexes. In conclusion, this study showed that
squamous cell hyperplasia induced by the Platycodi radix water extract in
the limiting ridge of the stomach is not considered to be abnormal proliferative change;
as a result, squamous cell hyperplasia is considered to be a non-adverse effect when
induced by the oral administration of the Platycodi radix water extract
once daily for 13 weeks in rats.
Collapse
Affiliation(s)
- Yinghua Li
- Dt&SanoMedics. Co. Ltd., 15F, 126, Teheran-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Seung-Beom Cha
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Youngil Park
- Non-clinical Center, Dt&CRO Co. Ltd., 46, Yurim-Ro 154 beon-Gil, Cheoin-Gu, Yongin-Si, Republic of Korea
| | - Bo-Ho Gong
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - In-Yeong Jeong
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Hak-Soo Kim
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Min-Soo Kang
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Young-Suk Kim
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Chang Hoon Han
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Hyun-Kul Lee
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Si-Whan Song
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| | - Chae-Gyoo Park
- Non-clinical Center, Dt&CRO Co. Ltd., 46, Yurim-Ro 154 beon-Gil, Cheoin-Gu, Yongin-Si, Republic of Korea
| | - Boo-Hyon Kang
- Nonclinical Research Institute, ChemOn Inc., Yongin-Si, Republic of Korea
| |
Collapse
|
63
|
Pandita V, Ajila V, Babu S, Hegde S. Oral leukoplakia: A review of clinical features and trends in management. ACTA STOMATOLOGICA NAISSI 2022. [DOI: 10.5937/asn2285417p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Oral potentially malignant disorders (OPMD) conisit of the group of diseases of great importance for dentists. Oral leukoplakia (OL) has long been the subject of debate by numerous researchers. A common etiologic factor is tobacco, which is associated with oral cancer. The aim of the study is to indicate the severity of the lesion, the most common clinical characreistics and localization. The prevalence of leukoplakia in the world is 2.6% with a rate of malignant conversion ranging from 0.1% to 17.5%. Literature data about the prevalence and annual rate of malignant transformation, approximately 2%, indicate that these changes should be taken seriously and regularymonitored Conclusion: Occurate diagnosis provides the key to preventing to malignant transformation. Various medical and surgical treatment modalities for this lesion have been described. This article highlights various trends in the diagnosis and treatment of oral leukoplakia.
Collapse
|
64
|
Kuriakose M, Birur P, Patrick S, Warnakulasuriya S, Gurushanth K, Raghavan S, Rath G, Chaturvedi P, Chandru V, Mathew B, Prabhash K, Gurudath S, Mukhia N, Sunny S, Mehrotra R, Vivek V, Patil S, Kumar GS, Fasalkar S, Pratima R. Consensus guidelines on management of oral potentially malignant disorders. Indian J Cancer 2022; 59:442-453. [DOI: 10.4103/ijc.ijc_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
65
|
Nandini C, Basha S, Agarawal A, Neelampari RP, Miyapuram K, Nileshwariba RJ. Deep learning approach to detect high-risk oral epithelial dysplasia: A step towards computer-assisted dysplasia grading. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
66
|
Expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins as predictive markers for relapse in oral squamous cell carcinoma (OSCC). PLoS One 2021; 16:e0261575. [PMID: 34941961 PMCID: PMC8700009 DOI: 10.1371/journal.pone.0261575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Local relapse of oral squamous cell carcinoma in non-involved mucosal surgical margins indicated possibility of field alteration in the margins, which could be predicted with certain biomarkers. The objectives were to evaluate the expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins and the association of clinicopathological prognosticators with local relapse in oral squamous cell carcinoma.
Methods
Surgical margins from the study (relapse) group (n = 23), control (non-relapse) group (n = 32) and normal oral mucosa (n = 5) were immunohistochemically stained using Ki-67, Cornulin and ISG15 antibodies. Association between expression of markers and clinicopathological prognosticators with local relapse in oral squamous cell carcinoma was analyzed statistically.
Results
The study group surgical margins demonstrated significantly decreased Cornulin expression (p = 0.032). Low Cornulin expression was significantly associated with local relapse (p = 0.004) and non-tongue primary tumor (p = 0.013). Although not significantly associated with local relapse, expression of Ki-67 was significantly reduced in female patients (p = 0.041). Age above 57.5 years, Chinese & Indian ethnicity, alcohol consumption, epithelial dysplasia in surgical margins, and type III and IV patterns of invasion of tumor were also significantly related to local relapse. Regression analysis showed low expression of Cornulin (p = 0.018), and increased patient’s age (p = 0.008) were predictors of local relapse in oral squamous cell carcinoma, with 34-fold risk and 18-fold risk, respectively. Expression of Ki-67 and ISG15 did not show significant association with local relapse in oral squamous cell carcinoma.
Conclusion
Low expression of Cornulin is an independent predictor of relapse in oral squamous cell carcinoma.
Collapse
|
67
|
Kujan O, Agag M, Smaga M, Vaishnaw Y, Idrees M, Shearston K, Farah CS. PD-1/PD-L1, Treg-related proteins, and tumour-infiltrating lymphocytes are associated with the development of oral squamous cell carcinoma. Pathology 2021; 54:409-416. [PMID: 34872754 DOI: 10.1016/j.pathol.2021.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/26/2022]
Abstract
Cancer immunomodulation has been implicated in the development of oral squamous cell carcinoma (OSCC), however the role of specific immunomodulatory proteins is not completely understood, particularly in the early stages of the disease. Oral potentially malignant disorders such as leukoplakia commonly precede OSCC but not all will undergo malignant transformation. The aim of this study was to evaluate the diagnostic utility of specific immunomodulator proteins and their role in the progression of OSCC. Samples from 101 patients were included in the study. Cases were classified based on histopathology into four groups: non-dysplastic epithelial hyperplasia/keratosis, low-grade dysplasia, high-grade dysplasia, and OSCC. The PD-1/PD-L1 pathway, as well as regulatory T cell (Treg)-related proteins including FOXP3, TGF-β, IL-6, and IL-10 were immunohistochemically quantified. The number of tumour-infiltrating lymphocytes (TILs) was also assessed for each case. Multinominal regression models were undertaken to assess the significance of each protein in predicting the histopathological grade of oral epithelial disorders, and three diagnostic models were assessed. Significant positive associations were found between the immunoreactive score of each protein and the histopathological grade, p<0.05 suggesting that the PD-1/PD-L1 pathway, Treg-related proteins, and TILs are associated with the development of OSCC. Diagnostic models using the investigated proteins and TILs predicted the grade of oral epithelial disorder, p<0.05. The associated accuracy of this approach was 84.92%. Our findings support the notion that immunomodulation events may play a role in evading the immune system and contributing to potential malignant transformation of oral epithelial disorders. Our data also provide supporting evidence for the potential application of immune checkpoint inhibitors in the chemoprevention of OSCC. Further longitudinal studies to assess individual T-cell populations within the immune microenvironment of various oral potentially malignant disorders are warranted.
Collapse
Affiliation(s)
- Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia.
| | - Muhamed Agag
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Monika Smaga
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Yash Vaishnaw
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Kate Shearston
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia; Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia; Anatomical Pathology, Australian Clinical Labs, Subiaco, WA, Australia
| |
Collapse
|
68
|
Pansini PF, do Valle IB, Damasceno TCD, de Abreu PM, Có ACG, López RVM, Lenzi J, Rocha RM, Souza ED, Curado MP, Mehanna H, Nankivell P, de Podestá JRV, von Zeidler SV. Differential Expression of Potential Biomarkers of Oral Squamous Cell Carcinoma Development. Head Neck Pathol 2021; 15:1127-1136. [PMID: 33840043 PMCID: PMC8633043 DOI: 10.1007/s12105-021-01322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
To evaluate molecular epithelial changes, we investigated whether a profile of survivin, cyclin dependent kinase inhibitor 2A (CDKN2A), epidermal growth factor receptor (EGFR), polo like kinase 1 (PLK1), p63, p40 (Δnp63 isoform), cyclin D1 (CCND1) and BCL2 apoptosis regulator (BCL2) proteins could predict malignant transformation. Different tissue segments (tumor adjacent epithelium; dysplasia and tumor) from a total of 109 patients were analyzed by immunohistochemistry. An increased expression of survivin (p < 0.001), PLK1 (p = 0.001), and p63 (p < 0.001) in parallel to reduced immunostaining of p40 (p < 0.001) and BCL2 (p = 0.029) was observed among the tissue segments analyzed. Our study revealed that survivin, PLK1, p63, p40 and BCL2 play a role in oral tumorigenesis and represent promising biomarkers able to recognize mesenchymal phenotype induction in the transition from nonmalignant cells to tumor cells. These results reveals critical interaction between survivin, PLK1, p63, p40 promising proteins during invasive carcinoma development.
