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Singh D, Aggarwal N, Minhas RS, Azad RK, Vasanthalakshmi MS, Thakur JS. Intraoral ultrasonography: an adjunct in oral onco-surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00023-1. [PMID: 38354851 DOI: 10.1016/j.otoeng.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To determine the precision and accuracy of intraoral sonography in assessing the depth of invasion in oral cancer. MATERIAL AND METHODS A prospective study was conducted in 30 cases of oral cancer. Subjects were subjected to computerised tomography and intraoral sonography before surgery. The depth of invasion assessed through clinical palpation and radiological tools was compared with surgical histopathology. RESULTS The depth of invasion assessed on clinical palpation and computerized tomography had statistically significant difference with histopathology whereas intraoral sonography didn't show any difference. The intraoral sonography and computerised tomography had comparable precision and accuracy, with a slight dominance of the computerised tomography in assessing the tumor's depth of invasion greater than 4 mm. However, intraoral sonography was more precise and accurate than computerised tomography in assessing the depth of invasion beyond 10 mm. CONCLUSION Intraoral sonography was found to be a reliable tool in the assessment of the depth of invasion in oral cancer. It can prove beneficial during surgery in achieving tumour-free surgical margins.
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Affiliation(s)
- Divyanshi Singh
- Dept of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, 171001. India
| | - Neeti Aggarwal
- Dept of Radiodiagnosis, Indira Gandhi Medical College, Shimla, HP 171001. India
| | - Ravinder S Minhas
- Dept of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, 171001. India
| | - Ramesh K Azad
- Dept of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, 171001. India
| | | | - Jagdeep S Thakur
- Dept of Otolaryngology-Head Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, HP, 171001. India.
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Ali S, Naveed A, Hussain I, Qazi J. Diagnosis and monitoring of hepatocellular carcinoma in Hepatitis C virus patients using attenuated total reflection Fourier transform infrared spectroscopy. Photodiagnosis Photodyn Ther 2023; 43:103677. [PMID: 37390855 DOI: 10.1016/j.pdpdt.2023.103677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Current diagnostic methods for assessment of hepatitis C virus related hepatocellular carcinoma and subsequent categorization of hepatocellular carcinoma into non-angio-invasive hepatocellular carcinoma and angio-invasive hepatocellular carcinoma, to establish appropriate treatment strategies, are costly, invasive and requires multiple screening steps. This demands alternative diagnostic approaches that are cost-effective, time-efficient, and minimally invasive, while maintaining their efficacy for screening of hepatitis c virus related hepatocellular carcinoma. In this study, we propose that attenuated total reflection Fourier transform infrared in conjunction with principal component analysis - linear discriminant analysis and support vector machine multivariate algorithms holds a potential as a sensitive tool for the detection of hepatitis C virus-related hepatocellular carcinoma and the subsequent categorization of hepatocellular carcinoma into non-angio-invasive hepatocellular carcinoma and angio-invasive hepatocellular carcinoma. METHODS Freeze-dried sera samples collected from 31 hepatitis c virus related hepatocellular carcinoma patients and 30 healthy individuals, were used to acquire mid-infrared absorbance spectra (3500-900 cm-1) using attenuated total reflection Fourier transform infrared. Chemometric machine learning techniques were utilized to build principal component analysis - linear discriminant analysis and support vector machine discriminant models for the spectral data of hepatocellular carcinoma patients and healthy individuals. Sensitivity, specificity, and external validation on blind samples were calculated. RESULTS Major variations were observed in the two spectral regions i.e., 3500-2800 and 1800-900 cm-1. IR spectral signatures of hepatocellular carcinoma were reliably different from healthy individuals. Principal component analysis - linear discriminant analysis and support vector machine models computed 100% accuracy for diagnosing hepatocellular carcinoma. To classify the non-angio-invasive hepatocellular carcinoma/ angio-invasive hepatocellular carcinoma status, diagnostic accuracy of 86.21% was achieved for principal component analysis - linear discriminant analysis. While the support vector machine showed a training accuracy of 98.28% and a cross-validation accuracy of 82.75%. External validation for support vector machine based classification observed 100% sensitivity and specificity for accurately classifying the freeze-dried sera samples for all categories. CONCLUSIONS We present the specific spectral signatures for non-angio-invasive hepatocellular carcinoma and angio-invasive hepatocellular carcinoma, which were prominently differentiated from healthy individuals. This study provides an initial insight into the potential of attenuated total reflection Fourier transform infrared to diagnose hepatitis C virus related hepatocellular carcinoma but also to further categorize into non-angio-invasive and angio-invasive hepatocellular carcinoma.
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Affiliation(s)
- Salmann Ali
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Ammara Naveed
- Department of gastroenterology and hepatology, Pakistan Kidney and Liver Institute, Lahore, Pakistan
| | - Irshad Hussain
- Department of Chemistry &Chemical Engineering, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences (LUMS), DHA, Lahore Cantt 54792, Pakistan
| | - Javaria Qazi
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.
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González-Ruiz I, Ramos-García P, Ruiz-Ávila I, González-Moles MÁ. Early Diagnosis of Oral Cancer: A Complex Polyhedral Problem with a Difficult Solution. Cancers (Basel) 2023; 15:3270. [PMID: 37444379 DOI: 10.3390/cancers15133270] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Oral and oropharyngeal cancers are a growing problem, accounting for 377,713 and 98,412 new cases per year all over the world and 177,757 and 48,143 deaths annually, respectively. Despite the substantial improvement in diagnostic procedures and treatment techniques in recent years, the mortality rate has not decreased substantially in the last 40 years, which is still close to 50% of cases. The major cause responsible for this high mortality is associated with the high percentage of oral cancers diagnosed in advanced stages (stages III and IV) where the treatment harbors poor efficacy, resulting in challenges, mutilations, or disability. The main reason for cancer to be diagnosed at an advanced stage is a diagnostic delay, so it is critical to reduce this delay in order to improve the prognosis of patients suffering from oral cancer. The causes of oral cancer diagnostic delay are complex and concern patients, healthcare professionals, and healthcare services. In this manuscript, oral cancer diagnostic delay is critically reviewed based on current evidence, as well as their major causes, main problems, and potential improvement strategies.
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Affiliation(s)
- Isabel González-Ruiz
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Isabel Ruiz-Ávila
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Hospital Universitario San Juan de Reus, CAP Marià Fortuny, 43204 Tarragona, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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4
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Mavedatnia D, Cuddy K, Klieb H, Blanas N, Goodman J, Gilbert M, Eskander A. Oral cancer screening knowledge and practices among dental professionals at the University of Toronto. BMC Oral Health 2023; 23:343. [PMID: 37254183 DOI: 10.1186/s12903-023-03062-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Opportunistic oral cancer screening during visits to the dentist is a non-invasive and accessible option for detection of pre-malignant lesions and early-stage malignancies. The objective of this study was to investigate the knowledge, practices, and attitudes towards oral cancer screening among dentists. METHODS A 42-item survey was sent to 650 dental professionals affiliated with the University of Toronto. Data regarding training/practice characteristics, knowledge of oral cavity cancer, current screening practices, attitudes towards screening, and remuneration were collected. RESULTS Ninety-one dentists responded. Most obtained their dental degree from Canada (71.4%) and were practicing in large urban centers (87.9%). Most dentists correctly identified the oral tongue (87.8%) and floor of mouth (80%) as the two of most common sites of oral cavity cancer but only 56% correctly identified the most common presentation. 91% performed intra/extra oral examinations at every patient visit. Only 9.9% of dentists discussed the risk factors of oral cancer and 33% were not familiar with resources for smoking cessation and alcohol abuse. International medical graduates were more likely to discuss risk factor management than Canadian medical graduates (p < 0.01). Over 80% of dentists referred to a specialist when a suspected lesion was found. The greatest barrier for oral cancer screening was lack of time. Almost all dentists (98.8%) reported that their screening practices do not differ depending on the patient's insurance status and 63.8% reported compensation would not influence their decision to perform oral examinations. CONCLUSION Most dentists have a good knowledge of the presentation and risk factors associated with oral cavity cancer. Most dentists perform screening with every patient, with no influence from compensation and insurance status. Dentists are therefore an excellent first contact for oral cavity cancer screening for the general public and for high-risk populations.
