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Abstract
Oral potentially malignant disorders (OPMDs) refer to epithelial lesions and conditions with an increased risk for malignant transformation; oral leukoplakia is the most commonly encountered. Overall, OPMDs have a low risk for malignant transformation, yet the challenge is the difficulty to reliably identify and predict which patients with OPMDs are at the highest risk for malignant transformation. Future research is needed to elucidate the molecular aspects of OPMDs, to improve current diagnostic strategies, leading to personalized management.
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52
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Baeten J, Johnson A, Sunny S, Suresh A, Birur P, Uma K, Kademani D. Chairside molecular imaging of aberrant glycosylation in subjects with suspicious oral lesions using fluorescently labeled wheat germ agglutinin. Head Neck 2017; 40:292-301. [PMID: 28963821 DOI: 10.1002/hed.24943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/22/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aberrant sialylation is accepted as a carcinogenic biomarker. In previous work, fluorescently labeled wheat germ agglutinin (WGA) distinguished between cancerous and normal oral biopsies. The purpose of this study was to investigate WGA-fluorescein isothiocyanate (FITC) as a point-of-care tool for detecting oral malignant and dysplastic lesions in vivo. METHODS Subject recruitment was divided into two groups: (1) the clinically normal oral mucosa group; or (2) the presence of clinically suspicious oral lesion(s) group. A WGA-FITC solution was topically applied to observable lesions or to half the subject's mouth (sagittal plane) if lesions were absent. Fluorescent molecular imaging was used to evaluate WGA-FITC localization. RESULTS Fluorescent imaging in 55 subjects demonstrated that WGA-FITC could detect histopathologically-confirmed cancerous and dysplastic lesions with high sensitivity (100% and 81%, respectively) and specificity (82%). CONCLUSION This study supports in vivo fluorescent molecular imaging of WGA-FITC to visualize aberrant sialic acid expression associated with carcinogenesis. This technique resulted in the immediate chairside detection of oral cancerous and dysplastic lesions.
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Affiliation(s)
| | | | - Sumsum Sunny
- Mazumdar Shaw Cancer Center, Narayana Health City, Bangalore, Karnataka, India.,Mazumdar Shaw Center for Translational Research, Bangalore, Karnataka, India
| | - Amritha Suresh
- Mazumdar Shaw Cancer Center, Narayana Health City, Bangalore, Karnataka, India.,Mazumdar Shaw Center for Translational Research, Bangalore, Karnataka, India.,Roswell Park Cancer Institute, Buffalo, New York
| | - Praveen Birur
- KLES Dental College, Department of Oral Medicine, Bangalore, Karnataka, India
| | - K Uma
- KLES Dental College, Department of Oral Pathology, Bangalore, Karnataka, India
| | - Deepak Kademani
- University of Minnesota, Minneapolis, Minnesota.,North Memorial Oral and Maxillofacial Surgery, Minneapolis, Minnesota
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53
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Li B, Gu ZY, Yan KX, Wen ZN, Zhao ZH, Li LJ, Li Y. Evaluating oral epithelial dysplasia classification system by near-infrared Raman spectroscopy. Oncotarget 2017; 8:76257-76265. [PMID: 29100309 PMCID: PMC5652703 DOI: 10.18632/oncotarget.19343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Until now, the classification system of oral epithelial dysplasia is still based on the architectural and cytological changes, which relies on the observation of pathologists and is relatively subjective. The purpose of present research was to discriminate the oral dysplasia by the near-infrared Raman spectroscope, in order to evaluate the classification system. We collected Raman spectra of normal mucosa, oral squamous cell carcinoma (OSCC) and dysplasia by near-infrared Raman spectroscope. The biochemical variations between different stages were analyzed by the characteristic peaks in the subtracted mean spectra. Gaussian radial basis function support vector machines (SVM) were used to establish the diagnostic models. At the same time, principal component analysis (PCA) and linear discriminant analysis (LDA) were used to verify the results of SVM. Raman spectral differences were observed in the range between 730~1913 cm-1. Compared with normal mucosa, high contents of protein and DNA in oral dysplasia and OSCC were observed. There were no significant or gradual variation of Raman peaks among different dysplastic grades. The accuracies of comparison between mild, moderate, severe dysplasia with OSCC were 100%, 44.44%, 71.15%, which elucidated the low modeling ability of support vector machines, especially for the moderate dysplasia. The analysis by PCA-LDA could not discriminate the stages, either. Combined with support vector machines, near-infrared Raman spectroscopy could detect the biochemical variations in oral normal, OSCC and dysplastic tissues, but could not establish diagnostic model accurately. The classification system needs further improvements.
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Affiliation(s)
- Bo Li
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhi-Yu Gu
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Kai-Xiao Yan
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhi-Ning Wen
- College of Chemistry, Sichuan University, Chengdu 610064, China
| | - Zhi-He Zhao
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Long-Jiang Li
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yi Li
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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54
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Aubreville M, Knipfer C, Oetter N, Jaremenko C, Rodner E, Denzler J, Bohr C, Neumann H, Stelzle F, Maier A. Automatic Classification of Cancerous Tissue in Laserendomicroscopy Images of the Oral Cavity using Deep Learning. Sci Rep 2017; 7:11979. [PMID: 28931888 PMCID: PMC5607286 DOI: 10.1038/s41598-017-12320-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/07/2017] [Indexed: 12/15/2022] Open
Abstract
Oral Squamous Cell Carcinoma (OSCC) is a common type of cancer of the oral epithelium. Despite their high impact on mortality, sufficient screening methods for early diagnosis of OSCC often lack accuracy and thus OSCCs are mostly diagnosed at a late stage. Early detection and accurate outline estimation of OSCCs would lead to a better curative outcome and a reduction in recurrence rates after surgical treatment. Confocal Laser Endomicroscopy (CLE) records sub-surface micro-anatomical images for in vivo cell structure analysis. Recent CLE studies showed great prospects for a reliable, real-time ultrastructural imaging of OSCC in situ. We present and evaluate a novel automatic approach for OSCC diagnosis using deep learning technologies on CLE images. The method is compared against textural feature-based machine learning approaches that represent the current state of the art. For this work, CLE image sequences (7894 images) from patients diagnosed with OSCC were obtained from 4 specific locations in the oral cavity, including the OSCC lesion. The present approach is found to outperform the state of the art in CLE image recognition with an area under the curve (AUC) of 0.96 and a mean accuracy of 88.3% (sensitivity 86.6%, specificity 90%).
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Affiliation(s)
- Marc Aubreville
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolai Oetter
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Jaremenko
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Erik Rodner
- Computer Vision Group, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Joachim Denzler
- Computer Vision Group, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helmut Neumann
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,First Department of Internal Medicine, University Hospital Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Florian Stelzle
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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55
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Zhang X, Kim KY, Zheng Z, Bazarsad S, Kim J. Nomogram for risk prediction of malignant transformation in oral leukoplakia patients using combined biomarkers. Oral Oncol 2017; 72:132-139. [PMID: 28797449 DOI: 10.1016/j.oraloncology.2017.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Squamous cell carcinomas (SCC) are the most common malignancies in the oral mucosa; these carcinomas have been preceded by potentially malignant oral disorders (PMODs), mostly oral leukoplakia (OL). No specific biomarker has been widely accepted for predicting the risk of malignant transformation of PMODs. The aim of this study was to develop an accurate prediction model for the malignant transformation of OL using clinical variables and candidate biomarkers. MATERIALS AND METHODS To achieve this goal, 10 candidate biomarkers that had previously been reported as useful molecules were investigated: P53, Ki-67, P16, β-catenin, c-jun, c-met, insulin like growth factor II mRNA-binding protein (IMP-3), cyclooxygenase (COX-2), podoplanin (PDPN) and carbonic anhydrase 9 (CA9). For this study, malignant transformed (n=22, median interval of malignant conversion: 3.3years) and untransformed (n=138) OL specimens with median follow-up period of 11.3years (range: 4.6-23.2years) were immunohistochemically stained. RESULTS Using univariate Cox regression analysis, all biomarkers were proven to be significant for predicting malignant transformation in OL. To reach the highest prediction accuracy, the repeated simulation was performed, revealing that the combination of P53 and CA9 with the clinical factors including age and degree of dysplasia achieved the highest prediction accuracy. We constructed a nomogram with the identified prognostic factors for predicting the 5-, 10-, and 15-year progression free survival of OL. CONCLUSIONS The proposed nomogram may be useful for the accurate and individual prediction of the transformation to SCC in OL patients and may help clinicians offer appropriate treatments and follow up.
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Affiliation(s)
- Xianglan Zhang
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, South Korea; Department of Pathology, Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Ki-Yeol Kim
- Brain Korea 21 Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Zhenlong Zheng
- Department of Dermatology, Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Shadavlonjid Bazarsad
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, South Korea; Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jin Kim
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, South Korea; Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea.
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56
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Alaizari NA, Sperandio M, Odell EW, Peruzzo D, Al-Maweri SA. Meta-analysis of the predictive value of DNA aneuploidy in malignant transformation of oral potentially malignant disorders. J Oral Pathol Med 2017; 47:97-103. [PMID: 28612463 DOI: 10.1111/jop.12603] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 01/18/2023]
Abstract
DNA aneuploidy is an imbalance of chromosomal DNA content that has been highlighted as a predictor of biological behavior and risk of malignant transformation. To date, DNA aneuploidy in oral potentially malignant diseases (OPMD) has been shown to correlate strongly with severe dysplasia and high-risk lesions that appeared non-dysplastic can be identified by ploidy analysis. Nevertheless, the prognostic value of DNA aneuploidy in predicting malignant transformation of OPMD remains to be validated. The aim of this meta-analysis was to assess the role of DNA aneuploidy in predicting malignant transformation in OPMD. The questions addressed were (i) Is DNA aneuploidy a useful marker to predict malignant transformation in OPMD? (ii) Is DNA diploidy a useful negative marker of malignant transformation in OPMD? These questions were addressed using the PECO method. Five studies assessing aneuploidy as a risk marker of malignant change were pooled into the meta-analysis. Aneuploidy was found to be associated with a 3.12-fold increased risk to progress into cancer (RR=3.12, 95% CI 1.86-5.24). Based on the five studies meta-analyzed, "no malignant progression" was more likely to occur in DNA diploid OPMD by 82% when compared to aneuploidy (RR=0.18, 95% CI 0.08-0.41). In conclusion, aneuploidy is a useful marker of malignant transformation in OPMD, although a diploid result should be interpreted with caution.