Collapse
Affiliation(s)
- Paola Fernandes Pansini
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
| | - Isabella Bittencourt do Valle
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Thabata Coeli Dias Damasceno
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
| | - Priscila Marinho de Abreu
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
| | - Anna Clara Gregório Có
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
| | - Rossana Verónica Mendoza López
- Instituto do Câncer do Estado de São Paulo (ICESP) - Center for Translational Research in Oncology, Universidade de São Paulo, São Paulo, Brazil
| | - Jeferson Lenzi
- Programa de Detecção Precoce do Câncer Bucal, Setor de Cirurgia de Cabeça e Pescoço, Hospital Santa Rita de Cássia, Vitoria, Espírito Santo Brazil
| | - Ricardo Mai Rocha
- Programa de Detecção Precoce do Câncer Bucal, Setor de Cirurgia de Cabeça e Pescoço, Hospital Santa Rita de Cássia, Vitoria, Espírito Santo Brazil
| | - Evandro Duccini Souza
- Programa de Detecção Precoce do Câncer Bucal, Setor de Cirurgia de Cabeça e Pescoço, Hospital Santa Rita de Cássia, Vitoria, Espírito Santo Brazil
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, AC Camargo Cancer Center, São Paulo, São Paulo Brazil
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Paul Nankivell
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - José Roberto Vasconcelos de Podestá
- Programa de Detecção Precoce do Câncer Bucal, Setor de Cirurgia de Cabeça e Pescoço, Hospital Santa Rita de Cássia, Vitoria, Espírito Santo Brazil
| | - Sandra Ventorin von Zeidler
- Departamento de Patologia, Programa de Pós-Graduação Em Biotecnologia, Centro de Ciências da Saúde - Universidade Federal do Espírito santo, Av. Marechal Campos, 1468 Maruípe, Vitoria, Espírito Santo 29.043-900 Brazil
| |
Collapse
|
69
|
Sathasivam HP, Sloan P, Thomson PJ, Robinson M. The clinical utility of contemporary oral epithelial dysplasia grading systems. J Oral Pathol Med 2021; 51:180-187. [PMID: 34797585 DOI: 10.1111/jop.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. METHODS Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. RESULTS 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. CONCLUSION This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).
Collapse
Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Peter J Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Max Robinson
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
70
|
Monteiro L, Silva P, Delgado L, Amaral B, Garcês F, Salazar F, Pacheco JJ, Lopes C, Bousbaa H, Warnakulasuriya S. Expression of spindle assembly checkpoint proteins BubR1 and Mad2 expression as potential biomarkers of malignant transformation of oral leukoplakia: an observational cohort study. Med Oral Patol Oral Cir Bucal 2021; 26:e719-e728. [PMID: 34704983 PMCID: PMC8601638 DOI: 10.4317/medoral.24511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Spindle Assembly Checkpoint (SAC) is a surveillance mechanism essential to ensure the accuracy of chromosome segregation during mitosis. Our aim was to evaluate the expression of SAC proteins in oral carcinogenesis, and to assess their potential in predicting malignant transformation of oral leukoplakia. Material and Methods We analysed the immunoexpression of BubR1, Mad2, Bub3, and Spindly proteins in 64 oral biopsies from 52 oral leukoplakias and 12 normal tissues. Univariate and multivariate analysis were performed to evaluate predictive factors for malignant transformation (MT). Results We observed that BubR1 and Mad2 were more highly expressed in high dysplasia grade lesions than in low grade or normal tissues (P<0.05). High expression of Spindly was significantly correlated with a high Ki-67 score (P=0.004). Six (11.5%) oral leukoplakias underwent malignant transformation. In univariate analysis, the binary dysplasia grade (high grade) (P<0.001) was associated with a higher risk of malignant transformation as well as high BubR1 (P<0.001) and high Mad2 (P=0.013) expression. In multivariate analysis, high expression of BubR1 and Mad2 when combined showed an increased risk for malignant transformation (P=0.013; HR of 4.6, 95% CI of 1.4-15.1). Conclusions Our findings reveal that BubR1 and Mad2 were associated with an increased risk for malignant transformation independently of histological grade and could be potential and useful predictive risk markers of malignant transformation in oral leukoplakias. Key words:BubR1, Mad2, Spindly, Bub3, Oral Leukoplakia, epithelial dysplasia, Oral squamous cell carcinoma.
Collapse
Affiliation(s)
- L Monteiro
- Rua Central de Gandra, 1317 4585-116 Gandra PRD, Portugal
| | | | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Dhumal SN, Choudhari SK, Patankar S, Ghule SS, Jadhav YB, Masne S. Cancer Stem Cell Markers, CD44 and ALDH1, for Assessment of Cancer Risk in OPMDs and Lymph Node Metastasis in Oral Squamous Cell Carcinoma. Head Neck Pathol 2021; 16:453-465. [PMID: 34655409 PMCID: PMC9187836 DOI: 10.1007/s12105-021-01384-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
Tumour heterogeneity in oral cancer is attributed to the presence of cancer stem cells (CSCs). CSCs are the most migratory and metastatic cellular subpopulation within tumours. Assessment of CSC markers as significant predictors of lymph node metastasis may prove valuable in the clinical setting. Furthermore, analysis of this panel of putative stem cell markers in oral dysplasia may additionally inform of the likelihood for oral potentially malignant disorders (OPMDs) to progress to oral squamous cell carcinoma (OSCC). The present study aims to assess the significance of CSC markers in the progression of OPMDs to OSCC and assessment of lymph node metastasis in OSCC. CD44 and ALDH1 were assessed immunohistochemically in 25 normal, 30 OPMDs, and 24 OSCCs. CD44 is a membranous marker and ALDH1 is a cytoplasmic marker. The immunohistochemical expression of these markers were compared between OPMDs with and without dysplasia, as well as between low-risk and high-risk dysplasias. Similarly, expression was compared between OSCC with and without lymph node metastasis and among grades of OSCC. Positive CD44 expression was seen in all normal mucosal tissues. The expression decreased from normal epithelium to OPMDs but increased in OSCC. CD44 expression was positive in 21 cases of OSCC (87.5%) and reduced from well-differentiated to poorly differentiated OSCC. CD44 staining index was higher in OSCC without lymph node metastasis (3.59) when compared with OSCC with lymph node metastasis (1.33). There was a statistically significant difference observed in the ALDH1 staining index among three groups (p < 0.05), with highest expression seen in OSCC. Within OPMDs, the ALDH1 staining index was statistically higher in OPMDs with dysplasia as compared to OPMDs without dysplasia. Furthermore, the expression was higher in OPMDs with high-risk dysplasia when compared with low-risk dysplasia, but this was not statistically significant (p = 0.82). In conclusion, The CD44 positive population possesses properties of CSCs in head and neck carcinoma, and continuous shedding could be found after CD44 down-regulation. The present study reports differences in ALDH1 expression between OPMDs with and without dysplasia, dysplastic and non-dysplastic epithelia, and low-risk and high-risk dysplasia. These findings may suggest ALDH1 as a specific marker for dysplasia. CD44 demonstrated a difference in staining index in OSCC without lymph node metastasis versus OSCC with lymph node metastasis. These findings may suggest CD44 as a marker for lymph node metastasis. Both proteins may play key roles in the tumorigenicity of CSCs in OPMDs and OSCC.
Collapse
Affiliation(s)
| | | | - Sangeeta Patankar
- YMT Dental College and Research Institute, Navi Mumbai, Maharashtra India
| | | | - Yogesh B. Jadhav
- YMT Dental College and Research Institute, Navi Mumbai, Maharashtra India
| | - Sneha Masne
- YMT Dental College and Research Institute, Navi Mumbai, Maharashtra India
| |
Collapse
|
72
|
Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021; 27:1947-1976. [PMID: 34418233 DOI: 10.1111/odi.13993] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
Collapse
Affiliation(s)
- Edward Odell
- King's College London and Head and Neck Pathology Guy's Hospital, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King's College London and The WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Chief Histopathologist, AMLo Biosciences, Newcastle upon Tyne, UK
| |
Collapse
|
73
|
Kawai R, Sugita Y, Suzumura T, Hattori T, Yoshida W, Kubo K, Maeda H. Melanoma Inhibitory Activity and Melanoma Inhibitory Activity 2 as Novel Immunohistochemical Markers of Oral Epithelial Dysplasia. J Clin Med 2021; 10:jcm10163661. [PMID: 34441956 PMCID: PMC8396825 DOI: 10.3390/jcm10163661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022] Open
Abstract
Oral potentially malignant disorders are associated with the development of oral squamous cell carcinoma (OSCC). Most OSCCs are diagnosed via histopathology as oral epithelial dysplasia (OED), but the histologic diagnostic criteria remain non-uniform. Accordingly, the establishment of a diagnostic marker to assist in diagnosis could contribute towards cancer prevention. Melanoma inhibitory activity (MIA) and MIA2 are involved in tumor growth, invasion, and lymph node metastasis in various malignancies. The purpose of this study was to clarify the usefulness of MIA and MIA2 as diagnostic markers of oral mucosal lesions. The expression of MIA and MIA2 was analyzed immunohistochemically in 100 specimens (10 specimens with normal oral mucosa (NOM) and 30 specimens each with low-grade epithelial dysplasia (LED), high-grade epithelial dysplasia (HED), and OSCC). Immunohistochemical results were evaluated based on the Allred scoring system. Cytoplasmic expression of MIA and MIA2 increased in the order of LED, HED, and OSCC. All NOM specimens were negative for cytoplasmic expression. Significant differences were observed between the groups (NOM vs. HED, p < 0.05, NOM vs. OSCC, p < 0.001). These results demonstrate that MIA and MIA2 are expressed in the oral mucosa within early neoplastic lesions and suggest that MIA and MIA2 are useful novel immunohistochemical markers for discriminating between normal tissue and OED.
