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Schemel AF, Manosalva RE, Pataroque D, Keirns D, Wagoner L, Au V, Byeman C, Renslo B, Virgen C, Sawaf T, Buchakjian M, Varvares MA, Bur AM, Holcomb AJ. Shortcomings of excisional biopsy in Early-Stage oral cavity carcinoma. Oral Oncol 2024; 157:106909. [PMID: 39116665 DOI: 10.1016/j.oraloncology.2024.106909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Ashley F Schemel
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Rudy E Manosalva
- Department of Head and Neck Oncology, Nebraska Methodist Hospital, Omaha, NE, USA
| | - Dominique Pataroque
- Department of Head and Neck Oncology, Nebraska Methodist Hospital, Omaha, NE, USA
| | - Darby Keirns
- Department of Head and Neck Oncology, Nebraska Methodist Hospital, Omaha, NE, USA
| | - Luke Wagoner
- Department of Head and Neck Oncology, Nebraska Methodist Hospital, Omaha, NE, USA
| | - Vivienne Au
- Department of Otolaryngology, Massachusetts Eye and Ear / Harvard Medical School, Boston, MA, USA
| | - Connor Byeman
- Department of Otolaryngology, University of Iowa Hospitals and Clinic, Iowa City, IA, USA
| | - Bryan Renslo
- Department of Otolaryngology, Thomas Jefferson University, USA
| | - Celina Virgen
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tuleen Sawaf
- Department of Otolaryngology, University of Maryland, USA
| | - Marisa Buchakjian
- Department of Otolaryngology, University of Iowa Hospitals and Clinic, Iowa City, IA, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear / Harvard Medical School, Boston, MA, USA
| | - Andrés M Bur
- Department of Otolaryngology, University of Iowa Hospitals and Clinic, Iowa City, IA, USA
| | - Andrew J Holcomb
- Department of Head and Neck Oncology, Nebraska Methodist Hospital, Omaha, NE, USA.
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2
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Liu W, Li H, Shi L. Perspectives on oral tissue biopsy surgery for patients with oral premalignant and malignant lesions. J Dent Sci 2024; 19:1877-1879. [PMID: 39035331 PMCID: PMC11259640 DOI: 10.1016/j.jds.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/17/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Fengcheng Hospital of Fengxian District, Shanghai Ninth People's Hospital Fengcheng Branch Hospital, Shanghai, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Hongquan Li
- Department of Oral Surgery, Shanghai Xuhui District Dental Center, Shanghai, China
| | - Linjun Shi
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Jeng PY, Chang MC, Chiang CP, Lee CF, Chen CF, Jeng JH. Oral soft tissue biopsy surgery: Current principles and key tissue stabilization techniques. J Dent Sci 2024; 19:11-20. [PMID: 38303868 PMCID: PMC10829751 DOI: 10.1016/j.jds.2023.09.015] [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: 09/11/2023] [Revised: 09/12/2023] [Indexed: 02/03/2024] Open
Abstract
There are different kinds of benign and malignant lesions in the oral cavity. Clinically, definite diagnosis can be confirmed only by doing adequate surgical biopsy and subsequent histopathological examination. Inadequate biopsy technique, unsuitable selection of the location for biopsy, inappropriate tissue handling and record of patients' information may lead to artifacts and misdiagnosis by the oral pathologists. Soft tissue stabilization is a challenge during oral surgery procedures. It needs the cooperation of operator, assistants, and patients to overcome the difficulty and ensure the successful outcome. In this article, we reviewed the procedures for clinical surgical biopsy, and raised three current tissue stabilization methods including fingers and gauze stabilization, stabilization with chalazion forceps and adapted instruments, and stabilization with retraction sutures. Moreover, some limitations were also presented. Clinician should examine the clinical characteristics of the oral lesion, the surrounding anatomical structures, and their own clinical experience and preference to select the appropriate tool. More understanding of these biopsy and tissue stabilization methods can effectively improve the biopsy procedures and obtain adequate tissues for histopathological examination and subsequent issue of an accurate pathological report.