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Affiliation(s)
| | - Karl Cuddy
- Division of Oral and Maxillofacial Surgery, University of Toronto, Mount Sinai, Princess Margaret and Humber River Hospitals, Toronto, ON, Canada
| | - Hagen Klieb
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Nick Blanas
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Jade Goodman
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Melanie Gilbert
- Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Gomes RFT, Schmith J, de Figueiredo RM, Freitas SA, Machado GN, Romanini J, Carrard VC. Use of Artificial Intelligence in the Classification of Elementary Oral Lesions from Clinical Images. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20053894. [PMID: 36900902 PMCID: PMC10002140 DOI: 10.3390/ijerph20053894] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Artificial intelligence has generated a significant impact in the health field. The aim of this study was to perform the training and validation of a convolutional neural network (CNN)-based model to automatically classify six clinical representation categories of oral lesion images. METHOD The CNN model was developed with the objective of automatically classifying the images into six categories of elementary lesions: (1) papule/nodule; (2) macule/spot; (3) vesicle/bullous; (4) erosion; (5) ulcer and (6) plaque. We selected four architectures and using our dataset we decided to test the following architectures: ResNet-50, VGG16, InceptionV3 and Xception. We used the confusion matrix as the main metric for the CNN evaluation and discussion. RESULTS A total of 5069 images of oral mucosa lesions were used. The oral elementary lesions classification reached the best result using an architecture based on InceptionV3. After hyperparameter optimization, we reached more than 71% correct predictions in all six lesion classes. The classification achieved an average accuracy of 95.09% in our dataset. CONCLUSIONS We reported the development of an artificial intelligence model for the automated classification of elementary lesions from oral clinical images, achieving satisfactory performance. Future directions include the study of including trained layers to establish patterns of characteristics that determine benign, potentially malignant and malignant lesions.
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Affiliation(s)
- Rita Fabiane Teixeira Gomes
- Department of Oral Pathology, Faculdade de Odontologia, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil
| | - Jean Schmith
- Polytechnic School, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
- Technology in Automation and Electronics Laboratory—TECAE Lab, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
| | - Rodrigo Marques de Figueiredo
- Polytechnic School, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
- Technology in Automation and Electronics Laboratory—TECAE Lab, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
| | - Samuel Armbrust Freitas
- Department of Applied Computing, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
| | - Giovanna Nunes Machado
- Polytechnic School, University of Vale do Rio dos Sinos—UNISINOS, São Leopoldo 93022-750, Brazil
| | - Juliana Romanini
- Oral Medicine, Otorhynolaringology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-003, Brazil
| | - Vinicius Coelho Carrard
- Department of Oral Pathology, Faculdade de Odontologia, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil
- Oral Medicine, Otorhynolaringology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-003, Brazil
- TelessaudeRS, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 91501-970, Brazil
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Challenges in the Early Diagnosis of Oral Cancer, Evidence Gaps and Strategies for Improvement: A Scoping Review of Systematic Reviews. Cancers (Basel) 2022; 14:cancers14194967. [PMID: 36230890 PMCID: PMC9562013 DOI: 10.3390/cancers14194967] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Oral cancer presents a worldwide incidence of 377,713 new cases and 177,757 deaths per year (GLOBOCAN, IARC, WHO). Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and has a 5-year mortality rate close to 50%. We aim to better understand, based on the evidence, and to discuss in depth, the reasons for the diagnostic delay of oral cancer by reviewing systematic reviews and meta-analyses. We also aim to, identify gaps in evidence, recommend future lines of research that should be implemented, and formulate strategies for improvement. Abstract Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances—patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.
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Datta M, Guillaud M, Chaitanya N, Shyam N, Palat G, Kumari P, Rapelli V, Jn J, Kumari S, Broughton S, Sutcliffe S, Laronde DM. Use of DNA image cytometry in conducting oral cancer screening in rural India. Cytopathology 2022; 33:600-610. [PMID: 35713951 DOI: 10.1111/cyt.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Oral cancer screening can assist in the early detection of oral potentially malignant lesions (OPMLs) and prevention of oral cancers. It can be challenging for clinicians to differentiate OPMLs from benign conditions. Adjunct screening tools such as fluorescence visualization (FV) and DNA image cytometry (DNA-ICM) have shown success in identifying OPMLs in high-risk clinics. For the first time we aimed to assess these technologies into Indian rural settings and evaluate if these tools helped clinicians identify high-risk lesions during screening. METHODS Dental students and residents screened participants in five screening camps held in villages outside of Hyderabad, India, using extraoral, intraoral, and FV examinations. Lesion and normal tissue brushings were collected for DNA-ICM analysis and cytology. RESULTS Of the 1116 participants screened, 184 lesions were observed in 152 participants. Based on white light examination (WLE), 45 lesions were recommended for biopsy. Thirty-five were completed on site; 25(71%) were diagnosed with low-grade dysplasias (17 mild dysplasia, 8 moderate dysplasia) and the remaining 10 showed no signs of dysplasia. FV loss was noted in all but one dysplastic lesion and showed a sensitivity of 96% and specificity of 17%. Cytology combined with DNA-ICM had a 64% sensitivity and 86% specificity in detecting dysplasia. CONCLUSION DNA-ICM combined with cytology identified majority of dysplastic lesions and identified additional lesions, which were not considered high-risk during WLE to biopsy on site. Efforts to follow-up with these participants are ongoing. FV identified most high-risk lesions but added limited value over WLE.
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Affiliation(s)
- Madhurima Datta
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada.,Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Martial Guillaud
- Imaging Unit, Integrative Oncology, BC Cancer, 675 West 10th Avenue, Vancouver, B.C, V5Z 1L3, Canada.,Department of Statistics, The University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Ndvn Shyam
- Government Dental College, Osmania University, Hyderabad, India
| | - Gayatri Palat
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Priya Kumari
- Nizam's College, Department of Zoology, Hyderabad, India
| | - Vineela Rapelli
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Jagannath Jn
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | - Sanjeeva Kumari
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | | | - Simon Sutcliffe
- Two Worlds Cancer Collaboration Foundation, Kelowna, BC, Canada
| | - Denise M Laronde
- Faculty of Dentistry, University of British Columbia, Vancouver, Canada.,Cancer Control Research, BC Cancer, Vancouver, Canada
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Ahuja NA, Kedia SK, Ward KD, Pichon LC, Chen W, Dillon PJ, Navaparia H. Effectiveness of Interventions to Improve Oral Cancer Knowledge: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:479-498. [PMID: 33506408 DOI: 10.1007/s13187-021-01963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Oral cancer is prone to late-stage diagnosis, and subsequent low five-year survival rates. A small number of interventions or campaigns designed to enhance knowledge of risk factors and symptoms associated with oral cancer have been attempted in the UK, US, and some other countries. The purpose of this systematic review is to assess the effectiveness of interventions designed to improve oral cancer knowledge. We searched five databases to identify randomized controlled trials (RCTs) and non-randomized/quasi-experimental (NR/QE) studies targeting the general population or high-risk groups (tobacco users or alcohol consumers), aged ≥15 years, and reporting the outcomes of individual and/or community level interventions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. Adhering to PRISMA guidelines, 27 (eight RCTs and 19 NR/QE studies) of the 551 studies identified from the five databases met the inclusion criteria. All RCTs and nine NR/QE studies used either printed materials, health education sessions, multimedia aids, or some combinations of these tools. The other ten NR/QE studies were community-based and used mass media campaigns to increase oral cancer awareness. Overall, the majority of studies significantly improved oral cancer knowledge; however, heterogeneity in study design and variation in measurement tools made it difficult to compare outcomes. Findings suggest that individual and/or community level interventions are generally effective in increasing knowledge of oral cancer risk factors, signs and symptoms, and/or its early diagnosis and prevention strategies among the general population or high-risk groups. However, the long-term benefits of these interventions are understudied.