Collapse
Affiliation(s)
- Ryoko Kawai
- Correspondence: ; Tel.: +81-52-757-6736; Fax: +81-52-751-2568
| | | | | | | | | | | | | |
Collapse
|
74
|
Sathasivam HP, Kist R, Sloan P, Thomson P, Nugent M, Alexander J, Haider S, Robinson M. Predicting the clinical outcome of oral potentially malignant disorders using transcriptomic-based molecular pathology. Br J Cancer 2021; 125:413-421. [PMID: 33972745 PMCID: PMC8329212 DOI: 10.1038/s41416-021-01411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study was undertaken to develop and validate a gene expression signature that characterises oral potentially malignant disorders (OPMD) with a high risk of undergoing malignant transformation. METHODS Patients with oral epithelial dysplasia at one hospital were selected as the 'training set' (n = 56) whilst those at another hospital were selected for the 'test set' (n = 66). RNA was extracted from formalin-fixed paraffin-embedded (FFPE) diagnostic biopsies and analysed using the NanoString nCounter platform. A targeted panel of 42 genes selected on their association with oral carcinogenesis was used to develop a prognostic gene signature. Following data normalisation, uni- and multivariable analysis, as well as prognostic modelling, were employed to develop and validate the gene signature. RESULTS A prognostic classifier composed of 11 genes was developed using the training set. The multivariable prognostic model was used to predict patient risk scores in the test set. The prognostic gene signature was an independent predictor of malignant transformation when assessed in the test set, with the high-risk group showing worse prognosis [Hazard ratio = 12.65, p = 0.0003]. CONCLUSIONS This study demonstrates proof of principle that RNA extracted from FFPE diagnostic biopsies of OPMD, when analysed on the NanoString nCounter platform, can be used to generate a molecular classifier that stratifies the risk of malignant transformation with promising clinical utility.
Collapse
Affiliation(s)
- Hans Prakash Sathasivam
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Ralf Kist
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Newcastle University Biosciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Philip Sloan
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.420004.20000 0004 0444 2244Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Thomson
- grid.194645.b0000000121742757Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael Nugent
- grid.416726.00000 0004 0399 9059Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - John Alexander
- grid.18886.3f0000 0001 1271 4623The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Syed Haider
- grid.18886.3f0000 0001 1271 4623The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Max Robinson
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.420004.20000 0004 0444 2244Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
75
|
Overview of Oral Potentially Malignant Disorders: From Risk Factors to Specific Therapies. Cancers (Basel) 2021; 13:cancers13153696. [PMID: 34359597 PMCID: PMC8345150 DOI: 10.3390/cancers13153696] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs' development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments.
Collapse
|
76
|
Gilvetti C, Soneji C, Bisase B, Barrett AW. Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit. Oral Oncol 2021; 121:105462. [PMID: 34303087 DOI: 10.1016/j.oraloncology.2021.105462] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). MATERIALS & METHODS A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). RESULTS Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). CONCLUSION Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
Collapse
Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Chandni Soneji
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew William Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| |
Collapse
|
77
|
Arroyo EA, Donís SP, Petronacci CMC, Alves MGO, Mendía XM, Fernandes D, Pouso AIL, Bufalino A, Bravo López S, Sayáns MP. Usefulness of protein-based salivary markers in the diagnosis of oral potentially malignant disorders: A systematic review and meta-analysis. Cancer Biomark 2021; 32:411-424. [PMID: 34334380 DOI: 10.3233/cbm-203043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
By using a meta-analytical approach, this study aimed to analyse the diagnostic capacity of protein-based biomarkers in saliva for the differential diagnosis of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) from healthy individuals as control group (HCG).Articles on protein-based biomarkers in saliva, which provided quantitative expression in individuals with clinical and histopathological diagnosis of OPMD or oral leukoplakia (OL) were considered eligible. Searches were conducted in eight electronic databases. The methodological quality was assessed using the Quality Assessment of Diagnostic Studies tool (QUADAS-2). Functional analysis was also performed. Meta-analyses were performed using the OpenMeta tool (Analyst).Meta-analysis was possible for 4 of the 11 biomarkers studied. Only the carcinoembryonic antigen (CEA) and the soluble fragment of cytokeratin 19 (CYFRA21) were significant for the OSCC/OPMD subgroup, both with a very low heterogeneity. CEA had an OE = 25.854 (CI95%: 13.215-38.492, p< 0.001, I2 = 0) and CYFRA21 had an OE = 9.317 (CI95%: 9.014-9.619, p< 0.001, I2 = 0). For the OPMD/HCG subgroup, only CYFRA21 was significant, with an OE = 3.679 (CI95%: 0.663-6.696, p= 0.017) although with high heterogeneity (I2 = 91.24).The CEA and CYFRA21 markers proved very useful when differentiating OSCC from OPMD. The CYFRA21 was the only protein that was capable of distinguishing between OPMD and healthy controls.
Collapse
Affiliation(s)
- Esteban Alexis Arroyo
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University, Araraquara, SP, Brazil
| | - Sergio Piñeiro Donís
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Spain
| | - Cintia M Chamorro Petronacci
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Spain.,Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Monica G Oliveira Alves
- Anhembi Morumbi University, School of Medicine, São José dos Campos, São Paulo, Brazil.,Universidade Mogi das Cruzes, School of Dentistry, Mogi das Cruzes, São Paulo, Brazil
| | | | - Darcy Fernandes
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University, Araraquara, SP, Brazil
| | - Alejandro I Lorenzo Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Spain
| | - Andreia Bufalino
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University, Araraquara, SP, Brazil
| | - Susana Bravo López
- Proteomic Unit, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Pérez Sayáns
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University, Araraquara, SP, Brazil.,Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Spain
| |
Collapse
|
78
|
Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4329-4340. [PMID: 34050426 DOI: 10.1007/s00784-021-04008-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems. MATERIAL AND METHODS A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED). RESULTS The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I2 = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I2 = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64). CONCLUSIONS Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation. CLINICAL RELEVANCE The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.
Collapse
|
79
|
Recurrence in Oral Premalignancy: Clinicopathologic and Immunohistochemical Analysis. Diagnostics (Basel) 2021; 11:diagnostics11050872. [PMID: 34066207 PMCID: PMC8151734 DOI: 10.3390/diagnostics11050872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023] Open
Abstract
Oral leukoplakia (OL) has a propensity for recurrence and malignant transformation (MT). Herein, we evaluate sociodemographic, clinical, microscopic and immunohistochemical parameters as predictive factors for OL recurrence, also comparing primary lesions (PLs) with recurrences. Thirty-three patients with OL, completely removed either by excisional biopsy or by laser ablation following incisional biopsy, were studied. Selected molecules associated with the STAT3 oncogenic pathway, including pSTAT3, Bcl-xL, survivin, cyclin D1 and Ki-67, were further analyzed. A total of 135 OL lesions, including 97 PLs and 38 recurrences, were included. Out of 97 PLs, 31 recurred at least once and none of them underwent MT, during a mean follow-up time of 48.3 months. There was no statistically significant difference among the various parameters in recurrent vs. non-recurrent PLs, although recurrence was most frequent in non-homogeneous lesions (p = 0.087) and dysplastic lesions recurred at a higher percentage compared to hyperplastic lesions (34.5% vs. 15.4%). Lower levels of Bcl-xL and survivin were identified as significant risk factors for OL recurrence. Recurrences, although smaller and more frequently homogeneous and non-dysplastic compared to their corresponding PLs, exhibited increased immunohistochemical expression of oncogenic molecules, especially pSTAT3 and Bcl-xL. Our results suggest that parameters associated with recurrence may differ from those that affect the risk of progression to malignancy and support OL management protocols favoring excision and close monitoring of all lesions.