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Affiliation(s)
- Nader A Alaizari
- Department of Oral Medicine and Diagnostic Sciences, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
| | - Marcelo Sperandio
- São Leopoldo Mandic Medical & Dental Institute and Research Center, Campinas, SP, Brazil
| | - Edward W Odell
- Head & Neck/Oral Pathology, King's College London, London, UK
| | - Daiane Peruzzo
- São Leopoldo Mandic Medical & Dental Institute and Research Center, Campinas, SP, Brazil
| | - Sadeq A Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, Faculty of Dentistry, Al-Farabi Colleges, Riyadh, Saudi Arabia
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57
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Biological significance of 5-hydroxymethylcytosine in oral epithelial dysplasia and oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:59-73.e2. [PMID: 28743666 DOI: 10.1016/j.oooo.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/27/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to determine the levels of 5-hydroxylmethylcytosine (5-hmC) in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) compared with those in benign, reactive inflammatory lesions and to explore whether DNA hydroxymethylation may serve as a novel biomarker for early diagnosis and prognosis of OSCC. STUDY DESIGN The study included normal mucosa from uninvolved margins of 9 fibromas, 10 oral lichen planus, 15 OED, and 23 OSCC. Cultured human keratinocyte lines from benign oral mucosa, OED, and OSCC, as well as a murine model in which OSCC was induced with 4-nitroquinoline-1-oxide, were also evaluated. RESULTS Progressive loss of 5-hmC from benign oral mucosal lesions to OED and OSCC was documented in patient samples. Decreased levels in 5-hmC that typify OED and OSCC were also detectable in human cell lines. Moreover, we characterized similar alterations in 5-hmC in an animal model of OED/OSCC. CONCLUSIONS This study demonstrated that 5-hmC distinguishes OED and OSCC from benign lesions with high sensitivity and specificity. Consequently, loss of 5-hmC may be useful for the diagnosis of OED with potential implications for therapy of OSCC.
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58
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Bienk Dias K, Pereira Costa Flores A, Gaiger Oliveira M, Varvaki Rados P, Sant'ana Filho M. Predictive value of p63, ki-67, and survivin expression in oral leukoplakia: A tissue microarray study. Microsc Res Tech 2017; 80:845-850. [PMID: 28346726 DOI: 10.1002/jemt.22872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to analyze the immunohistochemical expression of survivin, ki-67, and p63 in oral leukoplakic lesions, histopathologically differentiated into dysplastic and nondysplastic. A tissue microarray containing 57 samples of biopsies from clinically classified lesions, such as leukoplakia, was immunolabeled for survivin, ki-67, and p63. Samples were scored for percentage of positively stained. Scores were designated as follows: low = less than 25% of positive cells; and high = more than 25% of positive cells. On performing histopathological diagnosis, 20 dysplastic lesions and 37 nondysplastic lesions were seen, in which female patients (56.1%) were predominant with an average age of 58.27 years. The study showed a high expression of 37.5% for survivin, 43.7% for ki-67, and 88.2% for p63 in dysplastic lesions. However, there was a high expression of 16.7% for survivin, 16.7% for ki-67, and 92% for p63 in nondysplastic lesions. There is a positive correlation of expression among the three antibodies. In the association of immunoreactivity, in both dysplastic and nondysplastic lesions, increased expression of survivin reflects on the increased expression of ki-67, and there is an overexpression of p63. In leukoplakia, the expression of survivin associated with that of ki-67 reinforces the assumption that all these lesions are potentially malignant, regardless of histopathology; and the overexpression of p63 may indicate carcinogenic potential. These findings may help in the treatment of patients with this type of lesion.
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Affiliation(s)
- Kelly Bienk Dias
- Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | - Manoel Sant'ana Filho
- Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Brazil
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59
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Krishnan L, Karpagaselvi K, Kumarswamy J, Sudheendra US, Santosh KV, Patil A. Inter- and intra-observer variability in three grading systems for oral epithelial dysplasia. J Oral Maxillofac Pathol 2016; 20:261-8. [PMID: 27601820 PMCID: PMC4989558 DOI: 10.4103/0973-029x.185928] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: Management of oral premalignant lesions depends on clinical assessment and grading of oral epithelial dysplasia (OED), which remains one of the most important predictors of malignant potential. Numerous grading systems for OED exists with varying sets of assessing criteria and are largely considered subjective. The present study attempted to assess the inter- and intra-observer variability in three grading systems: Binary system, WHO (2005) and Ljubljana systems. Methodology: Histopathological grading of 63 cases of leukoplakia was performed by two oral pathologists and one general pathologist, who were blinded, using all the three grading systems at different time intervals and was repeated twice. Inter- and intra-observer variability was then evaluated by multivariate kappa analysis. Results: Inter-observer agreement in the two set of observations was found to be “slight” in WHO (k = 0.001 and 0.039), “slight” and “poor” in binary (k = 0.108 and −0.007), “poor” and “slight” in Ljubljana's (k = −0.027 and 0.106) grading systems. Intra-observer agreement ranged from “slight” to “fair” (k = 0.128 and 0.295) in WHO, “fair” to “moderate” (k = 0.224 and 0.420) in binary and “slight” to “fair” (k = 0.161 and −0.353) in Ljubljana's grading systems. Conclusions: The binary system of classification proved to have an overall better inter- and intra-observer agreement. This study also showed better intra-observer agreement in all the grading systems as well as in individual histopathological parameters. Defining the individual parameters more objectively with the reproducible structuring of the grading systems and training of the pathologists would help reduce the variability in diagnosing dysplasia.
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Affiliation(s)
| | - Karuppiah Karpagaselvi
- Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Center, Bengaluru, India
| | - Jayalakshmi Kumarswamy
- Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Center, Bengaluru, India
| | - U S Sudheendra
- Department of Oral Pathology and Microbiology, Coorg Institute of Dental Sciences, Virajpet, India
| | - K V Santosh
- Department of Pathology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, India
| | - Archana Patil
- Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Center, Bengaluru, India
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60
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Habiba U, Kitamura T, Yanagawa-Matsuda A, Higashino F, Hida K, Totsuka Y, Shindoh M. HuR and podoplanin expression is associated with a high risk of malignant transformation in patients with oral preneoplastic lesions. Oncol Lett 2016; 12:3199-3207. [PMID: 27899983 PMCID: PMC5103919 DOI: 10.3892/ol.2016.5061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/12/2016] [Indexed: 11/22/2022] Open
Abstract
The risk of malignant transformation in oral preneoplastic lesions (OPLs) is challenging to assess. The objective of the present study was to determine the expression of ELAV like RNA binding protein 1 (HuR) and podoplanin in OPLs, and to evaluate the use of each protein as biomarkers for the risk assessment of malignant transformations. Immunohistochemistry for HuR and podoplanin was performed on the tissues of 51 patients with OPL, including cases of low grade dysplasia (LGD) and high grade dysplasia (HGD). The association between the protein expression patterns and clinicopathological parameters, including oral cancer free survival (OCFS) time, was analyzed during the follow-up period. HuR and podoplanin expression was observed in 28 (55%) and 36 (71%) of 51 patients, respectively. Kaplan-Meier analysis showed that the expression of HuR and podoplanin was associated with the risk of progression to oral cancer (P<0.05). Multivariate analysis revealed that HuR and podoplanin expression was associated with a 2.93-fold (95% confidence interval (CI), 0.98–10.34; P=0.055) and 2.06-fold (95% CI, 0.55–8.01; P=0.283) increase in risk of malignant transformation, respectively. The risk of OPL malignant transformation was considerably increased with the coexpression of HuR and podoplanin compared with the histological grading (95% CI, 1.64–23.59; P=0.005). The results of the present study demonstrated that the expression of HuR and podoplanin associates with malignant transformation and suggests that the proteins may be used as biomarkers to identify OPL patients with an increased risk of cancer development.
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Affiliation(s)
- Umma Habiba
- Department of Oral Pathology and Biology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Tetsuya Kitamura
- Department of Oral Pathology and Biology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Aya Yanagawa-Matsuda
- Department of Oral Pathology and Biology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Fumihiro Higashino
- Department of Oral Pathology and Biology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Kyoko Hida
- Department of Vascular Biology, Hokkaido University Institute for Genetic Medicine, Sapporo, Hokkaido 060-0815, Japan
| | - Yasunori Totsuka
- Department of Oral and Maxillofacial Surgery, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
| | - Masanobu Shindoh
- Department of Oral Pathology and Biology, Hokkaido University Graduate School of Dental Medicine, Sapporo, Hokkaido 060-8586, Japan
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61
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Lodi G, Franchini R, Warnakulasuriya S, Varoni EM, Sardella A, Kerr AR, Carrassi A, MacDonald LCI, Worthington HV. Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database Syst Rev 2016; 7:CD001829. [PMID: 27471845 PMCID: PMC6457856 DOI: 10.1002/14651858.cd001829.pub4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral leukoplakia is a relatively common oral lesion that, in a small proportion of people, precedes the development of oral cancer. Most leukoplakias are asymptomatic; therefore, the primary objective of treatment should be to prevent onset of cancer. This review updates our previous review, published in 2006. OBJECTIVES To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 4), MEDLINE Ovid (1946 to 16 May 2016), Embase Ovid (1980 to 16 May 2016) and CancerLit via PubMed (1950 to 16 May 2016). We searched the metaRegister of Controlled Trials (to 10 February 2015), ClinicalTrials.gov (to 16 May 2016) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 16 May 2016). We placed no restrictions on the language or date of publication when searching electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled people with a diagnosis of oral leukoplakia and compared any treatment versus placebo or no treatment. DATA COLLECTION AND ANALYSIS We collected data using a data extraction form. Oral cancer development, demonstrated by histopathological examination, was our primary outcome. Secondary outcomes were clinical resolution of the lesion, improvement of histological features and adverse events. We contacted trial authors for further details when information was unclear. When valid and relevant data were available, we conducted a meta-analysis of the data using a fixed-effect model when we identified fewer than four studies with no heterogeneity. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We assessed risk of bias in studies by using the Cochrane tool. We assessed the overall quality of the evidence by using standardised criteria (Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE)). MAIN RESULTS We included 14 studies (909 participants) in this review. Surgical interventions, including laser therapy and cryotherapy, have never been studied by means of an RCT that included a no treatment or placebo arm. The included trials tested a range of medical and complementary treatments, in particular, vitamin A and retinoids (four studies); beta carotene or carotenoids (three studies); non-steroidal anti-inflammatory drugs (NSAIDs), specifically ketorolac and celecoxib (two studies); herbal extracts (four studies), including tea components, a Chinese herbal mixture and freeze-dried black raspberry gel; bleomycin (one study); and Bowman-Birk inhibitor (one study).We judged one study to be at low risk of bias, seven at unclear risk and six at high risk. In general, we judged the overall quality of the evidence to be low or very low, so findings are uncertain and further research is needed.Five studies recorded cancer incidence, only three of which provided useable data. None of the studies provided evidence that active treatment reduced the risk of oral cancer more than placebo: systemic vitamin A (RR 0.11, 95% CI 0.01 to 2.05; 85 participants, one study); systemic beta carotene (RR 0.71, 95% CI 0.24 to 2.09; 132 participants, two studies); and topical bleomycin (RR 3.00, 95% CI 0.32 to 27.83; 20 participants, one study). Follow-up ranged between two and seven years.Some individual studies suggested effectiveness of some proposed treatments, namely, systemic vitamin A, beta carotene and lycopene, for achieving clinical resolution of lesions more often than placebo. Similarly, single studies found that systemic retinoic acid and lycopene may provide some benefit in terms of improvement in histological features. Some studies also reported a high rate of relapse.Side effects of varying severity were often described; however, it seems likely that interventions were well accepted by participants because drop-out rates were similar between treatment and control groups. AUTHORS' CONCLUSIONS Surgical treatment for oral leukoplakia has not been assessed in an RCT that included a no treatment or placebo comparison. Nor has cessation of risk factors such as smoking been assessed. The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer. Treatments such as vitamin A and beta carotene may be effective in healing oral lesions, but relapses and adverse effects are common. Larger trials of longer duration are required to properly evaluate the effects of leukoplakia treatments on the risk of developing oral cancer. High-quality research is particularly needed to assess surgical treatment and to assess the effects of risk factor cessation in people with leukoplakia.