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Affiliation(s)
- Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Weiyu Chen
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hitesh Navaparia
- Department of Oral and Maxillofacial Surgery, Vaidik Dental College and Research Center, Daman, India
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Accuracy of liquid-based brush cytology and HPV detection for the diagnosis and management of patients with oropharyngeal and oral cancer. Clin Oral Investig 2021; 26:2587-2595. [PMID: 34839418 PMCID: PMC8898233 DOI: 10.1007/s00784-021-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 12/03/2022]
Abstract
Objectives This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment. Material and methods Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed. Results Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment. Conclusions Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment. Clinical relevance Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.
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Lin H, Chen H, Weng L, Shao J, Lin J. Automatic detection of oral cancer in smartphone-based images using deep learning for early diagnosis. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210141RR. [PMID: 34453419 PMCID: PMC8397787 DOI: 10.1117/1.jbo.26.8.086007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Oral cancer is a quite common global health issue. Early diagnosis of cancerous and potentially malignant disorders in the oral cavity would significantly increase the survival rate of oral cancer. Previously reported smartphone-based images detection methods for oral cancer mainly focus on demonstrating the effectiveness of their methodology, yet it still lacks systematic study on how to improve the diagnosis accuracy on oral disease using hand-held smartphone photographic images. AIM We present an effective smartphone-based imaging diagnosis method, powered by a deep learning algorithm, to address the challenges of automatic detection of oral diseases. APPROACH We conducted a retrospective study. First, a simple yet effective centered rule image-capturing approach was proposed for collecting oral cavity images. Then, based on this method, a medium-sized oral dataset with five categories of diseases was created, and a resampling method was presented to alleviate the effect of image variability from hand-held smartphone cameras. Finally, a recent deep learning network (HRNet) was introduced to evaluate the performance of our method for oral cancer detection. RESULTS The performance of the proposed method achieved a sensitivity of 83.0%, specificity of 96.6%, precision of 84.3%, and F1 of 83.6% on 455 test images. The proposed "center positioning" method was about 8% higher than that of a simulated "random positioning" method in terms of F1 score, the resampling method had additional 6% of performance improvement, and the introduced HRNet achieved slightly better performance than VGG16, ResNet50, and DenseNet169, with respect to the metrics of sensitivity, specificity, precision, and F1. CONCLUSIONS Capturing oral images centered on the lesion, resampling the cases in training set, and using the HRNet can effectively improve the performance of deep learning algorithm on oral cancer detection. The smartphone-based imaging with deep learning method has good potential for primary oral cancer diagnosis.
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Affiliation(s)
- Huiping Lin
- Zhejiang University School of Medicine, First Affiliated Hospital, Department of Stomatology, Hangzhou, China
| | - Hanshen Chen
- Zhejiang Institute of Communications, College of Intelligent Transportation, Hangzhou, China
| | - Luxi Weng
- Zhejiang University School of Medicine, First Affiliated Hospital, Department of Stomatology, Hangzhou, China
| | - Jiaqi Shao
- Zhejiang University School of Medicine, First Affiliated Hospital, Department of Stomatology, Hangzhou, China
| | - Jun Lin
- Zhejiang University School of Medicine, First Affiliated Hospital, Department of Stomatology, Hangzhou, China
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Cheung LC, Ramadas K, Muwonge R, Katki HA, Thomas G, Graubard BI, Basu P, Sankaranarayanan R, Somanathan T, Chaturvedi AK. Risk-Based Selection of Individuals for Oral Cancer Screening. J Clin Oncol 2021; 39:663-674. [PMID: 33449824 PMCID: PMC8189638 DOI: 10.1200/jco.20.02855] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated proof of principle for resource-efficient, risk-based screening through reanalysis of the Kerala Oral Cancer Screening Trial. METHODS The cluster-randomized trial included three triennial rounds of visual inspection (seven clusters, n = 96,516) versus standard of care (six clusters, n = 95,354) and up to 9 years of follow-up. We developed a Cox regression-based risk prediction model for oral cancer incidence. Using this risk prediction model to adjust for the oral cancer risk imbalance between arms, through intention-to-treat (ITT) analyses that accounted for cluster randomization, we calculated the relative (hazard ratios [HRs]) and absolute (rate differences [RDs]) screening efficacy on oral cancer mortality and compared screening efficiency across risk thresholds. RESULTS Oral cancer mortality was reduced by 27% in the screening versus control arms (HR = 0.73; 95% CI, 0.54 to 0.98), including a 29% reduction in ever-tobacco and/or ever-alcohol users (HR = 0.71; 95% CI, 0.51 to 0.99). This relative efficacy was similar across oral cancer risk quartiles (P interaction = .59); consequently, the absolute efficacy increased with increasing model-predicted risk-overall trial: RD in the lowest risk quartile (Q1) = 0.5/100,000 versus 13.4/100,000 in the highest quartile (Q4), P trend = .059 and ever-tobacco and/or ever-alcohol users: Q1 RD = 1.0/100,000 versus Q4 = 22.5/100,000; P trend = .026. In a population akin to the Kerala trial, screening of 100% of individuals would provide 27.1% oral cancer mortality reduction at number needed to screen (NNS) = 2,043. Restriction of screening to ever-tobacco and/or ever-alcohol users with no additional risk stratification would substantially enhance efficiency (43.4% screened for 23.3% oral cancer mortality reduction at NNS = 1,029), whereas risk prediction model-based screening of 50% of ever-tobacco and/or ever-alcohol users at highest risk would further enhance efficiency with little loss in program sensitivity (21.7% screened for 19.7% oral cancer mortality reduction at NNS = 610). CONCLUSION In the Kerala trial, the efficacy of oral cancer screening was greatest in individuals at highest oral cancer risk. These results provide proof of principle that risk-based oral cancer screening could substantially enhance the efficiency of screening programs.
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Affiliation(s)
- Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Kunnambath Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | | | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Gigi Thomas
- Regional Cancer Centre, Thiruvananthapuram, India
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Anil K. Chaturvedi
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Hosmani JV, Pujari VK, Kotrashetti VS, Nayak RS, Babji DV, Patanshetti SM. Comparison of the Efficacy of Sediment Cytology over Oral Brush Cytology in Oral Leukoplakia. Acta Cytol 2019; 64:368-374. [PMID: 31593966 DOI: 10.1159/000503216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/08/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A method called sediment cytology includes the investigation of smears arranged from the sediment of the biopsy specimen fixatives. The sediment from this fixative is used to prepare smears and provides a potentially rich source for cytological material. Investigation of the fixative sediment and understanding of the cytological picture with pertinent clinical and radiological information permits diagnosis in a few hours. AIM To evaluate the diagnostic efficacy of sediment cytology and oral brush cytology compared with histopathological findings in oral leukoplakia (OL) cases. METHODS Cytological smears were obtained from 30 clinically diagnosed OL lesions using 2 techniques: oral cytobrush and 10% formalin fixative sedimentation. Both smears were stained with Papanicolaou. Cytological smear evaluation was conducted with respect to cellularity, cell distribution, cellular clumping, and the presence of blood, debris, inflammatory cells, and microbial colonies. The cytopathological scores for all cases were compared between sediment and brush cytology and correlated with the histopathological diagnosis. For statistical analysis, the κ test and the Wilcoxon matched-pair test were used. RESULTS The cytobrush technique had a sensitivity of 83.3% for OL cases histopathologically diagnosed as severe dysplasia, while the sediment cytology technique had a sensitivity of 16.6%. For moderate/mild dysplasia cases, the cytobrush technique had a sensitivity of 7.7%, whereas the sediment technique showed no diagnostic sensitivity. CONCLUSION Based on the results from the present study, sediment cytology, unlike oral brush cytology, is not a useful screening tool for the preliminary diagnosis of potentially malignant oral lesions.