Collapse
|
80
|
Cerqueira JM, Pontes FS, Santos-Silva AR, Almeida OP, Costa RF, Fonseca FP, Gomez RS, Neto NC, Miyahara LA, Rodrigues-Fernandes CI, Neto ED, Araújo AL. Malignant transformation of oral leukoplakia: a multicentric retrospective study in Brazilian population. Med Oral Patol Oral Cir Bucal 2021; 26:e292-e298. [PMID: 33247570 PMCID: PMC8141311 DOI: 10.4317/medoral.24175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Among the oral potentially malignant disorders, leukoplakia stands out as the most prevalent. The purpose of this study was to analyse the clinical-pathological features of oral leukoplakia in groups of patients from three major pathology centers in two different regions of Brazil, in order to determine which factors would be associated to the clinical risk of malignant transformation.
Material and Methods A total of 148 patients was analyzed, and data regarding gender, age, site, classification of the clinical subtype, harmful habits such as use of tobacco and alcohol, time of evolution and presence of dysplasia were collected. The association between risk factors and malignant transformation was investigated using the chi-square test and Fischer's exact test for correlation of variables. A significance level of 5% (p≤0.05) was used.
Results The mean age of the patients was 60 years, and 56% were female. Most of the lesions (34,5%) were located in the lateral and ventral regions of the tongue. Of the 148 patients, ninety had clinical follow-up. Malignant transformation occurred in 13 patients (8.8%), with an average of 44 months of follow up.
Conclusions Non-smoker, nonhomogeneous clinical presentation, location at the tongue, and the presence of high degree of dysplasia were statistically relevant factors associated with a higher risk of transformation transformation. Key words:Potentially malignant disorders, leukoplakia, malignant transformation, squamous cell carcinoma.
Collapse
Affiliation(s)
- J-M Cerqueira
- Department of Surgery and Oral Pathology João de Barros Barreto University Hospital Mundurucus Street, nº 4487 Zip Code 66073-000, Belém, Pará, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
81
|
Chaturvedi AK, Udaltsova N, Engels EA, Katzel JA, Yanik EL, Katki HA, Lingen MW, Silverberg MJ. Oral Leukoplakia and Risk of Progression to Oral Cancer: A Population-Based Cohort Study. J Natl Cancer Inst 2021; 112:1047-1054. [PMID: 31860085 DOI: 10.1093/jnci/djz238] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The optimal clinical management of oral precancer remains uncertain. We investigated the natural history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician's decision to biopsy a leukoplakia vis-à-vis progression, and histopathologic predictors of progression. METHODS We conducted a retrospective cohort study (1996-2012) of patients with oral leukoplakia (n = 4886), identified using electronic medical records within Kaiser Permanente Northern California. Among patients with leukoplakia who received a biopsy (n = 1888), we conducted a case-cohort study to investigate histopathologic predictors of progression. Analyses included indirect standardization and unweighted or weighted Cox regression. RESULTS Compared with the overall Kaiser Permanente Northern California population, oral cancer incidence was substantially elevated in oral leukoplakia patients (standardized incidence ratio = 40.8, 95% confidence interval [CI] = 34.8 to 47.6; n = 161 cancers over 22 582 person-years). Biopsied leukoplakias had a higher oral cancer risk compared with those that were not biopsied (adjusted hazard ratio = 2.38, 95% CI = 1.73 to 3.28). However, to identify a prevalent or incident oral cancer, the biopsy decision had low sensitivity (59.6%), low specificity (62.1%), and moderate positive-predictive value (5.1%). Risk of progression to oral cancer statistically significantly increased with the grade of dysplasia; 5-year competing risk-adjusted absolute risks were: leukoplakia overall = 3.3%, 95% CI = 2.7% to 3.9%; no dysplasia = 2.2%, 95% CI = 1.5% to 3.1%; mild-dysplasia = 11.9%, 95% CI = 7.1% to 18.1%; moderate-dysplasia = 8.7%, 95% CI = 3.2% to 17.9%; and severe dysplasia = 32.2%, 95% CI = 8.1%-60.0%. Yet 39.6% of cancers arose from biopsied leukoplakias without dysplasia. CONCLUSIONS The modest accuracy of the decision to biopsy a leukoplakia vis-à-vis presence or eventual development of oral cancer highlights the need for routine biopsy of all leukoplakias regardless of visual or clinical impression. Leukoplakia patients, particularly those with dysplasia, need to be closely monitored for signs of early cancer.
Collapse
Affiliation(s)
- Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jed A Katzel
- Department of Oncology, Kaiser Permanente, San Francisco, CA, USA
| | | | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | |
Collapse
|
82
|
Gaida K, Deuerling L, Neumann H, Remmerbach TW. Comparison between two cell collecting methods for liquid-based brush biopsies: a consecutive and retrospective study. BMC Oral Health 2021; 21:195. [PMID: 33863321 PMCID: PMC8052744 DOI: 10.1186/s12903-021-01557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background This study compares two different cell collectors, the Orcellex Brush (rigid brush) and the Cytobrush GT (nylon brush), using liquid-based cytology. A comparison of their obtainment procedures was also considered. The aim was to determine the diagnostic accuracy for detection of malignancy in oral brush biopsies. PICO-Statement: In this consecutive and retrospective study we had as population of interests, patients with oral lesions, the intervention was the brush biopsy with two different cell collectors and the control was healthy oral mucosa. The outcome of the study was to compare both cell collectors. Methods From 2009 to 2018, 2018 patients with oral lesions were studied using the nylon brush (666 cases) and rigid brush (1352 cases). In the first cohort five smears per patient were taken with the nylon brush, while each patient received one smear with the rigid brush in the second cohort. These were further processed in a liquid-based procedure. Cytological evaluations were categorised into ‘negative’, which were considered as negative, whereas ‘doubtful’, ‘suspicious’ and ‘positive’ cytological results were overall considered as positive for malignancy in comparison to the final histological diagnoses. Additionally, the clinical expenditure for each collector was estimated. Results 2018 clinically and histologically proven diagnoses were established, including 181 cases of squamous cell carcinomas, 524 lichen, 454 leukoplakias, 34 erythroplakias and 825 other benign lesions. The sensitivity and specificity of the nylon brush was 93.8% (95% CI 91.6–95.5%) and 94.2% (95% CI 91.8–95.5%) respectively, whereas it was 95.6% (95% CI 94.4–96.6%) and 84.9% (95% CI 83.8–87.5%) for the rigid brush. The temporal advantage using the plastic brushes was 4× higher in comparison to the nylon brush. The risk suffering from a malignant oral lesion when the result of the brushes was positive, suspicious, or doubtful was significantly high for both tests (nylon brush OR: 246.3; rigid brush OR: 121.5). Conclusions Both systems have a similar sensitivity, although only the rigid brush achieved a satisfactory specificity. Additional methods, such as DNA image cytometry, should also be considered to improve the specificity. Furthermore, the rigid brush proved to be more effective at taking a sufficient number of cells, whilst also being quicker and presenting less stress for the patient.
Collapse
Affiliation(s)
- Kristin Gaida
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany
| | - Lena Deuerling
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany
| | - Heinrich Neumann
- Medical Care Centre for Histology, Cytology and Molecular Diagnostics, 52351, Düren, Germany
| | - Torsten W Remmerbach
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Section of Clinical and Experimental Oral Medicine, Leipzig University Hospital, Liebigstraße 10-14, 04103, Leipzig, Germany.
| |
Collapse
|
83
|
de Azevedo AB, Dos Santos TCRB, Lopes MA, Pires FR. Oral leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis: Analysis of 953 patients focusing on oral epithelial dysplasia. J Oral Pathol Med 2021; 50:829-840. [PMID: 33817883 DOI: 10.1111/jop.13183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To analyse the clinical and histological characteristics from a series of oral leukoplakias, leukoerythroplakias, erythroplakias and actinic cheilitis diagnosed in a 14-year period. METHODS The files were reviewed and all cases diagnosed as leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis were selected. Clinical information was obtained from the biopsy submission forms, and histological review was performed in all cases. RESULTS Final sample included 953 lesions, mostly affecting females (534, 56%), and 87.5% of the patients were 41 to 80 years old. The most commonly affected regions were the lower lip (20.1%), tongue (18.1%) and buccal mucosa (16.9%). Leukoplakias, actinic cheilitis, leukoerythroplakias and erythroplakias represented, respectively, 74.6%, 15.2%, 9.3% and 0.8% of the sample. Most cases presented no dysplasia (42.1%) or mild dysplasia (33.5%). Lesions in the tongue, floor of mouth and lower lip, as well as lesions that presented hyperparakeratosis, showed higher frequencies of moderate dysplasia and severe dysplasia/carcinoma in situ. The most common histological criteria were the increase in number and size of nucleoli, loss of polarity of the basal cells and variations in cellular size and shape. Classification by the binary system showed that 7% were high-risk lesions. CONCLUSION All histological criteria for classification of oral epithelial dysplasia recommended by the World Health Organization showed increased frequency as grading increased. Additional criteria seem to be useful in grading oral epithelial dysplasia, such as the presence of normal and abnormal superficial mitotic figures and endophytic epithelial proliferation.