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Affiliation(s)
- Po-Yuan Jeng
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Chi Chang
- Chang Gung University of Science and Technology, Kwei-Shan, Taoyuan, Taiwan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fang Lee
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Feng Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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4
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McNamara KK, Kalmar JR. Pearls and pitfalls in the diagnosis of small oral biopsies. Semin Diagn Pathol 2023; 40:313-320. [PMID: 37117100 DOI: 10.1053/j.semdp.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
Pathologic processes affecting the oral and maxillofacial region include a heterogenous group of diseases with widely variable biologic behaviors. Proper patient management begins with the establishment of an accurate diagnosis, which often relies on histopathologic interpretation of small tissue samples from oral lesions. While confident diagnosis of small oral biopsies can be challenging, an understanding of oral and maxillofacial disease and consistent clinicopathologic correlation can help pathologists recognize inflammatory confounders and overcome common errors in specimen management, including insufficient sample size and non-representative biopsy samples.
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Affiliation(s)
- Kristin K McNamara
- Professor - Clinical, Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, 2206 Postle Hall, 305W. 12th Ave, Columbus, OH 43210-1267, United States.
| | - John R Kalmar
- Professor - Clinical, Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, 2206 Postle Hall, 305W. 12th Ave, Columbus, OH 43210-1267, United States
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5
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Lazzarotto B, Garcia C, Martinelli-Klay C, Lombardi T. Biopsy of the oral mucosa: Does size matter? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e385-e389. [PMID: 35176511 DOI: 10.1016/j.jormas.2022.02.005] [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] [Received: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
AIM To analyze the relation between biopsy specimen's size and the definitive diagnosis. In addition, other variables including oral mucosa region, type of disease and general versus specialist practitioner were also assessed. METHODS Data from specimens submitted to histopathological examination between 2007 and 2017 were retrospectively analysed. RESULTS We analysed data on 792 patients. Out of 1089 archived reports, 81 (7.4%) had no definitive diagnosis. Multivariate analysis rendered biopsy length as the factor influencing the possibility to reach a definitive diagnosis. CONCLUSION The size of the specimen is an important parameter to achieve a correct histopathological diagnosis of the oral lesions investigated. According to our results, it seems that a 10 mm length is adequate to optimize the biopsy outcome. No statistically differences were observed between GPDs and oral surgery specialists, probably because biopsies were performed by experienced general practitioners, although not formally trained.
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Affiliation(s)
- Benjamin Lazzarotto
- Unit of Oral Medicine and Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland..
| | - Chloé Garcia
- Unit of Oral Medicine and Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Carla Martinelli-Klay
- Unit of Oral Medicine and Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Tommaso Lombardi
- Unit of Oral Medicine and Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
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6
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Idrees M, Farah CS, Sloan P, Kujan O. Oral brush biopsy using liquid-based cytology is a reliable tool for oral cancer screening: A cost-utility analysis: Oral brush biopsy for oral cancer screening. Cancer Cytopathol 2022; 130:740-748. [PMID: 35704619 PMCID: PMC9544877 DOI: 10.1002/cncy.22599] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 01/13/2023]
Abstract
Background This study aimed to assess the diagnostic utility and associated cost of oral liquid‐based brush cytology (OLBC) in the diagnosis of oral cancer and oral potentially malignant disorders (OPMDs). Methods A total of 284 patients with oral mucosal lesions were included. OLBC samples were collected from all patients immediately before undergoing surgical biopsies. A liquid‐based cytology slide was prepared from each OLBC sample for cytological evaluation using the modified 2014 Bethesda cytology system. The results and the cost were compared with the histopathological outcomes. Results The level of agreement between the two approaches was very good (weighted kappa = 0.824). The accuracy of OLBC in differentiating between the different diagnostic groups was 91.69%, whereas the associated sensitivity and specificity were 79.23% and 94.81%, respectively. The estimated cost of each OLBC sample was at least 26% less than the cost of a single biopsy and more than 42% less in cases of multiple biopsied lesions. Conclusions The proposed modifications of the Bethesda system can be adopted as a standardized system for oral cytological assessment. Our findings support OLBC as a reliable adjunct to surgical biopsy in the diagnosis of OPMDs. This tool has potential for oral cancer–finding and surveillance programs. Oral brush liquid‐based cytology is a reliable adjunct to surgical biopsy in the diagnosis of oral potentially malignant disorders. It has potential for oral cancer‐finding and surveillance programs.