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Affiliation(s)
- Giovanni Lodi
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Roberto Franchini
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Saman Warnakulasuriya
- King's College LondonClinical and Diagnostic SciencesBessemer RoadDenmark Hill CampusLondonUKSE5 9RW
| | - Elena Maria Varoni
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Andrea Sardella
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Alexander R Kerr
- New York University College of DentistryDepartment of Oral and Maxillofacial Pathology, Radiology and Medicine345 East 24th StreetSchwartz BuildingNew YorkUSA10010
| | - Antonio Carrassi
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - L CI MacDonald
- School of Dentistry, The University of ManchesterCochrane Oral HealthJ R Moore Building, Oxford RoadManchesterUK
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral HealthJ R Moore Building, Oxford RoadManchesterUK
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Pande P, Shrestha S, Park J, Gimenez-Conti I, Brandon J, Applegate BE, Jo JA. Automated analysis of multimodal fluorescence lifetime imaging and optical coherence tomography data for the diagnosis of oral cancer in the hamster cheek pouch model. BIOMEDICAL OPTICS EXPRESS 2016; 7:2000-15. [PMID: 27231638 PMCID: PMC4871098 DOI: 10.1364/boe.7.002000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 05/15/2023]
Abstract
It is known that the progression of oral cancer is accompanied by changes in both tissue biochemistry and morphology. A multimodal imaging approach combining functional and structural imaging modalities could therefore provide a more comprehensive prognosis of oral cancer. This idea forms the central theme of the current study, wherein this premise is examined in the context of a multimodal imaging system that combines fluorescence lifetime imaging (FLIM) and optical coherence tomography (OCT). Towards this end, in the first part of the present study, the diagnostic advantage obtained by using both fluorescence intensity and lifetime information is assessed. In the second part of the study, the diagnostic potential of FLIM-derived biochemical features is compared with that of OCT-derived morphological features. For an objective assessment, several quantitative biochemical and morphological features from FLIM and OCT data, respectively, were obtained using signal and image processing techniques. These features were subsequently used in a statistical classification framework to quantify the diagnostic potential of different features. The classification accuracy for combined FLIM and OCT features was estimated to be 87.4%, which was statistically higher than accuracy based on only FLIM (83.2%) or OCT (81.0%) features. Moreover, the complimentary information provided by FLIM and OCT features, resulted in highest sensitivity and specificity for the combined FLIM and OCT features for discriminating benign (88.2% sens., 92.0% spec.), pre-cancerous (81.5% sens., 96.0% spec.), and cancerous (90.1% sens., 92.0% spec.) classes.
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Affiliation(s)
- Paritosh Pande
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843,
USA
| | - Sebina Shrestha
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843,
USA
| | - Jesung Park
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843,
USA
| | - Irma Gimenez-Conti
- Department of Carcinogenesis, The University of Texas M.D. Anderson Cancer Center, Smithville, Texas 78957,
USA
| | - Jimi Brandon
- Department of Carcinogenesis, The University of Texas M.D. Anderson Cancer Center, Smithville, Texas 78957,
USA
| | - Brian E. Applegate
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843,
USA
| | - Javier A. Jo
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843,
USA
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Viveka TS, Shyamsundar V, Krishnamurthy A, Ramani P, Ramshankar V. p53 Expression Helps Identify High Risk Oral Tongue Pre- malignant Lesions and Correlates with Patterns of Invasive Tumour Front and Tumour Depth in Oral Tongue Squamous Cell Carcinoma Cases. Asian Pac J Cancer Prev 2016; 17:189-95. [PMID: 26838208 DOI: 10.7314/apjcp.2016.17.1.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Oral tongue squamous cell carcinoma (OTSCC) is the most common oral cancer subtype with a maximum propensity for regional spread. Our objective was to study if p53 expression might have any correlation with aggressive patterns of invasion within oral tongue cancers as well as with the histologically identified degree of oral tongue dysplasia. p53 immunoexpression was studied using immunohistochemistry in early staged OTSCCs (n=155), oral tongue dysplasias, (n=29) and oral tongue normal specimens (n=10) and evaluated for correlations with histological and clinicopathological parameters. Our study (n=194) showed a pattern of p53 expression increasing with different grades of tongue dysplasia to different grades of invasive OTSCC (p=0.000). Among the OTSCC tumours, positive p53 expression was seen in 43.2% (67/155) and a higher p53 labelling index was significantly associated with increased Bryne's grade of the tumour invasive front (p=0.039) and increased tumour depth (p=0.018). Among the OTSCC patients with tobacco habits, (n=91), a higher p53 labelling index was significantly associated with increased risk of local recurrence (p=0.025) and with lymphovascular space involvement (p=0.014). Evaluation of p53 through varying degrees of dysplasia to oral tongue cancer indicates that p53 expression is linked to aggressive features of oral tongue cancers and tongue precancers entailing a closer monitoring in positive cases. Among the OTSCCs, p53 expression is associated with tumour aggressiveness correlating with increased grading of invasive tumour front and tumour depth.
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64
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Vellappally S, Binmgren MA, Huraib SB, Hashem MI, Patil S, Anil S. Assessment of DNA Damage in Leukoplakia Patients with Different Degrees of Dysplasia. J Contemp Dent Pract 2015; 16:971-6. [PMID: 27018032 DOI: 10.5005/jp-journals-10024-1790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Single cell gel electrophoresis (SCGE) assay also known as comet assay is a rapid and highly sensitive fluorescent molecular technique for detecting various forms of deoxyribonucleic acid (DNA) damage at individual cellular level. MATERIALS AND METHODS The present study was done to detect the extent of DNA damage in oral leukoplakia (OL) and compare with normal individuals. The sample population was obtained from an outpatient clinic of a tertiary teaching dental institute. A total of 36 consecutive patients with leukoplakia and 10 healthy normal volunteers were recruited for the study and assessed for the extent of DNA damage using SCGE following clinical diagnosis and histological grading. Peripheral blood was obtained by venipuncture and SCGE assay was performed. Mean comet tail length was recorded and analyzed statistically to compare the extent of damage in each group. RESULTS The mean comet tail length seen in leukoplakia patients with moderate to severe dysplasia was 1.25 ± 0.14 mm while for the control subjects, it was 0.31 ± 0.10 mm. The difference was statistically significant (p = 0.000). On comparing within the grades of leukoplakia, a progressive trend of increasing tail length was observed with increasing grades of dysplasia. CONCLUSION Deoxyribonucleic acid damage as measured by SCGE is seen in leukoplakia. A stepwise increase in DNA damage levels from healthy controls, through patients with non-dysplastic epithelium to varying grades of dysplasia has been observed indicating the extent of DNA damage in this high risk group.
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Affiliation(s)
- Sajith Vellappally
- Assistant Professor, Department of Dental Health, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, e-mail:
| | - Mohammed A Binmgren
- Department of Dental Health, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sahar Bin Huraib
- Department of Dental Health, Dental Public Health, College of Applied Medical Sciences, King Saud University, Riyadh Saudi Arabia
| | - Mohamed I Hashem
- Department of Dental Health, College of Applied Medical Science, King Saud University; Dental Biomaterial Department Al-Azhar University, Cairo, Egypt
| | | | - Sukumaran Anil
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
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65
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Singh SP, Ibrahim O, Byrne HJ, Mikkonen JW, Koistinen AP, Kullaa AM, Lyng FM. Recent advances in optical diagnosis of oral cancers: Review and future perspectives. Head Neck 2015; 38 Suppl 1:E2403-11. [PMID: 26613806 DOI: 10.1002/hed.24293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/30/2015] [Accepted: 09/12/2015] [Indexed: 12/16/2022] Open
Abstract
Optical diagnosis techniques offer several advantages over traditional approaches, including objectivity, speed, and cost, and these label-free, noninvasive methods have the potential to change the future workflow of cancer management. The oral cavity is particularly accessible and, thus, such methods may serve as alternate/adjunct tools to traditional methods. Recently, in vivo human clinical studies have been initiated with a view to clinical translation of such technologies. A comprehensive review of optical methods in oral cancer diagnosis is presented. After an introduction to the epidemiology and etiological factors associated with oral cancers currently used, diagnostic methods and their limitations are presented. A thorough review of fluorescence, infrared absorption, and Raman spectroscopic methods in oral cancer diagnosis is presented. The applicability of minimally invasive methods based on serum/saliva is also discussed. The review concludes with a discussion on future demands and scope of developments from a clinical point of view. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2403-E2411, 2016.
