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Pošta P, Kolk A, Pivovarčíková K, Liška J, Genčur J, Moztarzadeh O, Micopulos C, Pěnkava A, Frolo M, Bissinger O, Hauer L. Clinical Experience with Autofluorescence Guided Oral Squamous Cell Carcinoma Surgery. Diagnostics (Basel) 2023; 13:3161. [PMID: 37891982 PMCID: PMC10605623 DOI: 10.3390/diagnostics13203161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
In our study, the effect of the use of autofluorescence (Visually Enhanced Lesion Scope-VELscope) on increasing the success rate of surgical treatment in oral squamous carcinoma (OSCC) was investigated. Our hypothesis was tested on a group of 122 patients suffering from OSCC, randomized into a study and a control group enrolled in our study after meeting the inclusion criteria. The preoperative checkup via VELscope, accompanied by the marking of the range of a loss of fluorescence in the study group, was performed before the surgery. We developed a unique mucosal tattoo marking technique for this purpose. The histopathological results after surgical treatment, i.e., the margin status, were then compared. In the study group, we achieved pathological free margin (pFM) in 55 patients, pathological close margin (pCM) in 6 cases, and we encountered no cases of pathological positive margin (pPM) in the mucosal layer. In comparison, the control group results revealed pPM in 7 cases, pCM in 14 cases, and pFM in 40 of all cases in the mucosal layer. This study demonstrated that preoperative autofluorescence assessment of the mucosal surroundings of OSCC increased the ability to achieve pFM resection 4.8 times in terms of lateral margins.
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Affiliation(s)
- Petr Pošta
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Kristýna Pivovarčíková
- Sikl’s Department of Pathology, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic;
- Bioptic Laboratory Ltd., 32600 Pilsen, Czech Republic
| | - Jan Liška
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Jiří Genčur
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Omid Moztarzadeh
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
- Department of Anatomy, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic
| | - Christos Micopulos
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Adam Pěnkava
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Maria Frolo
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Oliver Bissinger
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Lukáš Hauer
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
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Putri MIA, Panigoro SS, Harahap AS, Pakasi TA, Brahma B. Acetic Acid and Iodine Staining for Determining Malignancy in Solid Tumors. Asian Pac J Cancer Prev 2021; 22:463-469. [PMID: 33639661 PMCID: PMC8190337 DOI: 10.31557/apjcp.2021.22.2.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: Surgical margin is an important prognostic factor in solid cancer surgery. Frozen section (FS), the gold standard for intraoperative surgical margin evaluation, requires extensive waiting time and expensive FS devices. The purpose of this diagnostic study was to verify whether multi-staining (MS) method with acetic acid and iodine could be used to differentiate malignant and non-malignant lesions of solid tumor. Methods: The study was conducted on patients with solid tumor who underwent surgery in the Surgical Oncology Division of Dr. Cipto Mangunkusumo General Hospital from December 2017 to April 2018. Samples measuring less than 5 mm, necrotic tissue sample, and patients who did not agree to participate in the study were excluded. Every specimen was divided into two, one side as unstained control and the other side as MS samples. MS samples were sprayed with 10% acetic acid combined with iodine. MS samples and unstained controls were sent for histopathologic results and the pathologist was blinded to group assignment. Acetowhitening reaction in the sample was an indication of a positive MS result, and the presence of malignant foci in the histopathology examination was classified as positive pathological results. Results: Five-hundred-and-twenty samples were obtained from 150 patients. MS method was found to have sensitivity and specificity of 82%, and 63.5%, respectively. In subgroup analysis, we found that MS method has a sensitivity and specificity of 100% and 79.3%, respectively for epithelial breast tumor; 65.7% and 83.3%, respectively for thyroid nodules; and 94.1% and 33.3%, respectively for oral cavity tumors. MS method reacts positively to solid malignant tumor and negatively to benign tumor and normal tissue (from margin samples). Highest sensitivity was found for breast and oral cavity malignancy, and high specificity was found for thyroid cancers. Conclusion: This study provided an alternative staining method for intraoperative macroscopic surgical margin evaluation, especially for rural areas without frozen section facilities.
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Affiliation(s)
- Maulina Indah Anugrah Putri
- Surgical Oncology Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sonar Soni Panigoro
- Surgical Oncology Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Agnes Stephanie Harahap
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital, National Cancer Center, Jakarta, Indonesia
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Tilakaratne WM, Jayasooriya PR, Jayasuriya NS, De Silva RK. Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges. Periodontol 2000 2019; 80:126-147. [PMID: 31090138 DOI: 10.1111/prd.12259] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Oral epithelial dysplasia is a spectrum of architectural and cytological epithelial changes caused by accumulation of genetic changes, and is associated with an increased risk of progression to squamous cell carcinoma. It is a microscopic diagnosis of immense clinical importance. The initial reports of oral potentially malignant disorders with oral epithelial dysplasia transforming to oral cancer helped in understanding the nature of oral malignancies. Since then, clinical studies on oral potentially malignant disorders have combined microscopic findings of oral epithelial dysplasia to assess the malignant transformation potential of different grades of epithelial dysplasia. A significant amount of scientific literature has amassed on oral epithelial dysplasia relating to aspects of its diagnosis and management. However, the evidence base is weak as a result of the significant variability of published research. Poorly described study methods, variability in different oral epithelial dysplasia grading systems, inter- and intra-examiner variability causing issues of reliability, inadequate sample size, and inconsistent durations of follow-up are some of the methodological issues contributing to the failure to provide dependable information. Randomized clinical trials on the malignant transformation potential of oral epithelial dysplasia and its treatment outcomes are limited. This comprehensive literature review on oral epithelial dysplasia summarizes the scientific knowledge published in the scientific literature in English since its first description. The historical development, etiological factors, grading systems, diagnostic criteria, assessment of risk factors and prevention of malignant transformation, management principles of different grades of oral epithelial dysplasia (surgical and nonsurgical), recommendations on follow-up, and prognostic indicators are discussed in detail.