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Affiliation(s)
- Majdy Idrees
- University of Western Australia Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, Western Australia, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian Clinical Labs, Subiaco, Western Australia, Australia.,CQ University, Rockhampton, Queensland, Australia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Omar Kujan
- University of Western Australia Dental School, The University of Western Australia, Perth, Western Australia, Australia
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7
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Idrees M, Shearston K, Farah CS, Kujan O. Immunoexpression of oral brush biopsy enhances the accuracy of diagnosis for oral lichen planus and lichenoid lesions. J Oral Pathol Med 2022; 51:563-572. [PMID: 35460123 PMCID: PMC9542982 DOI: 10.1111/jop.13301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022]
Abstract
Background This study assessed the efficacy of using oral liquid‐based brush cytology (OLBC) coupled with immunostained cytology‐derived cell‐blocks, quantified using machine‐learning, in the diagnosis of oral lichen planus (OLP). Methods Eighty‐two patients diagnosed clinically with either OLP or oral lichenoid lesion (OLL) were included. OLBC samples were obtained from all patients before undergoing surgical biopsy. Liquid‐based cytology slides and cell‐blocks were prepared and assessed by cytomorphology and immunocytochemistry for four antibodies (Ki‐67, BAX, NF‐κB‐p65, and AMACR). For comparison purposes, a sub‐group of 31 matched surgical biopsy samples were selected randomly and assessed by immunohistochemistry. Patients were categorized according to their definitive diagnoses into OLP, OLL, and clinically lichenoid, but histopathologically dysplastic lesions (OEDL). Machine‐learning was utilized to provide automated quantification of positively stained protein expression. Results Cytomorphological assessment was associated with an accuracy of 77.27% in the distinction between OLP/OLL and OEDL. A strong concordance of 92.5% (κ = 0.84) of immunostaining patterns was evident between cell‐blocks and tissue sections using machine‐learning. A diagnostic index using a Ki‐67‐based model was 100% accurate in detecting lichenoid cases with epithelial dysplasia. A BAX‐based model demonstrated an accuracy of 92.16%. The accuracy of cytomorphological assessment was greatly improved when it was combined with BAX immunoreactivity (95%). Conclusions Cell‐blocks prepared from OLBC are reliable and minimally‐invasive alternatives to surgical biopsies to diagnose OLLs with epithelial dysplasia when combined with Ki‐67 immunostaining. Machine‐learning has a promising role in the automated quantification of immunostained protein expression.
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Affiliation(s)
- Majdy Idrees
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kate Shearston
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, Western Australia, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Anatomical Pathology, Australian Clinical Labs, Subiaco, Western Australia, Australia.,CQ University, Rockhampton, Queensland, Australia
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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8
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Wei T, Lu M, Li J, Hu Z, Li T, Cheng X, Wang L, Pu W. Comparative study on efficacy and safety of ultrasound guided transoral and transcutaneous core needle biopsy in patients with oral masses. BMC Med Imaging 2022; 22:65. [PMID: 35392835 PMCID: PMC8988314 DOI: 10.1186/s12880-022-00784-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Ultrasound (US) guided transoral biopsy is a novel and safe procedure for obtaining tissue in patients with oral masses. However, this procedure is less commonly used in comparison to US guided transcutaneous biopsy. The aim of this study is to compare the efficacy and safety of US-guided transoral and transcutaneous core needle biopsy (CNB) in patients with oral masses. Methods From November 2019 to March 2021, consecutive patients with oral masses were randomly assigned to undergo US-guided transoral CNB (transoral group) and US-guided transcutaneous CNB from a submental approach (transcutaneous group). During the operation, procedure time, intra‑operative blood loss volume, diagnostic performance, rate of complications and pain level were recorded and compared. Results There were 112 patients (62 in the transoral group and 50 in the transcutaneous group) evaluated in this study. The postprocedural complication rate of the transcutaneous group was significantly higher than the transoral group (24% vs. 0%, P = 0.000). There was no significant difference in accuracy (95.2% vs. 88%, P = 0.30), biopsy time (76 ± 12 s vs. 80 ± 13 s, p = 0.09), blood losses (2.6 ± 0.5 mL vs. 2.7 ± 0.4 mL, p = 0.17) and visual analogue score (p = 0.327 and p = 0.444 before and after the sampling procedure) between the two groups. Conclusion US-guided transoral CNB results in high rates of technical success and lower rates of postprocedural complications.