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Affiliation(s)
- Jagadish V Hosmani
- Oral Pathology Division, Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia,
| | - Vidya K Pujari
- Department of Oral Pathology, Maratha Mandal's NGH Institute of Dental Sciences and Research Center, Belgaum, India
| | - Vijayalaxmi S Kotrashetti
- Department of Oral Pathology, Maratha Mandal's NGH Institute of Dental Sciences and Research Center, Belgaum, India
| | - Ramakant S Nayak
- Department of Oral Pathology, Maratha Mandal's NGH Institute of Dental Sciences and Research Center, Belgaum, India
| | - Deepa V Babji
- Department of Oral Pathology, Maratha Mandal's NGH Institute of Dental Sciences and Research Center, Belgaum, India
| | - Smita M Patanshetti
- Department of Oral Pathology, Maratha Mandal's NGH Institute of Dental Sciences and Research Center, Belgaum, India
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Feasibility study: assessing the efficacy and social acceptability of using dental hygienist-therapists as front-line clinicians. Br Dent J 2018; 221:717-721. [PMID: 27932822 DOI: 10.1038/sj.bdj.2016.913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
Abstract
Background The oral health of the adult population has been improving in the United Kingdom decade upon decade. Over half of dental service activity in the National Health Service (NHS) is limited to a check-up without any further treatment. This raises a question as to whether check-ups could be provided by dental hygienist-therapists, rather than general dental practitioners. The aim of this study was to assess the feasibility of a definitive trial to evaluate the costs and effects of using dental hygienist-therapists to undertake the check-up.Methods/design Adult NHS patients were randomised into three arms in two dental practices: patients who only saw dental hygienist-therapists for a check-up, those that saw the general dental practitioner and dental hygienist-therapist alternatively and a control, where patients only saw the general dental practitioner for their check-up. The study ran for 15 months. The primary outcome measures of the study were patient recruitment, retention and fidelity. A parallel and embedded qualitative study was undertaken which recorded the views of participating patients to determine the social acceptability of the intervention.Results Sixty patients participated in the study. The initial recruitment rate for the study was 33.7%. This figure increased to over 82.1% when telephone calls or face-to-face recruitment was utilised. The retention rates were 60% for both the dental hygienist-therapist only group and the alternate general dental practitioner and dental hygienist-therapist group, compared to 70% for the general dental practitioner only group. Fifteen patients were interviewed in the qualitative study and supported a team approach to the provision of check-ups in the NHS. Conclusion This study demonstrates the feasibility of a definitive trial to evaluate the costs and effects of using dental-hygienist-therapists to undertake the check-up.
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Skandarajah A, Sunny SP, Gurpur P, Reber CD, D’Ambrosio MV, Raghavan N, James BL, Ramanjinappa RD, Suresh A, Kandasarma U, Birur P, Kumar VV, Galmeanu HC, Itu AM, Modiga-Arsu M, Rausch S, Sramek M, Kollegal M, Paladini G, Kuriakose M, Ladic L, Koch F, Fletcher D. Mobile microscopy as a screening tool for oral cancer in India: A pilot study. PLoS One 2017; 12:e0188440. [PMID: 29176904 PMCID: PMC5703562 DOI: 10.1371/journal.pone.0188440] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022] Open
Abstract
Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings.
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Affiliation(s)
- Arunan Skandarajah
- Department of Bioengineering, University of California, Berkeley, CA, United States of America
| | - Sumsum P. Sunny
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | | | - Clay D. Reber
- Department of Bioengineering, University of California, Berkeley, CA, United States of America
| | - Michael V. D’Ambrosio
- Department of Bioengineering, University of California, Berkeley, CA, United States of America
| | - Nisheena Raghavan
- Department of Pathology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | - Bonney Lee James
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Ravindra D. Ramanjinappa
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Amritha Suresh
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Uma Kandasarma
- Department of Oral and Maxillofacial Pathology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Praveen Birur
- Department of oral medicine and radiology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Vinay V. Kumar
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
| | | | | | | | | | | | | | - Gianluca Paladini
- Siemens Medical Solutions USA Inc., Princeton, NJ, United States of America
| | - Moni Kuriakose
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Lance Ladic
- Siemens Medical Solutions USA Inc., Princeton, NJ, United States of America
- * E-mail:
| | - Felix Koch
- Department of Oral and Maxillofacial Surgery–Plastic Surgery, University of Mainz, Mainz, Germany
| | - Daniel Fletcher
- Department of Bioengineering, University of California, Berkeley, CA, United States of America
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Camisasca DR, da Rós Gonçalves L, Soares MR, Sandim V, Nogueira FCS, Garcia CHS, Santana R, de Oliveira SP, Buexm LA, de Faria PAS, Dias FL, Pereira DDA, Zingali RB, Alves G, Lourenço SQC. A proteomic approach to compare saliva from individuals with and without oral leukoplakia. J Proteomics 2016; 151:43-52. [PMID: 27478070 DOI: 10.1016/j.jprot.2016.07.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oral leukoplakia is the most common potentially malignant disorder in the oral cavity and can precede carcinoma. This study aimed to identify possible oral leukoplakia salivary biomarkers. METHODS Unstimulated saliva was collected from participants and protein concentration was determined. Proteins were then precipitated with cold acetone and separated using 2DE over a pH range of 3-10. Spot demarcation and matching were performed and protein identification was done through MS analysis. Oral leukoplakia tissues were submitted to immunohistochemistry analysis for keratin 10 (CK10). A complementary analysis of oral leukoplakias that were not included previously was performed in addition. RESULTS 226±10 spots were identified in oral leukoplakia 2DE gels, and 262±12 spots were identified in volunteers. Twenty-two spots were highly abundant in oral leukoplakias or not detected in the control group, such as apolipoprotein A1, alpha amylase, cystatins, keratin 10, and lysozyme precursor. All were identified. All oral leukoplakia cases were immunopositive for CK10, mainly in the superficial epithelial layers. CONCLUSIONS The 2DE salivary protein profiles of individuals with and without oral leukoplakia were observably different. CK10 appears to be an interesting protein and should be further studied in oral carcinogenesis. SIGNIFICANCE MS-based proteomics enables large-scale analysis of proteins. Proteomics can provide detailed descriptions of proteomes of cells and tissues, including body fluids, and appears as a powerful tool to study human disorders. Saliva is readily accessible through non invasive collection and can mirror diverse disease states. Saliva from both diseased and healthy subjects can be analyzed through 2DE and differences between groups could be found. Routine immunohistochemistry analysis confirmed one of these findings, with CK10 being positive tissues from individuals with oral leukoplakia. Therefore, the present study allows insights into development of an important potential oral cancer precursor, named oral leukoplakia. However, the results can be extrapolated and tested in other precancer states, such as proliferative verrucous leukoplakia, patients at risk of oral cancer due to lifestyle behavior and/or cancer history in the family or even those who are under surveillance after a treated primary oral cancer.