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Affiliation(s)
- S P Singh
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,SIB Laboratories, University of Eastern Finland, Kuopio, Finland
| | - Ola Ibrahim
- DIT Centre for Radiation and Environmental Science, FOCAS Research Institute, Dublin Institute of Technology, Dublin, Ireland.,School of Physics, Dublin Institute of Technology, Dublin, Ireland
| | - Hugh J Byrne
- FOCAS Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Jopi W Mikkonen
- SIB Laboratories, University of Eastern Finland, Kuopio, Finland
| | - Arto P Koistinen
- SIB Laboratories, University of Eastern Finland, Kuopio, Finland
| | - Arja M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Research Group of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Fiona M Lyng
- DIT Centre for Radiation and Environmental Science, FOCAS Research Institute, Dublin Institute of Technology, Dublin, Ireland.,School of Physics, Dublin Institute of Technology, Dublin, Ireland
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66
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Geetha KM, Leeky M, Narayan TV, Sadhana S, Saleha J. Grading of oral epithelial dysplasia: Points to ponder. J Oral Maxillofac Pathol 2015; 19:198-204. [PMID: 26604497 PMCID: PMC4611929 DOI: 10.4103/0973-029x.164533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Over the years many grading systems have been put forward in an attempt to obtain objectivity in grading oral epithelial dysplasia (OED). However, despite these efforts variability remains unresolved. Our study aimed to evaluate the intra- and inter-observer variability in grading OED, using World Health Organization (WHO), Smith and Pindborg and Ljubljana grading systems and discuss the possible reasons for this variability if any. Materials and Methods: Three oral pathologists graded 50 slides of OED independently twice at a time interval of 3 months. Variability was evaluated by multivariate kappa analysis. Results: Intra-observer reproducibility ranged from moderate to good in WHO system, fair to moderate in Smith and Pindborg system and moderate to poor in Ljubljana grading system. Inter-observer agreement was found to be fair in WHO, poor in Smith and Pindborg system and poor to fair in Ljubljana grading systems. Intra-observer reproducibility of the dysplastic features in WHO system was good for all except the loss of polarity and basilar hyperplasia for first observer and enlarged nucleoli for the third observer. Inter-observer agreement was good for increased number of mitosis and nuclear hyperchromatism. Intra-observer reproducibility and inter-observer agreement were found to be best in the WHO grading system though variability within this system still existed. Conclusion: There is a need for an International body of pathologists to come to a consensus on a more definable grading system to resolve the issue of variability in grading dysplasia.
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Affiliation(s)
- K M Geetha
- Department of Oral Pathology and Microbiology, Mamata Dental College, Giriprasad Nagar, Khammam, Andhra Pradesh, India
| | - M Leeky
- Department of Oral and Maxillofacial Pathology, The Oxford Dental College, Bengaluru, Karnataka, India
| | - T V Narayan
- Private Dental Practitioner, Impressions Dental Care, No. 102, Elegant Desire, Bengaluru, Karnataka, India
| | - S Sadhana
- Department of Oral and Maxillofacial Pathology, The Oxford Dental College, Bengaluru, Karnataka, India
| | - J Saleha
- Department of Oral and Maxillofacial Pathology, The Oxford Dental College, Bengaluru, Karnataka, India
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67
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Chen S, Forman M, Sadow PM, August M. The Diagnostic Accuracy of Incisional Biopsy in the Oral Cavity. J Oral Maxillofac Surg 2015; 74:959-64. [PMID: 26682520 DOI: 10.1016/j.joms.2015.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the accuracy of incisional biopsy examination to diagnose oral lesions. MATERIALS AND METHODS This retrospective cohort study was performed to determine the concordance rate between incisional biopsy examination and definitive resection diagnosis for different oral lesions. The study sample was derived from the population of patients who presented to the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital (Boston, MA) from January 2005 through December 2012. Inclusion criteria were the diagnosis of an oral lesion from an incisional biopsy examination, subsequent diagnosis from the definitive resection of the same lesion, and complete clinical and pathologic patient records. The predictor variables were the origin and size of the lesion. The primary outcome variable was concordance between the provisional incisional biopsy diagnosis and definitive pathologic resection diagnosis. The secondary outcome variable was type of biopsy error for the discordant cases. Incisional biopsy errors were assessed and grouped into 5 categories: 1) sampling error; 2) insufficient tissue for diagnosis; 3) presence of inflammation making diagnosis difficult; 4) artifact; and 5) pathologist discordance. RESULTS A total of 272 patients met the inclusion criteria. The study sample had a mean age of 47.4 years and 55.7% were women. Of these cases, 242 (88.9%) were concordant when comparing the biopsy and final resection pathology reports. At histologic evaluation, 60.0% of discordant findings were attributed to sampling error, 23.3% to pathologist discrepancy, 13.3% to insufficient tissue provided in the biopsy specimen, and 3.4% to inflammation obscuring diagnosis. Overall, concordant cases had a larger average biopsy volume (1.53 cm(3)) than discordant cases (0.42 cm(3)). CONCLUSION The data collected indicate an 88.9% diagnostic concordance with final pathologic results for incisional oral biopsy diagnoses. Sixty percent of discordance was attributed to sampling error when sampled tissue was not representative of the lesion in toto. Multiple-site biopsy specimens and larger-volume samples allowed for a more accurate diagnosis.
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Affiliation(s)
- Sara Chen
- Resident PGY1, Department of Restorative Dentistry (Prosthodontics), University of Illinois at Chicago, Chicago, IL; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael Forman
- Student, Harvard School of Dental Medicine, Boston, MA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Peter M Sadow
- Associate Director, Head and Neck Pathology; Assistant Professor, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Meredith August
- Associate Professor, Massachusetts General Hospital and Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Boston MA.
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van der Waal I. Oral leukoplakia, the ongoing discussion on definition and terminology. Med Oral Patol Oral Cir Bucal 2015; 20:e685-92. [PMID: 26449439 PMCID: PMC4670248 DOI: 10.4317/medoral.21007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/17/2015] [Indexed: 11/05/2022] Open
Abstract
In the past decades several definitions of oral leukoplakia have been proposed, the last one, being authorized by the World Health Organization (WHO), dating from 2005. In the present treatise an adjustment of that definition and the 1978 WHO definition is suggested, being : “A predominantly white patch or plaque that cannot be characterized clinically or pathologically as any other disorder; oral leukoplakia carries an increased risk of cancer development either in or close to the area of the leukoplakia or elsewhere in the oral cavity or the head-and-neck region”. Furthermore, the use of strict diagnostic criteria is recommended for predominantly white lesions for which a causative factor has been identified, e.g. smokers’ lesion, frictional lesion and dental restoration associated lesion. A final diagnosis of such leukoplakic lesions can only be made in retrospect after successful elimination of the causative factor within a somewhat arbitrarily chosen period of 4-8 weeks. It seems questionable to exclude “frictional keratosis” and “alveolar ridge keratosis” from the category of leukoplakia as has been suggested in the literature. Finally, brief attention has been paid to some histopathological issues that may cause confusion in establishing a final diagnosis of leukoplakia.
Key words:Oral leukoplakia, potentially malignant oral disorders, definition.
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Affiliation(s)
- Isaäc van der Waal
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands,
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69
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Chediak Coelho MDN, Guimarães VDC, Rodrigues SO, Costa CC, Ramos HVL. Correlation Between Clinical Diagnosis and Pathological Diagnosis in Laryngeal Lesions. J Voice 2015; 30:595-9. [PMID: 26471810 DOI: 10.1016/j.jvoice.2015.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the degree of agreement between the clinical and the pathological diagnosis in patients undergoing laryngeal microsurgery due to epithelial or edematous lesions of the vocal folds. STUDY DESIGN This is a retrospective study. METHODS The study was developed in the ear, nose, and throat clinic of a tertiary hospital, through chart review. We included all patients who underwent microsurgery of the larynx, whose videolaryngoscopic tests showed vocal fold lesions, from January 2003 to August 2014. During the study period, we identified 48 patients with epithelial and edematous lesions. The patients were divided into two groups. In group A, patients with edematous lesions with clinical diagnosis of polyps and Reinke edema were included. Group B comprised patients with epithelial lesions, as leukoplakic injuries. A correlation between histopathological findings and clinical hypothesis between these two groups of lesions was performed. RESULTS In group B, there was agreement in 88.9% of cases between the clinical and pathological diagnosis. In group A, compatibility occurred in only 46.4% of cases. We observed a statistically significant difference between the compatibility of the clinical and pathological diagnosis just in edematous lesions (P = 0.029). CONCLUSIONS The study showed the limitation of the pathological examination on edematous laryngeal lesions. On the other hand, on the epithelial lesions, there was more agreement between those diagnosis.