Collapse
Affiliation(s)
| | | | - Márcio Ajudarte Lopes
- Semiology, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Fábio Ramoa Pires
- Oral Pathology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
84
|
Zohdy M, Cazzaniga S, Nievergelt H, Blum R, Suter VGA, Feldmeyer L, Beltraminelli H. Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases. Dermatopathology (Basel) 2021; 8:84-88. [PMID: 33915710 PMCID: PMC8167714 DOI: 10.3390/dermatopathology8020013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.
Collapse
Affiliation(s)
- Marwa Zohdy
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Department of Dermatology, Andrology and STDs, Mansoura University Hospitals, Mansoura University, Mansoura 35516, Egypt
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Centro Studi GISED, 24121 Bergamo, Italy
| | - Helga Nievergelt
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
| | - Roland Blum
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
| | - Valérie G. A. Suter
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Correspondence:
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
| |
Collapse
|
85
|
Bavle RM, Paremala K, Venugopal R, Rudramuni AS, Khan N, Hosthor SS. Grading of Oral Leukoplakia: Can It be Improvised Using Immunohistochemical Markers p63 and CD31. Contemp Clin Dent 2021; 12:37-43. [PMID: 33967536 PMCID: PMC8092094 DOI: 10.4103/ccd.ccd_493_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Oral squamous cell carcinoma is usually preceded by potentially malignant disorders (PMDs), the most common being oral leukoplakia. A conservative management protocol is followed for milder dysplastic cases, while severe dysplastic lesions are surgically excised. Several classification systems have been developed based mainly on histopathological features with a lot of inter-observer variations. The present study was done to assess the use of immunohistochemical (IHC) markers in grading leukoplakic lesions in addition to histopathological grading. Aims and Objectives To grade leukoplakia using different grading systems and assess if IHC markers can aid in categorizing leukoplakia. Materials and Methods Thirty-five cases of leukoplakia were graded using Ljubljana, 2005 World Health Organization (WHO), and Binary System followed by IHC staining with p63 and CD31. Results and Statistics Variation was noted in 12 cases while using WHO, 11 using Ljubljana, and 7 using Binary System and was significant on Cohen-Kappa statistics, with the least significant variation noted on Binary System. p63 staining assisted to group doubtful cases and even identify variation in cases graded positively on histopathology. In total, 17 cases stained one-third (mild/low), while 15 cases stained one-half or more (higher grade) epithelial thickness. A weak correlation was observed between all grading systems and p63 on Kendall's Tau-b analysis and the weak correlation was significant for the WHO and binary grading systems. Analyzing p63 and CD31 using Kruskal-Wallis test, an increase in mean vessel density (MVD) was noted for mild/moderate cases but decreased for severe cases. Conclusion Addressing histological categorization of PMDs assisted by IHC markers to understand the biological behavior of the tissues is currently essential with studies on more markers to assist in the management protocol.
Collapse
Affiliation(s)
- Radhika Manoj Bavle
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - K Paremala
- Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Reshma Venugopal
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - Amulya S Rudramuni
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - Nawal Khan
- Sher-i-Kashmir Institute of Medical Sciences, Community Medicine (Dental Unit), Srinagar, Jammu and Kashmir, India
| | - Sreenitha S Hosthor
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| |
Collapse
|
86
|
Pritzker KPH, Darling MR, Hwang JTK, Mock D. Oral Potentially Malignant Disorders (OPMD): What is the clinical utility of dysplasia grade? Expert Rev Mol Diagn 2021; 21:289-298. [PMID: 33682567 DOI: 10.1080/14737159.2021.1898949] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Oral epithelial dysplasia is considered a potential histologic precursor of subsequent squamous cell cancer. As standard clinical practice, pathologists grade dysplasia to assess risk for progression to malignancy. Except for the most advanced grade, severe dysplasia, dysplasia grading has failed to correlate well with the risk to develop invasive cancer. The questions of what process dysplasia grading best represents and what clinical utility dysplasia grading may have are explored. AREAS COVERED This narrative review is based on PubMed search with emphasis on papers since 2010. Epithelial dysplasia as a precursor lesion of cancer and dysplasia grading as a risk assessment tool for progression to cancer are discussed. The close clinical association of dysplasia with known carcinogens, alcohol, and tobacco products is presented. EXPERT OPINION Oral epithelial dysplasia is often, associated with prolonged exposure to tobacco and alcohol products. With reduction of carcinogen exposure, dysplasia is known to regress in some cases. It is proposed that histologic dysplasia grade together with macroscopic images of dysplastic clinical lesions be used as an educational tool to incentivize patients to reduce their known carcinogen exposure. This strategy has the potential to reduce lesion progression thereby reducing the disease burden of oral cancer.
Collapse
Affiliation(s)
- Kenneth P H Pritzker
- Professor Emeritus, Laboratory Medicine and Pathobiology; Surgery University of Toronto, Toronto, Ontario, Canada.,Proteocyte Diagnostics Inc., Toronto, Canada.,Department of Pathology and Laboratory Medicine, Pathology & Laboratory Medicine Mount Sinai Hospital, Toronto, Canada
| | - Mark R Darling
- Professor, Department of Pathology and Laboratory Medicine, Schulich Faculty of Medicine and Dentistry, Western University London Ontario, Canada
| | | | - David Mock
- Department of Pathology and Laboratory Medicine, Pathology & Laboratory Medicine Mount Sinai Hospital, Toronto, Canada.,Professor, Pathology/Oral Medicine & Dean Emeritus, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Department of Dentistry, Dentistry Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
87
|
Aguirre-Urizar JM, Lafuente-Ibáñez de Mendoza I, Warnakulasuriya S. Malignant transformation of oral leukoplakia: Systematic review and meta-analysis of the last 5 years. Oral Dis 2021; 27:1881-1895. [PMID: 33606345 DOI: 10.1111/odi.13810] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oral leukoplakia (OL) is the most frequently encountered oral potentially malignant disorder. The aims of this systematic review are to estimate the overall malignant transformation of OL and to assess the risk factors associated with malignant transformation of OL published in the last 5 years (2015-2020). MATERIALS AND METHODS We performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and Cochrane databases with keywords "oral leukoplakia", "oral cancer", "oral carcinoma" and "oral squamous cell carcinoma". Meta-analysis was conducted using a random-effects model. RESULTS Twenty-four studies were selected, that reported a total of 16,604 patients. Malignant transformation proportion varied between 1.1% and 40.8%. Female gender, non-homogeneous clinical type, and presence of epithelial dysplasia were significantly related to MT. Other risk factors previously suggested did not show significant results. CONCLUSIONS The pooled proportion of malignant transformation MT was 9.8% (95% CI: 7.9-11.7). It is necessary to continue to conduct well-designed prospective clinicopathological studies on OL, using a uniform definition for OL to reduce the risk of bias for evaluating various factors associated with the MT.
Collapse
Affiliation(s)
- José M Aguirre-Urizar
- Oral and Maxillofacial Medicine & Pathology Unit, Department of Stomatology II, Faculty of Medicine and Nursery, University of the Basque Country/EHU, Lejona, Spain
| | - Irene Lafuente-Ibáñez de Mendoza
- Oral and Maxillofacial Medicine & Pathology Unit, Department of Stomatology II, Faculty of Medicine and Nursery, University of the Basque Country/EHU, Lejona, Spain
| | - Saman Warnakulasuriya
- Faculty of Dental, Oral & Craniofacial Sciences, King's College London and WHO Collaborating Centre for Oral Cancer, London, UK
| |
Collapse
|
88
|
Solomon J, Hinther A, Matthews TW, Nakoneshny SC, Hart R, Dort JC, Chandarana SP. The impact of close surgical margins on recurrence in oral squamous cell carcinoma. J Otolaryngol Head Neck Surg 2021; 50:9. [PMID: 33579388 PMCID: PMC7881652 DOI: 10.1186/s40463-020-00483-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Close margins influence treatment and outcome in patients with oral squamous cell carcinoma (OSCC). This study evaluates 187 cases of surgically treated OSCC regarding the impact of close margins on recurrence-free survival (RFS) and disease-specific survival (DSS). METHODS Predictors of worsened outcome were identified using Kaplan-Meier analysis and multivariate Cox regression analysis. RESULTS Tumour size [HR:1.70(0.95-3.08)], nodal status [HR:2.15(1.00-4.64)], presence of extracapsular spread (ECS) [HR:6.36(2.41-16.74)] and smoking history [HR:2.87(1.19-6.86)] were associated with worsened RFS. Similar factors were associated with worsened DSS. Close margins did not influence RFS or DSS. CONCLUSIONS While most conventional risk factors for OSCC conferred a worsened outcome, close margins did not. One explanation for this would be that close margins (< 5 mm) are equivalent to clear margins and the cutoff definition for a close margin should be re-evaluated. Lack of standardized pathology could also reduce accuracy of reporting of close surgical margins.