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Affiliation(s)
- Danielle Resende Camisasca
- Oral Pathology, Federal Fluminense University (UFF), R. Marques de Paraná, 303/4° andar (Hospital Universitário Antônio Pedro), Centro Niterói, Brazil, CEP: 24033-900.
| | - Lorena da Rós Gonçalves
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Márcia Regina Soares
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Vanessa Sandim
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130; Laboratório de Hemostase e Venenos e Unidade de Espectrometria de Massas e Proteômica, Instituto de Bioquímica Médica, Programa de Biologia Estrutural, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, CCS Bloco H2 sala 04, Cidade Universitária, Rio de Janeiro, RJ, Brazil, CEP 21941-902.
| | - Fábio César Sousa Nogueira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Carlos Henrique Saraiva Garcia
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Av. Athos daSilveira, 149/541, Cidade Universitária, Rio deJaneiro, RJ, Brazil, CEP: 21941-909.
| | - Rodrigo Santana
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Silvia Paula de Oliveira
- Odontoclínica Central do Exército (OCEX), Praça da República, 123 - Centro, Rio de Janeiro, RJ, Brazil, CEP: 20211-340.
| | - Luisa Aguirre Buexm
- Oncology Graduate Program, Molecular Carcinogenesis Program, Research Center, Brazilian National Cancer Institute, Rua André Cavalcanti, 37, 6° andar, Centro, 20231-050 Rio de Janeiro, RJ, Brazil.
| | - Paulo Antônio Silvestre de Faria
- Pathology Division (Divisão de Patologia), Brazilian National Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Rio de Janeiro, RJ, Brazil, CEP:20220-400.
| | - Fernando Luiz Dias
- Head and Neck Surgery Department, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6°andar, Rio de Janeiro, RJ, Brazil, CEP:20230-130.
| | - Denise de Abreu Pereira
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Russolina B Zingali
- Rede Proteômica do Rio de Janeiro, Rio de Janeiro, Brazil; Laboratório de Hemostase e Venenos e Unidade de Espectrometria de Massas e Proteômica, Instituto de Bioquímica Médica, Programa de Biologia Estrutural, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, CCS Bloco H2 sala 04, Cidade Universitária, Rio de Janeiro, RJ, Brazil, CEP 21941-902.
| | - Gilda Alves
- Serviço de Hematologia, Laboratório de Genética Aplicada, Brazilian National Cancer Institute (INCA), Hospital do Câncer I, Praça da Cruz Vermelha, 23 - 6° andar, Rio de Janeiro, RJ, Brazil, CEP: 20230-130.
| | - Simone Queiroz Chaves Lourenço
- Oral Pathology, Federal Fluminense University (UFF), R. Marques de Paraná, 303/4° andar (Hospital Universitário Antônio Pedro), Centro Niterói, Brazil, CEP: 24033-900.
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The impact of GSTM1/GSTT1 polymorphism for the risk of oral cancer. Clin Oral Investig 2015; 19:1791-7. [PMID: 25595865 DOI: 10.1007/s00784-015-1400-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Since development of oral squamous cell cancer (OSCC) is triggered by various noxa, different variants of the antioxidant glutathione S-transferases (GSTs) can counteract toxic compounds (e.g., tobacco smoke). Because different polymorphisms of GST are known to have an increased sensitivity to carcinogenic agents, the aim of this study was to analyze whether GSTM1 or GSTT1 polymorphisms increase the risk for the development of OSCC. MATERIALS AND METHODS GSTM1 and GSTT1 polymorphism was examined in healthy volunteers (n = 93) and in patients with OSCC (n = 100) by PCR after brush biopsy of oral mucosa. Odds ratio (OR) was calculated to evaluate the risk of oral cancer development. RESULTS GSTM1 and GSTT1 deletion was found in 57% (53/93) and 18% (17/93), respectively, in healthy patients, while the OSCC group showed 57% (57/100) for GSTM1 deletion and 22% (22/100) with a deletion of GSTT1. Odds ratio for GSTM1 polymorphism was 1.00 and for GSTT1 1.26. Comparing smokers and nonsmokers with GSTM1 deletion polymorphism, OR was 4.35, while smokers without GSTM1 deletion showed an OR of 1.45. Adapting these data to the smoking habits of the general population in Germany, the OR was 9.25 for smokers with a GSTM1 deletion and OR 6.68 for smokers without a GSTM1 deletion. In smokers with GSTT1 deletion polymorphism, OR was 1.6 (adapted to the smoking habits of the general population: OR 6.16) and 3.16 (OR 8.56) in smokers without deletion in GSTT1 gene. CONCLUSIONS Analysis of GST-M1 polymorphism in smokers could help to identify patients with a higher risk for the development of oral cancer. CLINICAL RELEVANCE Early detection of OSCC due to a close meshed monitoring program for patients with GST-M1 polymorphism could help to improve the patient outcome. For polymorphism investigations, the oral brush biopsy is a sufficient method to gain DNA material.
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Hu F, Vishwanath K, Lo J, Erkanli A, Mulvey C, Lee WT, Ramanujam N. Rapid determination of oxygen saturation and vascularity for cancer detection. PLoS One 2013; 8:e82977. [PMID: 24358243 PMCID: PMC3865147 DOI: 10.1371/journal.pone.0082977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 11/01/2013] [Indexed: 01/22/2023] Open
Abstract
A rapid heuristic ratiometric analysis for estimating tissue hemoglobin concentration and oxygen saturation from measured tissue diffuse reflectance spectra is presented. The analysis was validated in tissue-mimicking phantoms and applied to clinical measurements in head and neck, cervical and breast tissues. The analysis works in two steps. First, a linear equation that translates the ratio of the diffuse reflectance at 584 nm and 545 nm to estimate the tissue hemoglobin concentration using a Monte Carlo-based lookup table was developed. This equation is independent of tissue scattering and oxygen saturation. Second, the oxygen saturation was estimated using non-linear logistic equations that translate the ratio of the diffuse reflectance spectra at 539 nm to 545 nm into the tissue oxygen saturation. Correlations coefficients of 0.89 (0.86), 0.77 (0.71) and 0.69 (0.43) were obtained for the tissue hemoglobin concentration (oxygen saturation) values extracted using the full spectral Monte Carlo and the ratiometric analysis, for clinical measurements in head and neck, breast and cervical tissues, respectively. The ratiometric analysis was more than 4000 times faster than the inverse Monte Carlo analysis for estimating tissue hemoglobin concentration and oxygen saturation in simulated phantom experiments. In addition, the discriminatory power of the two analyses was similar. These results show the potential of such empirical tools to rapidly estimate tissue hemoglobin in real-time spectral imaging applications.
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Affiliation(s)
- Fangyao Hu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Karthik Vishwanath
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Justin Lo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Christine Mulvey
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Walter T. Lee
- Division of Otolaryngology–Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
- Section of Otolaryngology–Head and Neck Surgery, Veterans Administration Medical Center, Durham, North Carolina, United States of America
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
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Brocklehurst P, Kujan O, O'Malley LA, Ogden G, Shepherd S, Glenny AM. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev 2013; 2013:CD004150. [PMID: 24254989 PMCID: PMC8078625 DOI: 10.1002/14651858.cd004150.pub4] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population-based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. OBJECTIVES To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 22 July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 22 July 2013), EMBASE via OVID (1980 to 22 July 2013) and CANCERLIT via PubMed (1950 to 22 July 2013). There were no restrictions on language in the search of the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We used mean differences (MDs) and 95% confidence intervals (CIs) for continuous data and risk ratios (RRs) with 95% CIs for dichotomous data. Meta-analyses would have been undertaken using a random-effects model if the number of studies had exceeded a minimum of three. Study authors were contacted where possible and where deemed necessary for missing information. MAIN RESULTS A total of 3239 citations were identified through the searches. Only one RCT, with 15-year follow-up met the inclusion criteria (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the oral cancer mortality rates for the screened group (15.4/100,000 person-years) and the control group (17.1/100,000 person-years), with a RR of 0.88 (95% CI 0.69 to 1.12). A 24% reduction in mortality was reported between the screening group (30/100,000 person-years) and the control group (39.0/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant (RR 0.76; 95% CI 0.60 to 0.97). No statistically significant differences were found for incidence rates. A statistically significant reduction in the number of individuals diagnosed with stage III or worse oral cancer was found for those in the screening group (RR 0.81; 95% CI 0.70 to 0.93). No harms were reported. The study was assessed as at high risk of bias. AUTHORS' CONCLUSIONS There is evidence that a visual examination as part of a population-based screening programme reduces the mortality rate of oral cancer in high-risk individuals. In addition, there is a stage shift and improvement in survival rates across the population as a whole. However, the evidence is limited to one study, which has a high risk of bias and did not account for the effect of cluster randomisation in the analysis. There was no evidence to support the use of adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging as a screening tool to reduce oral cancer mortality. Further RCTs are recommended to assess the efficacy and cost-effectiveness of a visual examination as part of a population-based screening programme in low, middle and high-income countries.