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Affiliation(s)
| | | | - Stela Oliveira Rodrigues
- Departamento de Clínica Cirúrgica, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Claudiney Candido Costa
- Departamento de Clínica Cirúrgica, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Hugo Valter Lisboa Ramos
- Departamento de Clínica Cirúrgica, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
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70
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Nayak S, Goel MM, Makker A, Bhatia V, Chandra S, Kumar S, Agarwal SP. Fibroblast Growth Factor (FGF-2) and Its Receptors FGFR-2 and FGFR-3 May Be Putative Biomarkers of Malignant Transformation of Potentially Malignant Oral Lesions into Oral Squamous Cell Carcinoma. PLoS One 2015; 10:e0138801. [PMID: 26465941 PMCID: PMC4605495 DOI: 10.1371/journal.pone.0138801] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/03/2015] [Indexed: 01/10/2023] Open
Abstract
There are several factors like angiogenesis, lymphangiogenesis, genetic alterations, mutational factors that are involved in malignant transformation of potentially malignant oral lesions (PMOLs) to oral squamous cell carcinoma (OSCC). Fibroblast growth factor-2 (FGF-2) is one of the prototypes of the large family of growth factors that bind heparin. FGF-2 induces angiogenesis and its receptors may play a role in synthesis of collagen. FGFs are involved in transmission of signals between the epithelium and connective tissue, and influence growth and differentiation of a wide variety of tissue including epithelia. The present study was undertaken to analyze expression of FGF-2 and its receptors FGFR-2 and FGFR-3 in 72 PMOLs, 108 OSCC and 52 healthy controls, and their role in risk assessment for malignant transformation of Leukoplakia (LKP) and Oral submucous fibrosis (OSMF) to OSCC. Immunohistochemistry was performed using antibodies against FGF-2, FGFR-2 and FGFR-3. IHC results were validated by Real Time PCR. Expression of FGF-2, FGFR-2 and FGFR-3 was upregulated from PMOLs to OSCC. While 90% (9/10) of PMOLs which showed malignant transformation (transformed) expressed FGF-2, only 24.19% cases (15/62) of PMOLs which were not transformed (untransformed) to OSCC expressed FGF-2. Similarly, FGFR-2 expression was seen in 16/62 (25.81%) of untransformed PMOLs and 8/10 (80%) cases of transformed PMOLs. FGFR-3 expression was observed in 23/62 (37.10%) cases of untransformed PMOLs and 6/10 (60%) cases of transformed PMOLs. A significant association of FGF-2 and FGFR-2 expression with malignant transformation from PMOLs to OSCC was observed both at phenotypic and molecular level. The results suggest that FGF-2 and FGFR-2 may be useful as biomarkers of malignant transformation in patients with OSMF and LKP.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Case-Control Studies
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Child
- Female
- Fibroblast Growth Factor 2/genetics
- Fibroblast Growth Factor 2/metabolism
- Gene Expression Regulation, Neoplastic
- Humans
- Leukoplakia, Oral/diagnosis
- Leukoplakia, Oral/genetics
- Leukoplakia, Oral/metabolism
- Leukoplakia, Oral/pathology
- Male
- Middle Aged
- Mouth Mucosa/metabolism
- Mouth Mucosa/pathology
- Mouth Neoplasms/diagnosis
- Mouth Neoplasms/genetics
- Mouth Neoplasms/metabolism
- Mouth Neoplasms/pathology
- Oral Submucous Fibrosis/diagnosis
- Oral Submucous Fibrosis/genetics
- Oral Submucous Fibrosis/metabolism
- Oral Submucous Fibrosis/pathology
- Receptor, Fibroblast Growth Factor, Type 2/genetics
- Receptor, Fibroblast Growth Factor, Type 2/metabolism
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Signal Transduction
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Affiliation(s)
- Seema Nayak
- Department of Pathology, King George’s Medical University, Lucknow, U.P. - 226003, India
| | - Madhu Mati Goel
- Department of Pathology, King George’s Medical University, Lucknow, U.P. - 226003, India
| | - Annu Makker
- Department of Pathology, King George’s Medical University, Lucknow, U.P. - 226003, India
| | - Vikram Bhatia
- Department of Pathology, King George’s Medical University, Lucknow, U.P. - 226003, India
| | - Saumya Chandra
- Department of Pathology, King George’s Medical University, Lucknow, U.P. - 226003, India
| | - Sandeep Kumar
- All India Institute of Medical Sciences Bhopal, M.P. – 462026, India
| | - S. P. Agarwal
- Department of Otorhinolaryngology, King George’s Medical University Lucknow, U.P. – 226003, India
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Mikkonen JJW, Singh SP, Herrala M, Lappalainen R, Myllymaa S, Kullaa AM. Salivary metabolomics in the diagnosis of oral cancer and periodontal diseases. J Periodontal Res 2015; 51:431-7. [PMID: 26446036 DOI: 10.1111/jre.12327] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 12/23/2022]
Abstract
Metabolomics is a systemic study of metabolites, which are small molecules generated by the process of metabolism. The metabolic profile of saliva can provide an early outlook of the changes associated with a wide range of diseases, including oral cancer and periodontal diseases. It is possible to measure levels of disease-specific metabolites using different methods as presented in this study. However, many challenges exist including incomplete understanding of the complicated metabolic pathways of different oral diseases. The review concludes with the discussion on future perspectives of salivary metabolomics from a clinician point of view. Salivary metabolomics may afford a new research avenue to identify local and systemic disorders but also to aid in the design and modification of therapies. A MEDLINE search using keywords "salivary metabolomics" returned 23 results in total, of which seven were omitted for being reviews or letters to the editor. The rest of the articles were used for preparation of the review, 13 of these were published in the last 5 years.
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Affiliation(s)
- J J W Mikkonen
- SIB Labs, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - S P Singh
- SIB Labs, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - M Herrala
- Faculty of Medicine, Institute of Dentistry, University of Oulu, Oulu, Finland
| | - R Lappalainen
- SIB Labs, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - S Myllymaa
- Institute of Dentistry, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - A M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.,Faculty of Medicine, Institute of Dentistry, University of Oulu, Oulu, Finland.,Educational Dental Clinic, Kuopio University Hospital, Kuopio, Finland
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72
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Scully C. Challenges in predicting which oral mucosal potentially malignant disease will progress to neoplasia. Oral Dis 2015; 20:1-5. [PMID: 24320967 DOI: 10.1111/odi.12208] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 01/18/2023]
Abstract
Probably the greatest challenge to those managing patients with oral diseases is the dilemma of attempting to predict which oral erythroplakias, leukoplakias, lichenoid and other potentially malignant mucosal disease (PMD) such as oral submucous fibrosis will progress to neoplasia--notably oral squamous cell carcinoma (OSCC). The paper reviews progress over the past decade and the application to the clinical situation.
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Affiliation(s)
- C Scully
- University College of London, London, UK
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73
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Kumar P, Bhattacharjee T, Ingle A, Maru G, Krishna CM. Raman Spectroscopy of Experimental Oral Carcinogenesis: Study on Sequential Cancer Progression in Hamster Buccal Pouch Model. Technol Cancer Res Treat 2015; 15:NP60-72. [PMID: 26272064 DOI: 10.1177/1533034615598622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/01/2015] [Indexed: 01/06/2023] Open
Abstract
Oral cancers suffer from poor 5-year survival rates, owing to late detection of the disease. Current diagnostic/screening tools need to be upgraded in view of disadvantages like invasiveness, tedious sample preparation, long output times, and interobserver variances. Raman spectroscopy has been shown to identify many disease conditions, including oral cancers, from healthy conditions. Further studies in exploring sequential changes in oral carcinogenesis are warranted. In this Raman spectroscopy study, sequential progression in experimental oral carcinogenesis in Hamster buccal pouch model was investigated using 3 approaches-ex vivo, in vivo sequential, and in vivo follow-up. In all these studies, spectral changes show lipid dominance in early stages while later stages and tumors showed increased protein to lipid ratio and nucleic acids. On similar lines, early weeks of 7,12-dimethylbenz(a)anthracene-treated and control groups showed higher overlap and low classification. The classification efficiency increased progressively, reached a plateau phase and subsequently increased up to 100% by 14 weeks. The misclassifications between treated and control spectra suggested some changes in controls as well, which was confirmed by a careful reexamination of histopathological slides. These findings suggests Raman spectroscopy may be able to identify microheterogeneity, which may often go unnoticed in conventional biochemistry wherein tissue extracts are employed, as well as in histopathology. In vivo findings, quite comparable to gold-standard supported ex vivo findings, give further proof of Raman spectroscopy being a promising label-free, noninvasive diagnostic adjunct for future clinical applications.
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Affiliation(s)
- Piyush Kumar
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Tanmoy Bhattacharjee
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Arvind Ingle
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Girish Maru
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - C Murali Krishna
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
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74
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Farah CS, Dalley AJ, Nguyen P, Batstone M, Kordbacheh F, Perry-Keene J, Fielding D. Improved surgical margin definition by narrow band imaging for resection of oral squamous cell carcinoma: A prospective gene expression profiling study. Head Neck 2015; 38:832-9. [DOI: 10.1002/hed.23989] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 12/26/2022] Open
Affiliation(s)
- Camile S. Farah
- University of Queensland Centre for Clinical Research, The University of Queensland; Brisbane Queensland Australia
- Australian Centre for Oral Oncology Research and Education; Brisbane Queensland Australia
| | - Andrew J. Dalley
- University of Queensland Centre for Clinical Research, The University of Queensland; Brisbane Queensland Australia
| | - Phan Nguyen
- Department of Thoracic Medicine; Royal Adelaide Hospital; Adelaide Australia
| | - Martin Batstone
- University of Queensland Centre for Clinical Research, The University of Queensland; Brisbane Queensland Australia
- Maxillofacial Unit; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Farzaneh Kordbacheh
- University of Queensland Centre for Clinical Research, The University of Queensland; Brisbane Queensland Australia
| | - Joanna Perry-Keene
- Department of Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - David Fielding
- Department of Thoracic Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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75
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Speight PM, Abram TJ, Floriano PN, James R, Vick J, Thornhill MH, Murdoch C, Freeman C, Hegarty AM, D'Apice K, Kerr AR, Phelan J, Corby P, Khouly I, Vigneswaran N, Bouquot J, Demian NM, Weinstock YE, Redding SW, Rowan S, Yeh CK, McGuff HS, Miller FR, McDevitt JT. Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials. Oral Surg Oral Med Oral Pathol Oral Radiol 2015. [PMID: 26216170 DOI: 10.1016/j.oooo.2015.05.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. STUDY DESIGN Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. RESULTS Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. CONCLUSIONS The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.
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Affiliation(s)
- Paul M Speight
- Academic Unit of Oral & Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Timothy J Abram
- Rice University, Department of Bioengineering, Houston, TX, USA
| | | | | | | | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Craig Murdoch
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Christine Freeman
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Anne M Hegarty
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Katy D'Apice
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - A Ross Kerr
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Joan Phelan
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Patricia Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Ismael Khouly
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Nadarajah Vigneswaran
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Jerry Bouquot
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Nagi M Demian
- The University of Texas Health Science Center at Houston, Department of Oral and Maxillofacial Surgery, Houston, TX, USA
| | - Y Etan Weinstock
- The University of Texas Health Science Center at Houston, Department of Otolaryngology-Head and Neck Surgery, Houston, TX, USA
| | - Spencer W Redding
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - Stephanie Rowan
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - Chih-Ko Yeh
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - H Stan McGuff
- The University of Texas Health Science Center at San Antonio, Department of Pathology, San Antonio, TX, USA
| | - Frank R Miller
- The University of Texas Health Science Center at San Antonio, Department of Otolaryngology-Head and Neck Surgery, San Antonio, TX, USA
| | - John T McDevitt
- Rice University, Department of Bioengineering, Houston, TX, USA; Department Biomaterials, Bioengineering Institute, New York University, New York, NY, USA; Rice University, Department of Chemistry, Houston, TX, USA.