Collapse
Affiliation(s)
- Joseph Solomon
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ashley Hinther
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - T Wayne Matthews
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Calgary, Canada
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rob Hart
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Calgary, Canada
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joseph C Dort
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Calgary, Canada
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shamir P Chandarana
- Department of Surgery, Section of Otolaryngology - Head & Neck Surgery, Calgary, Canada.
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Foothills Medical Centre, North Tower Rm 1012, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| |
Collapse
|
89
|
Endogenous APOBEC3B overexpression characterizes HPV-positive and HPV-negative oral epithelial dysplasias and head and neck cancers. Mod Pathol 2021; 34:280-290. [PMID: 32632179 PMCID: PMC8261524 DOI: 10.1038/s41379-020-0617-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
The DNA cytosine deaminase APOBEC3B (A3B) is a newly recognized endogenous source of mutations in a range of human tumors, including head/neck cancer. A3B inflicts C-to-T and C-to-G base substitutions in 5'-TCA/T trinucleotide motifs, contributes to accelerated rates of tumor development, and affects clinical outcomes in a variety of cancer types. High-risk human papillomavirus (HPV) infection causes A3B overexpression, and HPV-positive cervical and head/neck cancers are among tumor types with the highest degree of APOBEC signature mutations. A3B overexpression in HPV-positive tumor types is caused by the viral E6/E7 oncoproteins and may be an early off-to-on switch in tumorigenesis. In comparison, less is known about the molecular mechanisms responsible for A3B overexpression in HPV-negative head/neck cancers. Here, we utilize an immunohistochemical approach to determine whether A3B is turned from off-to-on or if it undergoes a more gradual transition to overexpression in HPV-negative head/neck cancers. As positive controls, almost all HPV-positive oral epithelial dysplasias and oropharyngeal cancers showed high levels of nuclear A3B staining regardless of diagnosis. As negative controls, A3B levels were low in phenotypically normal epithelium adjacent to cancer and oral epithelial hyperplasias. Interestingly, HPV-negative and low-grade oral epithelial dysplasias showed intermediate A3B levels, while high-grade oral dysplasias showed high A3B levels similar to oral squamous cell carcinomas. A3B levels were highest in grade 2 and grade 3 oral squamous cell carcinomas. In addition, a strong positive association was found between nuclear A3B and Ki67 scores suggesting a linkage to the cell cycle. Overall, these results support a model in which gradual activation of A3B expression occurs during HPV-negative tumor development and suggest that A3B overexpression may provide a marker for advanced grade oral dysplasia and cancer.
Collapse
|
90
|
Kujan O, Idrees M, Anand N, Soh B, Wong E, Farah CS. Efficacy of oral brush cytology cell block immunocytochemistry in the diagnosis of oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med 2021; 50:451-458. [PMID: 33368584 DOI: 10.1111/jop.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell block immunocytochemistry in the diagnosis of oral leukoplakia as minimally invasive diagnostic adjuncts. METHODS Seventy-two patients diagnosed clinically with either oral leukoplakia (OLK) or oral squamous cell carcinoma were included. Oral brush samples using Orcellex® brushes were obtained from all participants directly before undergoing surgical biopsy. Cell blocks were prepared for all samples and assessed for cytomorphology and immunocytochemistry of DNA mismatch repair proteins (MSH-6, MSH-2, MLH-1 and PMS-2). A combined index score of immunocytochemistry expression and cytology grading was compared against the gold standard (histopathological diagnosis). RESULTS A significant association was observed between the cytological assessments of oral liquid-based brush cytology samples and the histopathological diagnosis (P < .005). In addition, there was a significant inverse correlation between the grade of oral epithelial dysplasia and the cumulative score of the studied DNA mismatch repair proteins (P < .005). Grading criteria for both oral liquid-based brush cytology and immunocytochemistry cumulative index scores are proposed based on the analysis of receiver operating characteristic curve coordinates. The diagnostic accuracy of this approach was outstanding in terms of discrimination between the presence or absence of oral epithelial dysplasia (0.961) and squamous cell carcinoma (0.977) separately. CONCLUSION Oral liquid-based brush cytology cell block immunocytochemistry provides a reliable strategy to investigate oral mucosal epithelial disorders. This approach presents a minimally invasive, highly accurate and non-technically demanding method for the surveillance of oral potentially malignant disorders and squamous cell carcinoma.
Collapse
Affiliation(s)
- Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Neeraj Anand
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Brandon Soh
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Elton Wong
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia.,Head and Neck Pathology, Australian Clinical Labs, Subiaco, WA, Australia
| |
Collapse
|
91
|
Verza FA, Valente VB, Oliveira LK, Kayahara GM, Crivelini MM, Furuse C, Biasoli ÉR, Miyahara GI, Oliveira SHP, Bernabé DG. Social isolation stress facilitates chemically induced oral carcinogenesis. PLoS One 2021; 16:e0245190. [PMID: 33411841 PMCID: PMC7790246 DOI: 10.1371/journal.pone.0245190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/25/2020] [Indexed: 02/05/2023] Open
Abstract
Social isolation has affected a large number of people and may lead to impairment of physical and mental health. Although stress resulting from social isolation may increase cancer progression, its interference on tumorigenesis is poorly known. In this study, we used a preclinical model to evaluate the effects of social isolation stress on chemically induced oral carcinogenesis. Sixty-two 21-day-old male Wistar rats were divided into isolated and grouped groups. After 90 days of age, the rats from both groups underwent oral carcinogenesis with 4-nitroquinoline 1-oxide (4NQO) for 20 weeks. All rats were assessed for depressive-like behavior and euthanized for oral squamous cell carcinoma (OSCC) diagnosis and measurement of inflammatory mediators in the tumor microenvironment. Social isolation stress increased the OSCC occurrence by 20.4% when compared to control. Isolated rats also showed higher tumor volume and cachexia than the grouped rats. Social isolation did not induce changes in the depressive-like behavior after carcinogenic induction. Tumors from stressed rats had increased levels of the inflammatory mediators, TNF-alpha, IL1-beta and MCP-1. The concentrations of TNF-alpha and MCP-1 were significantly increased in the large tumors from isolated animals. Higher tumor levels of TNF-alpha, IL-6, IL1-beta and MCP-1 were positively correlated with OSCC growth. This study provides the first evidence that social isolation stress may facilitate OSCC occurrence and tumor progression, an event accompanied by increased local levels of inflammatory mediators.
Collapse
Affiliation(s)
- Flávia Alves Verza
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Vitor Bonetti Valente
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Lia Kobayashi Oliveira
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Giseli Mitsuy Kayahara
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Marcelo Macedo Crivelini
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Cristiane Furuse
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Éder Ricardo Biasoli
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Glauco Issamu Miyahara
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Sandra Helena Penha Oliveira
- Department of Basic Sciences, Laboratory of Immunopharmacology, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Daniel Galera Bernabé
- Laboratory of Psychoneuroimmunology, Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
92
|
de Castro Abrantes T, Fonsêca TC, Cabral MG, Agostini M, Benevenuto de Andrade BA, Romañach MJ, Abrahão AC. Epithelial Dysplasia in Actinic Cheilitis: Microscopic Study of 70 Cases from Brazil. Head Neck Pathol 2020; 15:566-571. [PMID: 33372240 PMCID: PMC8134645 DOI: 10.1007/s12105-020-01250-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
To compare two grading systems of epithelial dysplasia-World Health Organization (WHO) and binary system (BS) -in actinic cheilitis (AC). Seventy cases diagnosed as AC in an Oral Pathology Laboratory from Brazil in the last 12 years were retrospectively retrieved, including the demographic data of each patient. All conventionally stained slides were reviewed, and epithelial dysplasia was evaluated by two independent observers using both WHO and BS grading systems. Data correlation was performed using kappa and chi-square tests (p < 0.05). Most patients were white men with a mean age of 57 years old and history of chronic exposure to sunlight. Most of the lesions were clinically described as whitish plaques with irregular surface located in the lower lip semi-mucosa. Most cases were microscopically graded as severe epithelial dysplasia and low-risk by both observers. The interobserver and intraobserver agreement between systems was slight. All reddish lesions were graded as severe epithelial dysplasia, showing an equal distribution between low and high-risk grading. Most ulcerated lesions showed severe epithelial dysplasia but was graded as low-risk of malignant transformation. Statistical significance was observed among the presence of "irregular stratification", severe epithelial dysplasia and high-risk lesions (p < 0.05) likewise among the presence of "loss of polarity of basal cells" and "drop-shaped ridges" (p < 0.05) with high-risk lesions. The absence of "increased mitotic figures", "dyskeratosis" and "keratin pearls" (p < 0.05) were strongly correlated to low-risk lesions. The presence of "hyperchromasia" was statistically significant with severe epithelial dysplasia (p < 0.05) as well the absence of "atypical mitotic figures" with low-risk lesions (p < 0.05). Although there was slight agreement between microscopic grading systems, microscopic analysis indicated that architectural epithelial changes individually may be the more reliable criteria to indicate the risk of malignant transformation in AC in both grading systems.