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Affiliation(s)
- Paul Brocklehurst
- School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, UK, M13 9PL
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Löhler J, Gerstner AOH, Bootz F, Walther LE. Incidence and localization of abnormal mucosa findings in patients consulting ENT outpatient clinics and data analysis of a cancer registry. Eur Arch Otorhinolaryngol 2013; 271:1289-97. [PMID: 24114062 DOI: 10.1007/s00405-013-2738-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Abstract
For patients without symptoms and at risk, there is no established early detection program to discover carcinomas of the upper aerodigestive tract in the sense of secondary prevention. Such type of prevention seems even more desirable because the chances for a cure and the quality of life are strongly dependent on the stage of the tumor and the time of the initial diagnosis. Six hundred and eight patients without symptoms but at least one of the self-reported risk factors "smoking", "alcohol consumption" or "reflux" were examined with an endoscope or an optical microscope for pathological findings in the upper aerodigestive tract once a year. In addition, the incidence of malignancies of the upper aerodigestive tract between 2001 and 2010 was determined through the Cancer Registry of Schleswig-Holstein. Tissue samples were taken from 18 of the 608 patients. Eleven patients (1.8%) had a squamous cell carcinoma. Another patient suffered from non-Hodgkin's lymphoma and one from larynx tuberculosis. The ratio of detected malignancies in the oral cavity and the oropharynx on the one hand and the hypopharynx and larynx, which can only be examined by endoscopes, on the other hand were in our cohorts and in our survey according to the cancer registry was 5/6. The above-described methods allow examining risk patients easily and safely. According to current publications, the ratio of the found malignancies exceeds the expected ratio significantly, which presumably was caused by the examination targeting patients at risk. Due to the expanded examination area using optical instruments more than doubles the rate of discoverable malignancies compared to the limitations posed by the examination of directly visible areas of the oral cavity of the oropharynx.
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Affiliation(s)
- J Löhler
- Research Institute for Applied Otolaryngology (WIAHNO) of the German Professional Association of Otolaryngologists e. V., Maienbeeck 1, 24576, Bad Bramstedt, Germany,
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Primary care, the dental profession, and the prevalence of chronic diseases in the United States. Dent Clin North Am 2013; 56:699-730. [PMID: 23017547 DOI: 10.1016/j.cden.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The population of the United States is aging rapidly, and the prevalence of chronic diseases will increase as the population grows and ages. The management of chronic illnesses will become an increasing burden for primary care providers. This article suggests that dentists may need to monitor chronic disease and control the risk factors (ie, provide primary care) for their own dental patients.
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Bhoopathi V, Mascarenhas AK. Utility of oral cancer diagnostic adjuncts in the adult US populations. J Oral Pathol Med 2012. [DOI: 10.1111/jop.12027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vinodh Bhoopathi
- Department of Cariology and Restorative Sciences; Nova Southeastern University College of Dental Medicine; Fort Lauderdale FL USA
| | - Ana Karina Mascarenhas
- Chief of Developmental Sciences; Nova Southeatern University College of Dental Medicine; Fort Lauderdale FL USA
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Langevin SM, Michaud DS, Eliot M, Peters ES, McClean MD, Kelsey KT. Regular dental visits are associated with earlier stage at diagnosis for oral and pharyngeal cancer. Cancer Causes Control 2012; 23:1821-9. [PMID: 22961100 DOI: 10.1007/s10552-012-0061-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Oral and pharyngeal cancer patients diagnosed at an advanced stage experience increased morbidity and mortality relative to those with localized disease. The aim of this study was to assess the impact of dental insurance status and regularity of dental visits on early detection of oral and pharyngeal cancer. METHODS We examined the relationship of dental insurance and frequency of dental visits with stage at diagnosis among 441 oral and pharyngeal cancer cases from a population-based study of head and neck cancer. Ordinal logistic regression models were used to assess the association with stage, and tumor (T) and nodal (N) classification. RESULTS Never or rarely going to the dentist was associated with being diagnosed at higher stage for oral and pharyngeal cancer (cumulative OR = 2.28, 95 % CI: 1.02-5.10) and oral cancer (cumulative OR = 9.17, 95 % CI: 2.70-31.15) compared to those going to the dentist at least annually. Oral and pharyngeal cancer patients who went to the dentist infrequently (cumulative OR = 1.82, 95 % CI: 1.09-3.05) or rarely/never (cumulative OR = 3.24, 95 % CI: 1.59-6.57) were diagnosed with a higher T classification compared with those who went at least annually. CONCLUSIONS Receipt of regular dental examinations at least annually may reduce the public health burden of oral and pharyngeal cancer by facilitating earlier detection of the disease.
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Affiliation(s)
- Scott M Langevin
- Department of Epidemiology, Brown University, 70 Ship Street, Box G-E5, Providence, RI 02912, USA
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Sankaranarayanan R, Sauvaget C, Ramadas K, Ngoma T, Teguete I, Muwonge R, Naud P, Nessa A, Kuhaprema T, Qiao Y. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare. Ann Oncol 2011; 22 Suppl 7:vii20-vii28. [DOI: 10.1093/annonc/mdr422] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mehrotra R, Gupta DK. Exciting new advances in oral cancer diagnosis: avenues to early detection. HEAD & NECK ONCOLOGY 2011; 3:33. [PMID: 21798030 PMCID: PMC3170277 DOI: 10.1186/1758-3284-3-33] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 07/28/2011] [Indexed: 12/11/2022]
Abstract
The prognosis for patients with oral squamous cell carcinoma remains poor in spite of advances in therapy of many other malignancies. Early diagnosis and treatment remains the key to improved patient survival. Because the scalpel biopsy for diagnosis is invasive and has potential morbidity, it is reserved for evaluating highly suspicious lesions and not for the majority of oral lesions which are clinically not suspicious. Furthermore, scalpel biopsy has significant interobserver and intraobserver variability in the histologic diagnosis of dysplasia. There is an urgent need to devise critical diagnostic tools for early detection of oral dysplasia and malignancy that are practical, noninvasive and can be easily performed in an out-patient set-up. Diagnostic tests for early detection include brush biopsy, toluidine blue staining, autofluorescence, salivary proteomics, DNA analysis, biomarkers and spectroscopy. This state of the art review critically examines these tests and assesses their value in identifying oral squamous cell carcinoma and its precursor lesions.
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Affiliation(s)
- Ravi Mehrotra
- Department of Pathology, Moti Lal Nehru Medical College, Lowther Road Allahabad, 211001 India
| | - Dwijendra K Gupta
- Department of Biochemistry and Coordinator-Chair, Center of Bioinformatics, University of Allahabad, Allahabad, 211001 India
- Present Address: Department of Biochemistry, University of Bologna, Italy
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Morse DE, Vélez Vega CM, Psoter WJ, Vélez H, Buxó CJ, Baek LS, Elias A, Ayendez MS. Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study. BMC Public Health 2011; 11:391. [PMID: 21612663 PMCID: PMC3125369 DOI: 10.1186/1471-2458-11-391] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/26/2011] [Indexed: 01/22/2023] Open
Abstract
Background In Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions. Methods Key informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations. Results Key informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients. Conclusions Addressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.
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Affiliation(s)
- Douglas E Morse
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 250 Park Avenue South, Room 633, MC: 9479, New York, NY 10003-1402, USA.
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Steele TO, Meyers A. Early detection of premalignant lesions and oral cancer. Otolaryngol Clin North Am 2011; 44:221-9, vii. [PMID: 21093631 DOI: 10.1016/j.otc.2010.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cancers of the oral cavity account for approximately 3% of malignancies diagnosed annually in the United States. As with other upper aerodigestive tract cancers, 5-year survival rates for oral cavity cancers decrease with delayed diagnosis. Cancers of the oral cavity are thought to progress from premalignant/precancerous lesions, beginning as hyperplastic tissue and developing into invasive squamous cell carcinoma. Despite the general accessibility of the oral cavity during physical examination, many malignancies are not diagnosed until late stages of disease. To prevent malignant transformation of these oral precursor lesions, multiple screening and detection techniques have been developed to address this problem.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA.