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76
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Gissi DB, Gabusi A, Servidio D, Cervellati F, Montebugnoli L. Predictive Role of p53 Protein as a Single Marker or Associated with ki67 Antigen in Oral Leukoplakia: A Retrospective Longitudinal Study. Open Dent J 2015; 9:41-5. [PMID: 25674170 PMCID: PMC4319198 DOI: 10.2174/1874210601509010041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 01/07/2023] Open
Abstract
Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral cavity. Immunohistochemical analysis of p53 and Ki67 proteins is a simple and inexpensive method widely used in non-dysplastic OLs to reveal lesions predicted to develop oral cancer. The present longitudinal study evaluated the predictive role of p53 and Ki67 proteins alone or in combination in a group of OLs without dysplasia followed for many years. Seventy-seven OL patients referred to our Department between January 2006 and October 2013 underwent histochemical analysis of p53 and Ki67 expression. OLs were considered at high risk in the presence of either high p53 expression (>20%), or low/normal p53 expression associated with high Ki67 expression (Ki67/p53 ratio >3). Seven OLs evolved to OSCC during the follow-up period. Three cases had p53 overexpression, while four had a high Ki67/p53 ratio. Statistical significance was reached when samples with p53 overexpression were combined with samples with high Ki67/p53 ratio (Chi square 5.3; p<0.02). The combined immunohistochemical expression of p53 and Ki67 proteins could be a useful and simple molecular marker for early detection of non-dysplastic OLs at risk of developing oral cancer.
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Affiliation(s)
- Davide B Gissi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Italy
| | - Andrea Gabusi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Italy
| | - Dora Servidio
- Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Italy
| | - Fabio Cervellati
- Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Italy
| | - Lucio Montebugnoli
- Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Italy
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77
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Devpura S, Barton KN, Brown SL, Palyvoda O, Kalkanis S, Naik VM, Siddiqui F, Naik R, Chetty IJ. Vision 20/20: the role of Raman spectroscopy in early stage cancer detection and feasibility for application in radiation therapy response assessment. Med Phys 2014; 41:050901. [PMID: 24784365 DOI: 10.1118/1.4870981] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Raman spectroscopy is an optical technique capable of identifying chemical constituents of a sample by their unique set of molecular vibrations. Research on the applicability of Raman spectroscopy in the differentiation of cancerous versus normal tissues has been ongoing for many years, and has yielded successful results in the context of prostate, breast, brain, skin, and head and neck cancers as well as pediatric tumors. Recently, much effort has been invested on developing noninvasive "Raman" probes to provide real-time diagnosis of potentially cancerous tumors. In this regard, it is feasible that the Raman technique might one day be used to provide rapid, minimally invasive real-time diagnosis of tumors in patients. Raman spectroscopy is relatively new to the field of radiation therapy. Recent work involving cell lines has shown that the Raman technique is able to identify proteins and other markers affected by radiation therapy. Although this work is preliminary, one could ask whether or not the Raman technique might be used to identify molecular markers that predict radiation response. This paper provides a brief review of Raman spectroscopic investigations in cancer detection, benefits and limitations of this method, advances in instrument development, and also preliminary studies related to the application of this technology in radiation therapy response assessment.
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Affiliation(s)
- Suneetha Devpura
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202
| | - Kenneth N Barton
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202
| | - Stephen L Brown
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202
| | - Olena Palyvoda
- College of Engineering, Wayne State University, Detroit, Michigan 48202
| | - Steven Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan 48202
| | - Vaman M Naik
- Department of Natural Sciences, University of Michigan-Dearborn, Dearborn, Michigan 48128
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202
| | - Ratna Naik
- Department of Physics and Astronomy, Wayne State University, Detroit, Michigan 48201
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202
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78
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Varoni E, Decani S, Franchini R, Baruzzi E, Lodi G. Macchie bianche o leucoplachia? Quando preoccuparsi? DENTAL CADMOS 2014. [DOI: 10.1016/s0011-8524(14)70229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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79
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Histopathogenesis of non-HPV-related differentiated oral squamous intraepithelial neoplasia. Appl Immunohistochem Mol Morphol 2014; 23:273-9. [PMID: 25356942 DOI: 10.1097/pai.0000000000000080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A study of immunohistopathologic and cytohistopathologic changes of the parabasal/basal layers in the differentiated squamous intraepithelial neoplasia (DSIN) may elucidate the histopathogenesis and reveal changes aiding early diagnosis and grading of the lesion. MATERIALS AND METHODS A total of 55 consecutive resection specimens of nonbasaloid squamous cell carcinoma of the anterior oral cavity and 8 biopsies before resections displaying DSIN in the overlying squamous epithelium were examined. RESULTS Squamous epithelium that is continuous/immediately adjacent to invasive squamous cell carcinoma (type 1) and the more peripheral (type 2) epithelium of resection specimens displayed consistent changes in the parabasal/basal layers: (A) cytologic atypia with proliferation of parabasal cells with downward expansion causing reactive proliferation of the basal cell layer in the early stage, invading the basal layer in the late stage; (B) disordered nuclear/cytoplasmic arrangement; (C) "Cobblestone" appearance. Immunoreactivity for TP53 and Ki67 was helpful in the diagnosis. The epithelial spectrum of changes decreased as one moved from type 1 to type 2 lesions. Five out of 8 biopsies showed type 1 lesions (followed by resection in a period of 11±6 mo) and 3 showed type 2 lesions (followed by resection in a period of 55±20 mo). In addition, resections were margin positive for type 2 lesions in 5 cases associated with recurrence at the site of resection during a period of 69±9 months. CONCLUSIONS DSIN is characterized by a proliferation of neoplastic parabasal cells with dyskeratosis, downward expansion/pushing of the basal layer with elongation of rete ridges. We proposed grading of DSIN based on the changes of the parabasal/basal layers.
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80
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Murdoch C, Brown BH, Hearnden V, Speight PM, D'Apice K, Hegarty AM, Tidy JA, Healey TJ, Highfield PE, Thornhill MH. Use of electrical impedance spectroscopy to detect malignant and potentially malignant oral lesions. Int J Nanomedicine 2014; 9:4521-32. [PMID: 25285005 PMCID: PMC4181751 DOI: 10.2147/ijn.s64087] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The electrical properties of tissues depend on their architecture and cellular composition. We have previously shown that changes in electrical impedance can be used to differentiate between different degrees of cervical dysplasia and cancer of the cervix. In this proof-of-concept study, we aimed to determine whether electrical impedance spectroscopy (EIS) could distinguish between normal oral mucosa; benign, potentially malignant lesions (PML); and oral cancer. EIS data were collected from oral cancer (n=10), PML (n=27), and benign (n=10) lesions. EIS from lesions was compared with the EIS reading from the normal mucosa on the contralateral side of the mouth or with reference spectra from mucosal sites of control subjects (n=51). Healthy controls displayed significant differences in the EIS obtained from different oral sites. In addition, there were significant differences in the EIS of cancer and high-risk PML versus low-risk PML and controls. There was no significant difference between benign lesions and normal controls. Study subjects also deemed the EIS procedure considerably less painful and more convenient than the scalpel biopsy procedure. EIS shows promise at distinguishing among malignant, PML, and normal oral mucosa and has the potential to be developed into a clinical diagnostic tool.
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Affiliation(s)
- Craig Murdoch
- Unit of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom
| | - Brian H Brown
- University of Sheffield Medical School, Beech Hill Road, Sheffield, United Kingdom
| | - Vanessa Hearnden
- Unit of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom
| | - Paul M Speight
- Unit of Oral and Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom
| | - Katy D'Apice
- Unit of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom ; Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Anne M Hegarty
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - John A Tidy
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - T Jamie Healey
- Department of Medical Physics, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Peter E Highfield
- Zilico Ltd., The MedTECH Centre, Rutherford House, Manchester Science Park, Manchester, United Kingdom
| | - Martin H Thornhill
- Unit of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom ; Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
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81
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Christian K, Johanna M, Werner A, Kathrin B, Tesfay GM, Robert H, Abbas A, Stefan W, Andreas B, Wilhelm NF, Florian S. Raman difference spectroscopy: a non-invasive method for identification of oral squamous cell carcinoma. BIOMEDICAL OPTICS EXPRESS 2014; 5:3252-65. [PMID: 25401036 PMCID: PMC4230857 DOI: 10.1364/boe.5.003252] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/16/2014] [Accepted: 07/31/2014] [Indexed: 05/04/2023]
Abstract
The feasibility of shifted-excitation Raman difference spectroscopy (SERDS) as a label-free and non-invasive technique for an objective diagnosis of oral cancer (OSCC) was investigated by analyzing 12 ex vivo OSCC samples. 72 mean SERDS spectra from each three physiological tissue points and pathological lesions were correlated with the histo-pathological diagnosis. Principal component analysis (PCA) and linear discriminant analysis (LDA) showed excellent results with an area under the curve of 94.5% and a classification error of 9.7% (sensitivity: 86.1%; specificity: 94.4%). The SERDS Raman spectra of malignant and benignant tissues were discriminable with respect to the spectral features of proteins, lipids and nucleic acids. The presented method is capable of a highly accurate identification of OSCC. These findings suggest a high validity and reproducibility of SERDS combined with PCA and LDA analysis regarding oral cancer tissue.