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Affiliation(s)
- Wanninayake M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Primali R Jayasooriya
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nadeena S Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Kumara De Silva
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Tirelli G, Piovesana M, Gatto A, Torelli L, Boscolo Nata F. Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma? Ann Otol Rhinol Laryngol 2016; 125:596-601. [PMID: 27056557 DOI: 10.1177/0003489416641428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Obtaining free resection margins is the main goal of oncological surgeons. Narrow-band imaging (NBI) has been recently used to help define resection margins in transoral laser microsurgery for laryngeal carcinoma. The aim of this study was to evaluate the effect of intraoperative NBI in defining the surgical resection margins of oral and oropharyngeal cancers. METHODS Between January 2014 and March 2015, NBI was used intraoperatively after an initial definition of resection margins with white light in 26 patients (group A). The rate of superficial positive margins at definitive histology was compared with that of a historical cohort of 44 patients (group B) previously managed without the use of intraoperative NBI. RESULTS A statistically significant reduction in the rate of positive superficial margins was observed at definitive histology in group A (P = .028). NBI helped to identify the presence of dysplasia and cancer around the visible tumor not otherwise detectable with visual examination alone. CONCLUSIONS NBI could be a useful tool for obtaining free resection margins in oral and oropharyngeal carcinoma.
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Affiliation(s)
| | - Marco Piovesana
- ENT Clinic, Head and Neck Department, University of Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, University of Trieste, Italy
| | - Lucio Torelli
- Department of Mathematics and Earth Science, University of Trieste, Italy
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Tirelli G, Piovesana M, Gatto A, Tofanelli M, Biasotto M, Boscolo Nata F. Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer. Oral Oncol 2015. [DOI: 10.1016/j.oraloncology.2015.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Carreras-Torras C, Gay-Escoda C. Techniques for early diagnosis of oral squamous cell carcinoma: Systematic review. Med Oral Patol Oral Cir Bucal 2015; 20:e305-15. [PMID: 25662554 PMCID: PMC4464918 DOI: 10.4317/medoral.20347] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/01/2014] [Indexed: 02/04/2023] Open
Abstract
Background and objectives The diagnosis of early oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) is of paramount clinical importance given the mortality rate of late stage disease. The aim of this study is to review the literature to assess the current situation and progress in this area. Material and Methods A search in Cochrane and PubMed (January 2006 to December 2013) has been used with the key words “squamous cell carcinoma”, “early diagnosis” “oral cavity”, “Potentially Malignant Disorders” y “premalignant lesions”. The inclusion criteria were the use of techniques for early diagnosis of OSCC and OPMD, 7 years aged articles and publications written in English, French or Spanish. The exclusion criteria were case reports and studies in other languages. Results Out of the 89 studies obtained initially from the search 60 articles were selected to be included in the systematic review: 1 metaanalysis, 17 systematic reviews, 35 prospective studies, 5 retrospective studies, 1 consensus and 1 semi-structured interviews. Conclusions The best diagnostic technique is that which we have sufficient experience and training. Definitely tissue biopsy and histopathological examination should remain the gold standard for oral cancer diagnose. In this systematic review it has not been found sufficient scientific evidence on the majority of proposed techniques for early diagnosis of OSCC, therefore more extensive and exhaustive studies are needed. Key words:
Squamous cell carcinoma, early diagnosis, oral cavity, potentially malignant disorders, premalignant lesions.
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A chemiluminescent light system in combination with toluidine blue to assess suspicious oral lesions-clinical evaluation and review of the literature. Clin Oral Investig 2014; 19:459-66. [PMID: 24888605 DOI: 10.1007/s00784-014-1252-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 05/04/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of the study was an evaluation of an acetic acid wash and chemiluminescent light system in combination with toluidine blue in order to detect visual identified, potentially malignant lesions. MATERIALS AND METHODS Forty-four patients with 50 oral lesions of primary uncertain visible dignity were included. Next to a clinical examination, a screening with ViziLite® (VL) as well as toluidine blue (TB; together ViziLite® Plus (VLP)) was conducted. Histopathology served as gold standard and sensitivity (SE), specificity (SP), positive as well as negative predictive value (PPV, NPV) was calculated descriptively. Additionally, a PubMed literature search using the key words "ViziLite" and "chemiluminescence oral cancer" was conducted. RESULTS Histological diagnosis showed 40 lesions of reactive/inflammatory nature, moderate dysplasia (n = 3) and oral squamous cell carcinoma (OSCC n = 7). All OSCCs and one dysplasia were identified correct via clinical diagnosis (SE 90 %, SP 100 %, PPV 100 %, NPV 97.5 %). VL examination could show all malignancies with low specificity (SE 100 %, SP 30 %, PPV 26 %, NPV 100 %). TB and VLP were positive in all cases of cancer and in one case of inflammation (SE 80 %, SP 97.5 %, PPV 89 %, NPV 95 %). In the review, eight clinical trials with similar results were included. CONCLUSIONS The adjunct of TB to VL reduces the number of false positives without increasing the rate of false negatives. CLINICAL RELEVANCE Clinical evidence to justify the additional cost of the system for diagnosis of suspicious lesions is weak. However, for the potential role of VLP in detection of lesions not otherwise identified in the visual exam in general dental practice further studies are required.
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