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Brocklehurst P, Kujan O, Glenny AM, Oliver R, Sloan P, Ogden G, Shepherd S. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev 2010:CD004150. [PMID: 21069680 DOI: 10.1002/14651858.cd004150.pub3] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. OBJECTIVES To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH STRATEGY The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 20 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 20 May 2010), EMBASE via OVID (1980 to 20 May 2010) and CANCERLIT via PubMed (1950 to 20 May 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS The original review identified 1389 citations and this update identified an additional 330 studies, highlighting 1719 studies for consideration. Only one study met the inclusion criteria and validity assessment, data extraction and statistics evaluation were undertaken by six independent review authors. MAIN RESULTS One 9-year RCT has been included (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). A 43% reduction in mortality was reported between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant. However, this study had a number of methodological weaknesses and the associated risk of bias was high. AUTHORS' CONCLUSIONS Although there is evidence that a visual examination as part of a population based screening programme reduced the mortality rate of oral cancer in high-risk individuals, whilst producing a stage shift and improvement in survival rates across the population as a whole, the evidence is limited to one study and is associated with a high risk of bias. This was compounded by the fact that the effect of cluster randomisation was not accounted for in the analysis. Furthermore, no robust evidence was identified to support the use of other adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging within a primary care environment. Further randomised controlled trials are recommended to assess the efficacy, effectiveness and cost-effectiveness of a visual examination as part of a population based screening programme.
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Affiliation(s)
- Paul Brocklehurst
- Department of Dental Public Health & Primary Care, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
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Gerstner AOH. Early detection in head and neck cancer - current state and future perspectives. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2010; 7:Doc06. [PMID: 22073093 PMCID: PMC3199835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Survival and quality of life in head and neck cancer are directly linked to the size of the primary tumor at first detection. In order to achieve substantial gain at these issues, both, primary prevention and secondary prevention, which is early detection of malignant lesions at a small size, have to be improved. So far, there is not only a lack in the necessary infrastructure not only in Germany, but rather worldwide, but additionally the techniques developed so far for early detection have a significance and specificity too low as to warrant safe implementation for screening programs. However, the advancements recently achieved in endoscopy and in quantitative analysis of hypocellular specimens open new perspectives for secondary prevention. Chromoendoscopy and narrow band imaging (NBI) pinpoint suspicious lesions more easily, confocal endomicroscopy and optical coherence tomography obtain optical sections through those lesions, and hyperspectral imaging classifies lesions according to characteristic spectral signatures. These techniques therefore obtain optical biopsies. Once a "bloody" biopsy has been taken, the plethora of parameters that can be quantified objectively has been increased and could be the basis for an objective and quantitative classification of epithelial lesions (multiparametric cytometry, quantitative histology). Finally, cytomics and proteomics approaches, and lab-on-the-chip technology might help to identify patients at high-risk. Sensitivity and specificity of these approaches have to be validated, yet, and some techniques have to be adapted for the specific conditions for early detection of head and neck cancer. On this background it has to be stated that it is still a long way to go until a population based screening for head and neck cancer is available. The recent results of screening for cancer of the prostate and breast highlight the difficulties implemented in such a task.
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Demographics and efficacy of head and neck cancer screening. Otolaryngol Head Neck Surg 2010; 143:353-60. [PMID: 20723771 DOI: 10.1016/j.otohns.2010.05.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/04/2010] [Accepted: 05/25/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was designed to 1) describe the demographics and 2) determine the efficacy of a head and neck cancer screening program to optimize future programs. STUDY DESIGN Database analysis plus chart review. SETTING Tertiary care academic medical center. SUBJECTS AND METHODS After Institutional Review Board approval, we reviewed our 14-year experience (1996-2009) conducting a free annual head and neck cancer screening clinic. Available demographic and clinical data, as well as clinical outcomes, were analyzed for all participants (n = 761). The primary outcome was the presence of a finding suspicious for head and neck cancer on screening evaluation. RESULTS Five percent of participants had findings suspicious for head and neck cancer on screening evaluation, and malignant or premalignant lesions were confirmed in one percent of participants. Lack of insurance (P = 0.05), tobacco use (P < 0.001), male gender (P = 0.03), separated marital status (P = 0.03), and younger age (P = 0.04) were the significant demographic predictors of a lesion suspicious for malignancy. Patients complaining of a neck mass (P < 0.001) or oral pain (P < 0.001) were significantly more likely to have findings suspicious of malignancy. A high percentage (40%) was diagnosed with benign otolaryngologic pathologies on screening evaluation. CONCLUSION A minority of patients presenting to a head and neck cancer screening clinic will have a suspicious lesion identified. Given these findings, to achieve maximal potential benefit, future head and neck cancer screening clinics should target patients with identifiable risk factors and take full advantage of opportunities for education and prevention.
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Shanmugham JR, Zavras AI, Rosner BA, Giovannucci EL. Alcohol-folate interactions in the risk of oral cancer in women: a prospective cohort study. Cancer Epidemiol Biomarkers Prev 2010; 19:2516-24. [PMID: 20841386 DOI: 10.1158/1055-9965.epi-10-0499] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this cohort study was to quantify the effect of alcohol on the risk of oral cancer in different strata of folate intake, controlling for known confounders. METHODS A cohort of 87,621 women in the Nurses' Health Study was followed up from 1980 to 2006, and 147 incident oral cancer cases were reported and confirmed. Data on alcohol intake and diet were obtained through self-reported food frequency questionnaires every 4 years. Cox proportional regression analysis was conducted to estimate the adjusted risk ratios (RR) and 95% confidence intervals (95% CI). RESULTS When compared with nondrinkers, the adjusted RRs (95% CIs) for alcohol intake were 0.59 (0.39-0.87) for 0.1-14.9 g/d, 1.15 (0.67-1.97) for 15-29.9 g/d, and 1.92 (1.08-3.40) for ≥30 g/d. We observed a significant interaction between alcohol and folate intakes (P = 0.02). The cancer risk for subjects with high alcohol (≥30 g/d) and low folate (<350 μg/d) intakes was significantly elevated (RR, 3.36; 95% CI, 1.57-7.20) as compared with nondrinkers with low folate intake. The risk associated with high alcohol intake (≥30 g/d) was reduced to 0.98 (0.35-2.70) in the high-folate (≥350 μg/d) group as compared with nondrinkers with high folate intake. CONCLUSIONS High alcohol intake is associated with significantly increased oral cancer risk, especially in women with low folate intake. IMPACT A significant interaction between alcohol and folate intakes seems to affect oral cancer risk in women, a finding with potential public health utility.
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Reychler H, Weynand B. [Screening and diagnosis of precancerous oral mucosa lesions]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2010; 111:203-7. [PMID: 20797741 DOI: 10.1016/j.stomax.2010.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
The screening and early diagnosis of cancerous oral mucosa lesions are still key elements for a better prognosis. Therefore, it is of tremendous importance to try to determine how and when to diagnose precancerous oral mucosa lesions. Usually, clinical examination data must be completed by a pathological examination. This study, based on an exhaustive literature review, has for purpose to determine the sensitivity and specificity of complementary diagnostic tools currently available.
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Affiliation(s)
- H Reychler
- Service de stomatologie et chirurgie maxillo-faciale, cliniques universitaires Saint-Luc, université catholique de Louvain, 10, avenue Hippocrate, B-1200, Bruxelles, Belgique.