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Affiliation(s)
- Knipfer Christian
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Motz Johanna
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Adler Werner
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Brunner Kathrin
- Department of Pathology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gebrekidan Medhaine Tesfay
- Lehrstuhl für Technische Thermodynamik, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hankel Robert
- Lehrstuhl für Technische Thermodynamik, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Agaimy Abbas
- Department of Pathology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Will Stefan
- Lehrstuhl für Technische Thermodynamik, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Braeuer Andreas
- Lehrstuhl für Technische Thermodynamik, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Neukam Friedrich Wilhelm
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stelzle Florian
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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82
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Oral cancer and oral potentially malignant disorders. Int J Dent 2014; 2014:853479. [PMID: 24891850 PMCID: PMC4033498 DOI: 10.1155/2014/853479] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 12/20/2022] Open
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83
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Guze K, Pawluk HC, Short M, Zeng H, Lorch J, Norris C, Sonis S. Pilot study: Raman spectroscopy in differentiating premalignant and malignant oral lesions from normal mucosa and benign lesions in humans. Head Neck 2014; 37:511-7. [DOI: 10.1002/hed.23629] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 11/22/2013] [Accepted: 02/10/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kevin Guze
- Department of Oral Medicine; Infection and Immunity; Harvard School of Dental Medicine; Boston Massachusetts
- Divisions of Oral Medicine; Dana-Farber Cancer Institute and Brigham and Women's Hospital; Boston Massachusetts
| | - Hanna C. Pawluk
- Imaging Unit - Integrative Oncology Department; British Columbia Cancer Agency Research Centre; Vancouver British Columbia Canada
| | - Michael Short
- Imaging Unit - Integrative Oncology Department; British Columbia Cancer Agency Research Centre; Vancouver British Columbia Canada
| | - Haishan Zeng
- Imaging Unit - Integrative Oncology Department; British Columbia Cancer Agency Research Centre; Vancouver British Columbia Canada
| | - Jochen Lorch
- Head and Neck Oncology Program; Dana Farber Cancer Institute; Boston Massachusetts
| | - Charles Norris
- Head and Neck Oncology Program; Dana Farber Cancer Institute; Boston Massachusetts
| | - Stephen Sonis
- Department of Oral Medicine; Infection and Immunity; Harvard School of Dental Medicine; Boston Massachusetts
- Divisions of Oral Medicine; Dana-Farber Cancer Institute and Brigham and Women's Hospital; Boston Massachusetts
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84
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Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:343-52. [DOI: 10.1016/j.oooo.2013.09.017] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/22/2013] [Accepted: 09/29/2013] [Indexed: 12/11/2022]
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85
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Dionne KR, Warnakulasuriya S, Zain RB, Cheong SC. Potentially malignant disorders of the oral cavity: current practice and future directions in the clinic and laboratory. Int J Cancer 2014; 136:503-15. [PMID: 24482244 DOI: 10.1002/ijc.28754] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 01/12/2014] [Accepted: 01/15/2014] [Indexed: 12/28/2022]
Abstract
Despite commendable progress in the prevention, detection, and treatment of a wide variety of solid tumor types, oral squamous cell carcinoma (OSCC) remains a significant health burden across the globe. OSCC carcinogenesis involves accumulation of genetic alterations that coincide with the multistep malignant transformation of normal oral epithelium. OSCC is often first diagnosed at late stages of the disease (advanced regional disease and/or metastasis). Delayed diagnosis precludes successful treatment and favorable outcomes. In clinical practice, opportunities exist to identify patients with oral potentially malignant disorders (OPMDs), which precede the development of cancer. This review addresses the current status of laboratory and clinical research on OPMDs, with emphasis on leukoplakia and erythroplakia. OSF is also presented, though there is a paucity of published studies on this disorder. We focus on findings that could translate into earlier diagnosis and more efficacious treatment of those lesions with significant malignant potential. We explore how markers of OPMD malignant transformation might be implemented into current diagnostic practice to help clinicians objectively stratify patients into treatment/follow-up groups according to relative risk. We provide an overview of recently concluded and ongoing OPMD chemoprevention trials. We describe laboratory OPMD models that can be used to not only to reveal the genetic and molecular intricacies of oral cancer but also to develop novel screening methods and therapeutic approaches. Finally, we call for targeted screening programs of at-risk populations in order to facilitate diagnosis and treatment of OPMD and early OSCC.
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Affiliation(s)
- Kalen R Dionne
- Faculty of Dentistry, Oral Cancer Research and Co-ordinating Centre (OCRCC), University of Malaya, Kuala Lumpur, Malaysia; Oral Cancer Research Team, Cancer Research Initiatives Foundation (CARIF), Subang Jaya, Selangor Darul Ehsan, Malaysia; Medical Scientist Training Program, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
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86
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Pentenero M, Marino R, Tempia Valenta G, Navone R, Gandolfo S. Microbiopsy a novel sampling technique to early detect dysplastic/malignant alterations in oral mucosal lesions: practicability by general dentists. J Oral Pathol Med 2014; 43:435-40. [DOI: 10.1111/jop.12161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Pentenero
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Roberto Marino
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Guido Tempia Valenta
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Roberto Navone
- Department of Biomedical Sciences and Human Oncology of Pathology Unit; University of Turin; Turin Italy
| | - Sergio Gandolfo
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
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87
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Mallery SR, Tong M, Shumway BS, Curran AE, Larsen PE, Ness GM, Kennedy KS, Blakey GH, Kushner GM, Vickers AM, Han B, Pei P, Stoner GD. Topical application of a mucoadhesive freeze-dried black raspberry gel induces clinical and histologic regression and reduces loss of heterozygosity events in premalignant oral intraepithelial lesions: results from a multicentered, placebo-controlled clinical trial. Clin Cancer Res 2014; 20:1910-24. [PMID: 24486592 DOI: 10.1158/1078-0432.ccr-13-3159] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. EXPERIMENTAL DESIGN This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. RESULTS Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRB's chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. CONCLUSIONS Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size.
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Affiliation(s)
- Susan R Mallery
- Authors' Affiliations: Divisions of Oral Maxillofacial Pathology & Radiology and Oral Maxillofacial Surgery & Anesthesiology, College of Dentistry, The Ohio State University; The Ohio State University Comprehensive Cancer, Columbus, Ohio; Departments of Oral & Maxillofacial Pathology and Oral & Maxillofacial Surgery, School of Dentistry, University of Louisville, Kentucky; Departments of Diagnostic Sciences and Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina; and Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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88
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Noninvasive Biomarkers in Head and Neck Squamous Cell Carcinoma. Cancer Biomark 2014. [DOI: 10.1201/b16389-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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89
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William WN, Papadimitrakopoulou VA. Optimizing biomarkers and endpoints in oral cancer chemoprevention trials. Cancer Prev Res (Phila) 2013; 6:375-8. [PMID: 23639861 DOI: 10.1158/1940-6207.capr-13-0114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chemoprevention, defined as the use of natural, synthetic, or biologic compounds to halt, reverse, or prevent the initial phases of carcinogenesis or the progression of neoplastic cells to cancer, has produced successes, but progress has been slow. Notably, in the field of oral cancer prevention and despite extensive clinical investigations, a standard systemic therapy for patients with oral premalignant lesions is yet to be developed. In view of safety concerns surrounding the use of pharmaceuticals, the use of phytochemicals derived from the diet has been considered but has not yet translated into clinical success. The Bowman Birk Inhibitor (BBI) is a serine protease inhibitor isolated from soybeans possessing domains with trypsin and chymotrypsin inhibitory activity. Encouraging results were previously reported in a phase IIa trial of BBI complex in patients with oral leukoplakia with measurable clinical responses and favorable biomarker changes. In this issue of the journal, the less promising results of the randomized, placebo-controlled phase IIb trial are presented. In this commentary, the complexities involved in defining optimal biomarkers and endpoints for oral cancer prevention trials and the development of dietary chemoprevention agents are discussed.
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Affiliation(s)
- William N William
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 432, Houston, TX 77030, USA
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90
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Paliga A, Mai KT. Squamous Cell Carcinomas of the Anterior Oral Cavity Are Commonly Associated With Simplex (or Differentiated) Oral Intraepithelial Neoplasia. Int J Surg Pathol 2013; 22:231-40. [DOI: 10.1177/1066896913512866] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: We investigated the occurrence of differentiated oral intraepithelial neoplasia (DOIN) that met the criteria for differentiated intravulvar neoplasia, associated with invasive squamous cell carcinoma (SCC) of the anterior oral cavity, and its clinicopathologic significance. Materials and Methods: Sixty-nine consecutive cases of SCC of the anterior oral cavity were categorized into 2 groups: group A comprised SCC associated with DOIN; Group B consisted of cases associated with classical SCC in situ. Results: Fifty-five cases (80%) were classified as group A, or DOIN lesions, with only 14 (20%) as group B. All cases were associated with invasive SCC, except 2 cases in group B. Squamous epithelium continuous or adjacent to invasive SCC displayed consistent changes in the parabasal and basal layers with (1) cytologic atypia with proliferation of parabasal cells in downward expansion causing reactive proliferation of the basal cell layer in early stage and invading the basal layer in late stage, (2) disordered nuclear/cytoplasmic arrangement, and (3) a “cobblestone” appearance characterized by prominent intercellular spaces and cytoplasmic density involving the entire cell (dyskeratosis) of the parabasal layer. p53 and Ki67 immunostaining revealed linear reactivity mainly in the parabasal layer. Conclusions: DOIN lesions are frequently associated with invasive SCC of anterior oral cavity. Due to the subtle histopathologic changes, DOIN lesions pose potential diagnostic difficulty with differentiation from mild dysplasia or reactive atypia.
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Affiliation(s)
- Aleksandra Paliga
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ontario, Canada
| | - Kien T. Mai
- Department of Anatomical Pathology, The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
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91
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Lucio M, Andrea G, Bartolomeo GD, Fabio C, Dora S. Between-lesion discrepancies in terms of dysplasia, cell turnover and diagnosis in patients with multiple potentially malignant oral lesions. Open Dent J 2013; 7:169-74. [PMID: 24363787 PMCID: PMC3866629 DOI: 10.2174/1874210601307010169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/26/2013] [Indexed: 02/03/2023] Open
Abstract
Objective: The present study assessed patients with multiple oral lesions to evaluate the mis-estimation rate in terms of diagnosis and risk of malignant transformation when only one biopsy is performed.
Study Design: Thirty-five patients presenting at least two white and/or red lesions in different oral mucosa sites with a final diagnosis of leuko/erythroplakias or lichenoid lesions were included, for a total of 70 biopsies.
Results: Nineteen patients (54%) had at least one between-lesion discrepancy considering the presence/absence of dysplasia (10 patients), normal/high cell turnover (13 patients) or diagnosis (5 patients). Discrepancies were not related to clinical aspect or within-patient similarity of lesions.
Conclusions: Multiple oral lesions in the same patient can significantly differ in terms of dysplasia, high cell turnover and, even diagnosis. Multiple biopsies are imperative and diagnosis as well as risk of malignant transformation should be formulated for each single lesion rather than for each individual patient.