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Affiliation(s)
- Ting Wei
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Man Lu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Juan Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Ziyue Hu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Tingting Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Xueqing Cheng
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Lu Wang
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Wei Pu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
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9
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Sathasivam HP, Sloan P, Thomson PJ, Robinson M. The clinical utility of contemporary oral epithelial dysplasia grading systems. J Oral Pathol Med 2021; 51:180-187. [PMID: 34797585 DOI: 10.1111/jop.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. METHODS Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. RESULTS 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. CONCLUSION This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).
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Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Peter J Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Max Robinson
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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10
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Chadwick JW, Macdonald R, Ali AA, Glogauer M, Magalhaes MA. TNFα Signaling Is Increased in Progressing Oral Potentially Malignant Disorders and Regulates Malignant Transformation in an Oral Carcinogenesis Model. Front Oncol 2021; 11:741013. [PMID: 34650923 PMCID: PMC8507421 DOI: 10.3389/fonc.2021.741013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
Oral carcinogenesis represents a multi-stage process which encompasses several genetic and molecular changes that promote the progression of oral potentially malignant disorders (OPMDs) to oral squamous cell carcinomas (OSCCs). A better understanding of critical pathways governing the progression of OMPDs to OSCCs is critical to improve oncologic outcomes in the future. Previous studies have identified an important role of tumor necrosis factor α (TNFα) and TNF receptor 1 (TNFR1) in the invasiveness of oral cancer cell lines. Here, we investigate the expression of TNFα and TNFR1 in human OPMDs that progress to OSCC compared to non-progressing OPMDs utilizing fluorescent immunohistochemistry (FIHC) to show increased TNFα/TNFR1 expression in progressing OPMDs. In order to interrogate the TNFα/TNFR1 signaling pathway, we utilized a 4-nitroquinoline 1-oxide (4-NQO) mouse model of oral carcinogenesis to demonstrate that TNFα/TNFR1 expression is upregulated in 4-NQO-induced OSCCs. TNFα neutralization decreased serum cytokines, inhibited the development of invasive lesions and reduced tumor-associated neutrophils in vivo. Combined, this data supports the role of TNFα in oral malignant transformation, suggesting that critical immunoregulatory events occur downstream of TNFR1 leading to malignant transformation. Our results advance the understanding of the mechanisms governing OSCC invasion and may serve as a basis for alternative diagnostic and therapeutic approaches to OPMDs and OSCC management.
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Affiliation(s)
- Jeffrey W Chadwick
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rachel Macdonald
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Aiman A Ali
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Marco A Magalhaes
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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11
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Archibald H, Buryska S, Ondrey FG. An active surveillance program in oral preneoplasia and translational oncology benefit. Laryngoscope Investig Otolaryngol 2021; 6:764-772. [PMID: 34401501 PMCID: PMC8356884 DOI: 10.1002/lio2.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We desired to establish an active surveillance clinic for head and neck cancer. In this review we examined. METHODS We examined the natural history of human oral carcinogenesis, the types of preneoplastic lesions, and efforts at oral chemoprevention over the past decades for presentation here. RESULTS We established a clinic and program for patients with oral premalignant lesions approximately over 15 years ago based on an unmetneed for this service. We have completed over 4000 outpatient visits for this cohort and have a place for referrals of difficult oral lesions. We have leveraged this population for multiple federally funded trials on oral cancer prevention as well as specimen banking. CONCLUSION There is need for routine active surveillance for oral preneoplastic conditions in patients at high risk for conversion to cancer. There are no effective durable treatment or preventions for these individuals and we have attempted to fill this unmet need with our program.