Collapse
Affiliation(s)
- Thamiris de Castro Abrantes
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Thamyres Campos Fonsêca
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Márcia Grillo Cabral
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho 373, Prédio do CCS, Bloco K, 2° andar, Sala 56. Ilha da Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil.
| |
Collapse
|
93
|
Chitturi Suryaprakash RT, Kujan O, Shearston K, Farah CS. Three-Dimensional Cell Culture Models to Investigate Oral Carcinogenesis: A Scoping Review. Int J Mol Sci 2020; 21:E9520. [PMID: 33327663 PMCID: PMC7765087 DOI: 10.3390/ijms21249520] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2023] Open
Abstract
Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultures, are more physiologically representative of the human tumor microenvironment (TME) than traditional two-dimensional (2-D) cell culture models. They have been used as in vitro models to investigate various aspects of oral cancer but, to date, have not be widely used in investigations of the process of oral carcinogenesis. The aim of this scoping review was to evaluate the use of 3-D cell cultures in oral squamous cell carcinoma (OSCC) research, with a particular emphasis on oral carcinogenesis studies. Databases (PubMed, Scopus, and Web of Science) were systematically searched to identify research applying 3-D cell culture techniques to cells from normal, dysplastic, and malignant oral mucosae. A total of 119 studies were included for qualitative analysis including 53 studies utilizing spheroids, 62 utilizing organotypic cultures, and 4 using organoids. We found that 3-D oral carcinogenesis studies had been limited to just two organotypic culture models and that to date, spheroids and organoids had not been utilized for this purpose. Spheroid culture was most frequently used as a tumorosphere forming assay and the organoids cultured from human OSCCs most often used in drug sensitivity testing. These results indicate that there are significant opportunities to utilize 3-D cell culture to explore the development of oral cancer, particularly as the physiological relevance of these models continues to improve.
Collapse
Affiliation(s)
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia; (R.T.C.S.); (K.S.)
| | - Kate Shearston
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia; (R.T.C.S.); (K.S.)
| | - Camile S. Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA 6009, Australia;
- Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
- Head & Neck Pathology, Australian Clinical Labs, Subiaco, WA 6008, Australia
| |
Collapse
|
94
|
Non-Invasive Diagnostic System Based on Light for Detecting Early-Stage Oral Cancer and High-Risk Precancerous Lesions-Potential for Dentistry. Cancers (Basel) 2020; 12:cancers12113185. [PMID: 33138188 PMCID: PMC7692288 DOI: 10.3390/cancers12113185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The early detection of oral cancer and oral potentially malignant disorders can facilitate minimum intervention and subsequent improvements in prognosis and quality of life after treatment. Recently, several non-invasive adjunctive fluorescence-based detection systems have improved the accuracy of detection and diagnosis of oral cancer and oral potentially malignant disorders. This article summarizes current knowledge about fluorescence-based diagnostic methods and discusses their benefits and drawbacks from a clinical viewpoint. Abstract Oral health promotion and examinations have contributed to the early detection of oral cancer and oral potentially malignant disorders, leading to the adaptation of minimally invasive therapies and subsequent improvements in the prognosis/maintenance of the quality of life after treatments. However, the accurate detection of early-stage oral cancer and oral epithelial dysplasia is particularly difficult for conventional oral examinations because these lesions sometimes resemble benign lesions or healthy oral mucosa tissues. Although oral biopsy has been considered the gold standard for accurate diagnosis, it is deemed invasive for patients. For this reason, most clinicians are looking forward to the development of non-invasive diagnostic technologies to detect and distinguish between cancerous and benign lesions. To date, several non-invasive adjunctive fluorescence-based detection systems have improved the accuracy of the detection and diagnosis of oral mucosal lesions. Autofluorescence-based systems can detect lesions as a loss of autofluorescence through irradiation with blue-violet lights. Photodynamic diagnosis using 5-aminolevulinic acid (ALA-PDD) shows the presence of very early oral cancers and oral epithelial dysplasia as a red fluorescent area. In this article, currently used fluorescence-based diagnostic methods are introduced and discussed from a clinical point of view.
Collapse
|
95
|
Raut T, Keshwar S, Rimal J, Lamsal M, Shrestha A. Biochemical status of serum iron in histopathological grades of oral submucous fibrosis. J Oral Biol Craniofac Res 2020; 10:753-757. [PMID: 33117643 DOI: 10.1016/j.jobcr.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022] Open
Abstract
Background Oral submucous fibrosis is a multifactorial, chronic disease of oral mucosa characterized by mucosal atrophy and fibrosis leading to functional morbidity; amongst many iron deficiency is considered as one of the risk factor. Also the iron level is considered to be depleted due to increased utilization during collagen synthesis. This study was conducted to evaluate the level of iron in patients with fibrosis and correlate with different histopathological grades. Methods A total of 40 clinically diagnosed and histopathologically confirmed cases of submucous fibrosis were considered. Clinical data were recorded and status of iron was estimated through serum iron and total iron binding capacity by ferrozine method using a digital auto-analyzer. The level of iron was correlated with the histopathological grades and epithelial dysplasia. Result The mean age of patients was 37.07 ± 14.63 years with the male to female ratio of 6.5:1. Areca nut consumption was associated with all the cases among which 87.5% of cases were exposed to commercial forms. 37.5% of cases were in early grade whereas 60% in moderately advanced histopathological grade. The level of mean serum iron and total iron binding capacity was higher in moderately advanced than in early grade. However no statistically significant difference was observed within the histopathological grades. Conclusion Iron is influenced by many factors like dietary intake, food habits, metabolic reactions, chronic diseases, etc. Serum iron is reduced in patients with oral submucous fibrosis which should be supplemented to impede the carcinogenic potential and improve the treatment outcome.
Collapse
Affiliation(s)
- Toniya Raut
- Department of Oral Pathology, BP Koirala Institute of Health Sciences, Nepal
| | - Shashi Keshwar
- Department of Oral Pathology, BP Koirala Institute of Health Sciences, Nepal
| | - Jyotsna Rimal
- Department of Oral Medicine and Radiology, BP Koirala Institute of Health Sciences, Nepal
| | - Madhab Lamsal
- Department of Biochemistry, BP Koirala Institute of Health Sciences, Nepal
| | - Ashish Shrestha
- Department of Oral Pathology, College of Dental Surgery, BP Koirala Institute of Health Sciences, Nepal
| |
Collapse
|
96
|
Evren I, Brouns ER, Wils LJ, Poell JB, Peeters CFW, Brakenhoff RH, Bloemena E, de Visscher JGAM. Annual malignant transformation rate of oral leukoplakia remains consistent: A long-term follow-up study. Oral Oncol 2020; 110:105014. [PMID: 33038723 DOI: 10.1016/j.oraloncology.2020.105014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Numerous clinical and histopathological characteristics have been associated with malignant transformation (MT) of oral leukoplakia (OL), including classic and differentiated epithelial dysplasia, but MT predictions remain suboptimal. The objective of this study was to determine the annual MT rate of OL and to identify clinicopathological risk factors associated with MT. PATIENTS AND METHODS 170 patients with OL were included in this retrospective cohort study, 117 females and 53 males. Follow-up ranged from 12 to 219 months (median 54). The analyzed variables included age, gender, smoking habits, clinical presentation, subsite, size and treatment. In a subgroup of 140 patients, histopathological diagnoses were reviewed with regard to the presence of dysplasia, discerning both classic dysplasia and differentiated dysplasia. RESULTS MT occurred in 23% of the patients, resulting in an annual MT rate of 4.9% (95% CI: 3.5 - 6.6) which remained consistent. High-risk subsite (tongue and floor of mouth) was the only clinical predictor for MT (Hazard Ratio = 2.7, 95% CI: 1.3 - 5.5, p = 0.007). In 140 patients, classic dysplasia (Hazard Ratio = 7.2, 95% CI: 1.6 - 33.1, p = 0.012) and differentiated dysplasia (Hazard Ratio = 6.6, 95% CI: 1.2 - 25.4, p = 0.026) were predictors for MT. Binary grading between dysplasia and no dysplasia was significant for predicting MT (Hazard Ratio = 6.4, 95% CI: 1.5 - 27.5, p = 0.013). CONCLUSION Since annual MT rate of OL remains stable during follow-up, regular long-term or even life-long follow-up is advocated. Specific oral subsites and epithelial dysplasia are predictors for MT of OL.