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Affiliation(s)
- Montebugnoli Lucio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Gabusi Andrea
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Cervellati Fabio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Servidio Dora
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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92
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Tetraspanins CD9 and CD151, epidermal growth factor receptor and cyclooxygenase-2 expression predict malignant progression in oral epithelial dysplasia. Br J Cancer 2013; 109:2864-74. [PMID: 24201754 PMCID: PMC3844903 DOI: 10.1038/bjc.2013.600] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/13/2013] [Accepted: 09/11/2013] [Indexed: 12/31/2022] Open
Abstract
Background: Prognostic biomarkers aim to improve on the current inadequate method of histological assessment to identify patients with oral epithelial dysplasia at greatest risk of malignant transformation. We aimed to assess the prognostic ability of six protein biomarkers linked to the epidermal growth factor receptor (EGFR) pathway, including three tetraspanins, in a large multicentre oral dysplasia cohort. Methods: One hundred and forty-eight cases with varying degrees of epithelial dysplasia underwent immunohistochemical assessment for CD9, CD151, CD82, EGFR, Her-2, and COX-2. Scoring was performed independently by two observers. Univariate analyses using both logistic and Cox regression models and a multivariate regression were performed. Results: Malignant progression was significantly greater in those cases with decreased expression of CD9 (P=0.02), and increased expression of CD151 (P=0.02), EGFR (P=0.04), and COX-2 (P=0.003). Histological grade (P=0.0002) and morphology (P=0.03) were also prognostic, whereas smoking and alcohol were not. The optimal combination by backward-variable selection was of histological grade (hazard ratio (HR) 1.64; 95% CI 1.12, 2.40), COX-2 overexpression (HR 1.12; 1.02, 1.24) and CD9 underexpression (HR 0.88; 0.80, 0.97). CD82 and Her-2 demonstrated no prognostic ability. Conclusion: This is the first study of the expression and prognostic potential of the tetraspanins in oral dysplasia. A combination of certain biomarkers with clinical factors appeared to improve the accuracy of determining the risk of malignancy in individuals with oral dysplasia. These findings may also offer potential new therapeutic approaches for this condition.
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93
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Abdulmajeed AA, Farah CS. Gene expression profiling for the purposes of biomarker discovery in oral potentially malignant lesions: a systematic review. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2013; 7:279-90. [PMID: 24250244 PMCID: PMC3825664 DOI: 10.4137/cmo.s12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Early and accurate diagnosis of oral potentially malignant lesions (OPML) is of critical importance in preventing malignant transformation. Although histopathological interpretation of the degree of epithelial dysplasia is considered the gold standard for diagnosis, this method is subjective and lacks sensitivity. Therefore, many attempts have been made to identify objective molecular biomarkers to improve diagnosis. Microarray technology has the advantage of screening the expression of the whole genome making it one of the best tools for searching for novel biomarkers. However, microarray studies of OPMLs are limited, and no review has been published to highlight and compare their findings. In this paper, we systematically review all studies that have incorporated microarray analyses in the investigation of gene profile alterations in OPMLs and suggest a set of commonly dysregulated genes across multiple gene expression profile studies. This list of common genes may help focus selection of markers for further analysis regarding their importance in the diagnosis and prognosis of OPMLs.
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Affiliation(s)
- Ahmad A Abdulmajeed
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia. ; The University of Queensland, School of Dentistry, Brisbane, Queensland, Australia
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94
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Abdulmajeed AA, Farah CS. Can immunohistochemistry serve as an alternative to subjective histopathological diagnosis of oral epithelial dysplasia? BIOMARKERS IN CANCER 2013; 5:49-60. [PMID: 24179398 PMCID: PMC3798313 DOI: 10.4137/bic.s12951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many attempts have been made to identify objective molecular biomarkers to diagnose and prognosticate oral epithelial dysplasia (OED) because histopathological interpretation is subjective and lacks sensitivity. The majority of these efforts describe changes in gene expression at protein level in OED as determined by immunohistochemistry (IHC). However, the literature on these putative markers of oral cancer progression is vast and varied. The main purpose of this article is to review current knowledge on biomarkers of protein expression for OED by IHC approaches. We further discuss these findings in terms of the proposed essential hallmarks of cancer cells to better understand their role in oral oncogenesis.
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Affiliation(s)
- Ahmad A Abdulmajeed
- The University of Queensland, UQ Centre for Clinical Research, Herston, School of Dentistry, Brisbane, Australia
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95
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Seethalakshmi C. Early Detection of Oral Squamous Cell Carcinoma (OSCC) - Role of Genetics: A Literature Review. J Clin Diagn Res 2013; 7:1824-6. [PMID: 24086928 DOI: 10.7860/jcdr/2013/5552.3281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/28/2013] [Indexed: 11/24/2022]
Affiliation(s)
- C Seethalakshmi
- Senior Lecturer, (Oral Medicine and Radiology) Chettinad Dental College and Research Institute , Kelambakkam, Chennai, Tamil Nadu, India
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96
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Balasundaram I, Payne KFB, Al-Hadad I, Alibhai M, Thomas S, Bhandari R. Is there any benefit in surgery for potentially malignant disorders of the oral cavity? J Oral Pathol Med 2013; 43:239-44. [DOI: 10.1111/jop.12088] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- I. Balasundaram
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - K. F. B. Payne
- Department of Oral and Maxillofacial Surgery; Kings College Hospital; London UK
| | - I. Al-Hadad
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - M. Alibhai
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - S. Thomas
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - R. Bhandari
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
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97
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Nankivell P, Williams H, Matthews P, Suortamo S, Snead D, McConkey C, Mehanna H. The binary oral dysplasia grading system: validity testing and suggested improvement. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:87-94. [PMID: 23217539 DOI: 10.1016/j.oooo.2012.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/09/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES A binary system is reputed to be superior to the World Health Organization (WHO) system in grading oral dysplasia. We aimed to validate its reproducibility and prognostic ability and examine whether it could be improved. STUDY DESIGN Three pathologists graded 141 oral epithelial dysplasia biopsies with the use of both systems. Observer variability and prognostic ability were assessed with the use of kappa and logistic regression models. RESULTS The binary system showed superior agreement to the WHO system (multirater kappa 0.59 vs. 0.49, respectively) but similar prognostic ability (odds ratio [OR] 4.59 [P = .014] vs. OR 2.25 [P = .02], respectively). Adding smoking and alcohol slightly improved the prognostic ability of both systems (OR 5.10 vs. OR 2.42, respectively). Our new binary system with a refined diagnostic threshold demonstrated a slightly greater prognostic ability and improved ability to differentiate between high- and low-risk moderate dysplasia cases. CONCLUSIONS The binary system has similar prognostic ability but superior reproducibility compared with the WHO system. Prognostication is improved still further by using a new threshold.
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Affiliation(s)
- Paul Nankivell
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
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98
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Prospective, blinded comparison of cytology and DNA-image cytometry of brush biopsies for early detection of oral malignancy. Oral Oncol 2013; 49:420-6. [DOI: 10.1016/j.oraloncology.2012.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/10/2012] [Accepted: 12/16/2012] [Indexed: 02/02/2023]
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99
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Giaretti W, Monteghirfo S, Pentenero M, Gandolfo S, Malacarne D, Castagnola P. Chromosomal instability, DNA index, dysplasia, and subsite in oral premalignancy as intermediate endpoints of risk of cancer. Cancer Epidemiol Biomarkers Prev 2013; 22:1133-41. [PMID: 23629518 DOI: 10.1158/1055-9965.epi-13-0147] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chromosomal instability and aneuploidy may represent biomarkers of oral exposure to damaging agents and early signs of clinical disease according to the theory of "oral field cancerization." METHODS The hypothesis was tested that the DNA index (DI) values, obtained by high-resolution DNA flow cytometry (DNA-FCM), may potentially contribute to oral cancer risk prediction. For this purpose, the DI of oral fields of normal-appearing mucosa and oral potentially malignant disorders (OPMDs) in 165 consecutive patients was tested for association with dysplasia and/or the oral subsites of tongue and floor of the mouth taken as high-risk intermediate endpoints surrogate of cancer clinical endpoints. The association was evaluated by logistic regression using patient gender, age, tobacco, cigarette smoking habit, and alcohol abuse as confounding variables. RESULTS Different DI models provided evidence of statistical significant associations. Subdividing the DI values in diploid, near-diploid aneuploid, and high or multiple aneuploid from both OPMDs and oral normal-appearing mucosa, ORs, respectively, of 1, 4.3 (P = 0.001), and 18.4 (P < 0.0005) were obtained. CONCLUSION Routine DI analysis by high-resolution DNA-FCM seems potentially useful to complement dysplasia and subsite analysis for assessment of oral cancer risk prediction and for a better management of the patients with OPMDs. Work is in progress to validate the present findings in a prospective study with clinical endpoints. IMPACT Identifying DNA abnormalities in oral premalignancy may lead to biomarkers of oral exposure and cancer risk and potentially to more effective prevention measures.
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100
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de Vicente JC, Rodrigo JP, Rodriguez-Santamarta T, Lequerica-Fernández P, Allonca E, García-Pedrero JM. Podoplanin expression in oral leukoplakia: tumorigenic role. Oral Oncol 2013; 49:598-603. [PMID: 23473850 DOI: 10.1016/j.oraloncology.2013.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/06/2013] [Accepted: 02/14/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Recent studies have identified podoplanin, a mucin-type transmembrane glycoprotein, as a biomarker for oral cancer risk in patients with oral leukoplakia (OPL). The aim of this study was to investigate the potential association between podoplanin and the risk of malignant transformation of OPL with epithelial dysplasia. MATERIALS AND METHODS In this retrospective study, podoplanin immunoexpression was analyzed in 58 patients with oral leukoplakia that showed epithelial dysplasia. Lesions with podoplanin expression in the basal and suprabasal layers of oral epithelium at one area or showing suprabasal expression at two or more areas were considered as positive. Association between podoplanin expression and oral cancer development was analyzed. RESULTS Twenty-two of the 58 lesions (38%) were classified as podoplanin-positive, and the remaining 36 (62%) lesions were considered podoplanin-negative. The expression of podoplanin was correlated with the grade of dysplasia (p<0.0005), and with the risk of progression to oral cancer (p<0.0005). In multivariate survival analysis, only premalignant oral lesions displaying positive podoplanin expression showed a significantly increased risk of developing an oral squamous cell carcinoma (hazard ratio=8.738, p=0.007). CONCLUSION Podoplanin could be a valuable biomarker for risk assessment of malignant transformation in patients with OPL along with histological assessment.
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Affiliation(s)
- Juan Carlos de Vicente
- Department of Oral and Maxillofacial Surgery, Facultad de Medicina, Universidad de Oviedo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
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