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Koch FP, Kaemmerer PW, Biesterfeld S, Kunkel M, Wagner W. Effectiveness of autofluorescence to identify suspicious oral lesions--a prospective, blinded clinical trial. Clin Oral Investig 2010; 15:975-82. [PMID: 20714910 DOI: 10.1007/s00784-010-0455-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 07/26/2010] [Indexed: 12/30/2022]
Abstract
Regular screening through white light inspection of the entire oral mucosa is the most important examination method to identify precancerous lesions and early oral carcinoma. Additionally, the physiologic autofluorescence of the oral mucosa has been described as a novel screening method for the detection of mucosal lesions that are not visible by white light. This study aimed to evaluate the sensitivity and specificity of the autofluorescence examination. Seventy-eight patients were examined in this study. All of them suffered from suspicious oral mucosal lesions. Two different investigation methods were applied: the standard examination by white light and an examination by a novel light source of 400 nm that evoked a green light emission (>500 nm) in normal mucosa. It was proposed that malignant oral mucosal lesions show different autofluorescence characteristics than the green autofluorescence of healthy mucosa. Red autofluorescence indicated SCC with a sensitivity of 20% and a specificity of 98%. The results showed that dysplasia and carcinoma could be identified with a sensitivity of 96% and a specificity of 18% by using the autofluorescence method. The sensitivity decreased according to the grade of mucosal keratosis and was influenced by the localisation of the lesion. In conclusion, benign as well as malignant oral lesions could not be distinguished by a diminished autofluorescence signal. A red autofluorescence signal, however, could indicate cancerous processes of the oral mucosa.
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Affiliation(s)
- Felix Peter Koch
- Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Lingen MW. Pragmatics versus contrarians: how does one resolve their differences with respect to oral cancer screening? ACTA ACUST UNITED AC 2010; 109:325-6. [PMID: 20219595 DOI: 10.1016/j.tripleo.2009.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Predictor, forecaster or augur. J Am Dent Assoc 2010; 141:825-6. [DOI: 10.14219/jada.archive.2010.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Diagnostic efficiency of differentiating small cancerous and precancerous lesions using mucosal brush smears of the oral cavity--a prospective and blinded study. Clin Oral Investig 2010; 15:763-9. [PMID: 20593209 DOI: 10.1007/s00784-010-0434-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 06/07/2010] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the diagnostic accuracy of oral brush biopsy to identify early malignancy. One hundred and eighty-six brush biopsies of suspicious mucosal lesions were obtained, haematoxilin and eosin (H&E)-stained and compared with the histology of conventional excision biopsies of the same site performed concomitantly. The sensitivity for identifying squamous cell carcinoma (SCC) was 88.5%. High-risk lesions including squamous intraepithelial neoplasia (SIN II, SIN III) and SCC were identified with a sensitivity of 86.4%, using a pap-analogous classification, which is considered to be carcinomatous, as well as moderate and severe dysplastic cells positive. Depending on the cytopathologic definition for malignancy and the tumour size, the test accuracy varied: Extending the cytopathologic criteria for malignancy by defining all dysplastic or malignant cytopathologic findings as positive, the sensitivity was increased to 95.2% at the expense of the specificity, which was reduced from 94.9% to 82.3%. Separately analysing SCCs of less than 20 mm, the sensitivity was reduced by 9.5% to 78%. Although small malignant lesions seem to be less reliable by the conventional oral brush biopsy, it is a useful screening instrument for early diagnosis of suspicious, epithelial lesions and could therefore contribute to improved cancer prognosis.
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Evidence-Based Clinical Recommendations Regarding Screening for Oral Squamous Cell Carcinomas. J Am Dent Assoc 2010; 141:509-20. [PMID: 20436098 DOI: 10.14219/jada.archive.2010.0223] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nunn H, Lalli A, Fortune F, Croucher R. Oral cancer screening in the Bangladeshi community of Tower Hamlets: a social model. Br J Cancer 2010; 101 Suppl 2:S68-72. [PMID: 19956167 PMCID: PMC2790708 DOI: 10.1038/sj.bjc.6605394] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: UK oral cancer incidence has risen by 22% in the last 10 years. Oral cancer is often detected at a late stage when treatment is debilitating and the chances of survival are poor. Certain black and minority ethnic groups are at elevated risk of oral cancer due to the prevalence of risk factor behaviours. We describe the background to, the development of and outcomes of an oral cancer screening activity appropriate to the needs of members of a disadvantaged community at high risk of oral cancer, carried out between 2006 and 2008 in Tower Hamlets, East London. Methods: In all, 1320 people participated during 34 days of screening, divided into two phases (Phase I (2006/2007): n=485, Phase II (2008): n=835). Modifications to the delivery process were implemented for Phase II in an attempt to recruit more high-risk individuals and to improve screening specificity. Results: In total, 75 people were urgently referred for further investigation (Phase I: n=20, Phase II: n= 55). Nine were diagnosed with dysplastic lesions (Phase I: n=3, Phase II: n=6) and a further eight showed potentially malignant disorders without dysplasia (Phase I: n=1, Phase II: n=7). Screening participants with low levels of completed education (OR: 6.94, 95% CI: 1.66, 28.98) and who chewed paan with tobacco (OR: 8.01, 95% CI: 3.54, 18.08) were more likely to be referred for further investigation. Conclusion: The project offers insights for the further development of oral cancer screening interventions for disadvantaged communities.
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Affiliation(s)
- H Nunn
- Health Information Department, Cancer Research UK, 61 Lincoln's Inn Fields, London, UK.
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Abstract
Luca Pastore and colleagues discuss the differential diagnosis and management of a 62-year-old man who presented with a 6-cm fungating mass on the dorsum of the tongue.
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Kurachi C, Fontana CR, Rosa LEB, Bagnato VS. Fluorescence spectroscopy for the detection of tongue carcinoma--validation in an animal model. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:034018. [PMID: 18601563 DOI: 10.1117/1.2937214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The efficacy of fluorescence spectroscopy to detect squamous cell carcinoma is evaluated in an animal model following laser excitation at 442 and 532 nm. Lesions are chemically induced with a topical DMBA application at the left lateral tongue of Golden Syrian hamsters. The animals are investigated every 2 weeks after the 4th week of induction until a total of 26 weeks. The right lateral tongue of each animal is considered as a control site (normal contralateral tissue) and the induced lesions are analyzed as a set of points covering the entire clinically detectable area. Based on fluorescence spectral differences, four indices are determined to discriminate normal and carcinoma tissues, based on intraspectral analysis. The spectral data are also analyzed using a multivariate data analysis and the results are compared with histology as the diagnostic gold standard. The best result achieved is for blue excitation using the KNN (K-nearest neighbor, a interspectral analysis) algorithm with a sensitivity of 95.7% and a specificity of 91.6%. These high indices indicate that fluorescence spectroscopy may constitute a fast noninvasive auxiliary tool for diagnostic of cancer within the oral cavity.
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Affiliation(s)
- Cristina Kurachi
- Universidade de Sao Paulo, Instituto de Fisica de Sao Carlos, Avenida Trabalhador Sancarlense, 400, Centro, 13566-250, Sao Carlos, Sao Paulo, Brazil.
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Rozier RG, Pahel BT. Patient- and population-reported outcomes in public health dentistry: oral health-related quality of life. Dent Clin North Am 2008; 52:345-vii. [PMID: 18329448 DOI: 10.1016/j.cden.2007.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
At present no process is in place in the United States to comprehensively monitor the national burden of oral diseases from the perspective of oral health-related quality of life (OHRQoL), yet available evidence shows that a substantial percentage of the adult population rates their oral health poorly. This article reviews applications of OHRQoL in dental public health. The authors specifically review its use, contributions, and needed advances in: (1) monitoring the impacts of oral diseases on OHRQoL at the national level, and in public health surveillance at the state and local levels; (2) treatment outcomes research and program evaluation; and (3) clinical practice.
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Affiliation(s)
- R Gary Rozier
- Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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Yusof ZY, Jallaludin RLR, Mohd-Dom TN. Insufficient Evidence to Support or Refute the Need for Screening Programs for Oral Cancer and Precancer. J Evid Based Dent Pract 2007; 7:129-31. [DOI: 10.1016/j.jebdp.2007.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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