Collapse
Affiliation(s)
- Ilkay Evren
- Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Elisabeth R Brouns
- Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Leon J Wils
- Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Jos B Poell
- Amsterdam UMC, location VUmc, Department of Otolaryngology / Head & Neck Surgery, Cancer Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Carel F W Peeters
- Amsterdam UMC, location VUmc, Department of Epidemiology & Data Science, Amsterdam Public Health research institute, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Ruud H Brakenhoff
- Amsterdam UMC, location VUmc, Department of Otolaryngology / Head & Neck Surgery, Cancer Center Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Elisabeth Bloemena
- Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Amsterdam UMC, location VUmc, Department of Pathology, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Jan G A M de Visscher
- Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery / Oral Pathology, Cancer Center Amsterdam, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| |
Collapse
|
97
|
Gupta S, Jawanda MK, Madhushankari GS. Current challenges and the diagnostic pitfalls in the grading of epithelial dysplasia in oral potentially malignant disorders: A review. J Oral Biol Craniofac Res 2020; 10:788-799. [PMID: 33194541 DOI: 10.1016/j.jobcr.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
Oral cancer is one of the common cancers in the world causing high morbidity. Development of cancer is preceded by certain asymptomatic clinical lesions and conditions all together known as 'oral potentially malignant disorders'. Histologically they are represented by the term 'oral epithelial dysplasia'. The degree of severity of dysplasia is determined in the form of 'grade'. Despite the existence of several grading systems proposed by various scholars, it is still a challenging task for the Pathologists to grade dysplasia accurately for the proper diagnosis of the disease and to follow preferable treatment plans. This review aims to focus on the current challenges and the diagnostic pitfalls in the grading of oral epithelial dysplasia in various oral potentially malignant disorders.
Collapse
Key Words
- CIN, Cervical Intraepithelial Neoplasia
- CIS, Carcinoma in situ
- Challenge
- EAI, Epithelial atypia index
- ED, Epithelial dysplasia
- ELP, Erythroleukoplakia
- EP, Erythroplakia
- Epithelial dysplasia
- Grade
- HPV, Human Papilloma Virus
- JSOP, Japanese Society for Oral Pathology
- LP, Leukoplakia
- N:C, Nuclear cytoplasmic ratio
- OED, Oral epithelial dysplasia
- OIN, Oral intraepithelial neoplasia
- OLP, Oral lichen planus
- OPMDs, Oral potentially malignant disorders
- OSCC, Oral squamous cell carcinoma
- OSMF, Oral submucous fibrosis
- Oral
- Potentially malignant
- SIL, Squamous intraepithelial lesions
- SIN, Squamous intraepithelial neoplasia
- WHO, World health organization
Collapse
Affiliation(s)
- Sonia Gupta
- Dept. of Oral & Maxillofacial Pathology and Microbiology, Rayat Bahra Dental College and Hospital, Mohali, Punjab, India
| | - Manveen Kaur Jawanda
- Dept. of Oral & Maxillofacial Pathology and Microbiology, Luxmibai institute of dental sciences and hospital, Patiala, Punjab, India
| | - G S Madhushankari
- Dept. of Oral & Maxillofacial Pathology and Microbiology, College of dental sciences, Davangere, Karnatka, India
| |
Collapse
|
98
|
Li CC, Almazrooa S, Carvo I, Salcines A, Woo SB. Architectural Alterations in Oral Epithelial Dysplasia are Similar in Unifocal and Proliferative Leukoplakia. Head Neck Pathol 2020; 15:443-460. [PMID: 32939744 PMCID: PMC8134567 DOI: 10.1007/s12105-020-01216-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
The current WHO histopathologic criteria for oral epithelial dysplasia (ED) are based on architectural and cytologic alterations, and do not address other histopathologic features of ED. Here we propose new diagnostic criteria including architectural, organizational, and cytologic features for oral ED. Cases of unifocal leukoplakia (UL) and proliferative leukoplakia (PL) with clinical photographs and follow-up information were identified. Only cases that showed minimal cytologic atypia or mild ED were used to demonstrate critical architectural changes as defined in this study. Eight biopsies from eight UL patients and 34 biopsies from four PL patients were included. The biopsies showed (a) corrugated, verrucous or papillary architecture, (b) hyperkeratosis with epithelial atrophy, (c) bulky squamous epithelial proliferation, and (d) demarcated hyperkeratosis and "skip" segments. The architectural alterations defined here are as important as the currently used criteria for the diagnosis of ED. Clinicopathologic correlation when diagnosing oral ED is also of the utmost importance in accurate diagnosis.
Collapse
Affiliation(s)
- Chia-Cheng Li
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA USA
| | - Soulafa Almazrooa
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ingrid Carvo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA USA
| | - Alfonso Salcines
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA USA ,Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA USA ,Center for Oral Pathology, StrataDx Inc, Lexington, MA USA
| |
Collapse
|
99
|
Cubuk S, Uckan S, Ozdemir H, Taslica ZF, Bacanli D. The efficiency of propranolol on occurrence and development of 4-nitroquinoline 1-oxide-induced squamous cell carcinoma of the tongue in rats. J Oral Maxillofac Pathol 2020; 24:400. [PMID: 33456259 PMCID: PMC7802876 DOI: 10.4103/jomfp.jomfp_88_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Aims: The aim of this study to investigate the efficiency of propranolol on occurrence and development of 4-nitroquinoline 1-oxide (4NQO)-induced squamous cell carcinogenesis of the tongue in rats. Subjects and Methods: The sample was composed of 27 male Sprague Dawley rats that received 50 ppm 4NQO for 20 weeks in drinking water. Group 1 (n = 9) was treated with 50 mg/kg/day propranolol for 20 weeks, Group 2 (n = 9), after carcinogenesis inducement for 20 weeks, received propranolol (50 mg/kg/day) for 2 weeks and Group 3 (n = 9) received no treatment. At the end of the experimental stage, the tongue specimens were evaluated under a light microscope and categorized as low- or high-risk lesions according to a binary system. Statistical Analysis Used: The statistical comparison was performed with a likelihood ratio test. Results: Histopathological analysis revealed the risk of malignant transformation rates as 33.3% in Group 1, 55.5% in Group 2 and 77.8% in Group 3; however, the difference between the groups was not statistically significant (P > 0.05). Conclusion: The results of the study suggest that propranolol has a tendency to preventive effect against carcinogenesis.
Collapse
Affiliation(s)
- Secil Cubuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, İstanbul, Turkey
| | - Sina Uckan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Medipol University, İstanbul, Turkey
| | - Handan Ozdemir
- Department of Pathology, Faculty of Medicine, Başkent University, İstanbul, Turkey
| | - Zeynep Firdevs Taslica
- Pathology Laboratory, Council of Forensic Medicine, Ankara Group Chairmanship, İstanbul, Turkey
| | - Didem Bacanli
- Animal Research Center, Başkent University, İstanbul, Turkey
| |
Collapse
|
100
|
Tiwari L, Kujan O, Farah CS. Clinico-pathological correlation of optical fluorescence imaging in oral mucosal lesions. Oral Dis 2020; 26:1230-1239. [PMID: 32198955 DOI: 10.1111/odi.13334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/22/2020] [Accepted: 03/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to identify clinical and pathological characteristics of oral mucosal lesions that may be predictive of optical autofluorescence imaging patterns. METHODS Clinical data and archival histopathological material were collected from patients who presented with at least one oral mucosal lesion and underwent assessment via conventional oral examination, optical autofluorescence imaging and histopathological analysis. An open-source digital pathology image analysis software was used to perform histomorphometric measurements. Classification and regression trees were used to determine histopathological characteristics most predictive of a clinical autofluorescence outcome. RESULTS Histomorphometric features associated with tissue architecture, epithelial changes, inflammation and vasculature were found to be significantly associated with autofluorescence patterns. Diascopic fluorescence was found to be significantly predicted by lichenoid inflammation and was significantly associated with a diagnosis of oral lichen planus. Loss of autofluorescence with partial blanching was significantly associated with histopathological features noted in dysplastic and malignant lesions. CONCLUSIONS This study provides evidence for the use of diascopic fluorescence as a technique to aid in clinical differentiation of benign inflammatory lesions from potentially malignant pathology. Based on the findings of this study, optical fluorescence imaging is a technique of added value in discernment of oral mucosal lesions, and our results support its clinical use.
Collapse
Affiliation(s)
- Lalima Tiwari
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| | - Omar Kujan
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia
- Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| |
Collapse
|