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Affiliation(s)
- Hunter Archibald
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Seth Buryska
- University of Minnesota Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Frank G. Ondrey
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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12
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Yang SW, Lee YS, Chang LC, Yang CH, Luo CM, Wu PW. Oral tongue leukoplakia: analysis of clinicopathological characteristics, treatment outcomes, and factors related to recurrence and malignant transformation. Clin Oral Investig 2021; 25:4045-4058. [PMID: 33411001 PMCID: PMC8137631 DOI: 10.1007/s00784-020-03735-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The tongue is identified as a high-risk site for oral leukoplakia and malignant transformation. The purpose of this study is to investigate the clinicopathological characteristics and treatment outcomes of tongue leukoplakia and assess the factors related to recurrence and malignant transformation. MATERIALS AND METHODS One hundred and forty-four patients who received carbon dioxide laser surgery for tongue leukoplakia from 2002 to 2019 were analyzed statistically. RESULTS The follow-up period was 54.90 ± 54.41 months. Thirty patients showed postoperative recurrence (20.83%), and 12 patients developed malignant transformation (8.33%). The annual transformation rate was 2.28%. Univariate analysis showed that a history of head and neck cancer, size of lesion area, clinical appearance, and pathology were significant factors for both recurrence and malignant transformation. In the multivariate logistic regression, a history of head and neck cancer and size of lesion area were independent prognostic factors for recurrence, and a history of head and neck cancer was the only independent factor for postoperative malignant change. CONCLUSIONS Clinicians should adopt more aggressive strategies for tongue leukoplakia patients with a history of head and neck cancer. CLINICAL RELEVANCE These results may help clinicians gain a better understanding of oral tongue leukoplakia.
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Affiliation(s)
- Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan, Republic of China
| | - Liang-Che Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Cheng-Han Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Cheng-Ming Luo
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Pei-Wen Wu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, No. 222, Mai Chin Road, Keelung, 204, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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13
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Kujan O, Idrees M, Anand N, Soh B, Wong E, Farah CS. Efficacy of oral brush cytology cell block immunocytochemistry in the diagnosis of oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med 2021; 50:451-458. [PMID: 33368584 DOI: 10.1111/jop.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell block immunocytochemistry in the diagnosis of oral leukoplakia as minimally invasive diagnostic adjuncts. METHODS Seventy-two patients diagnosed clinically with either oral leukoplakia (OLK) or oral squamous cell carcinoma were included. Oral brush samples using Orcellex® brushes were obtained from all participants directly before undergoing surgical biopsy. Cell blocks were prepared for all samples and assessed for cytomorphology and immunocytochemistry of DNA mismatch repair proteins (MSH-6, MSH-2, MLH-1 and PMS-2). A combined index score of immunocytochemistry expression and cytology grading was compared against the gold standard (histopathological diagnosis). RESULTS A significant association was observed between the cytological assessments of oral liquid-based brush cytology samples and the histopathological diagnosis (P < .005). In addition, there was a significant inverse correlation between the grade of oral epithelial dysplasia and the cumulative score of the studied DNA mismatch repair proteins (P < .005). Grading criteria for both oral liquid-based brush cytology and immunocytochemistry cumulative index scores are proposed based on the analysis of receiver operating characteristic curve coordinates. The diagnostic accuracy of this approach was outstanding in terms of discrimination between the presence or absence of oral epithelial dysplasia (0.961) and squamous cell carcinoma (0.977) separately. CONCLUSION Oral liquid-based brush cytology cell block immunocytochemistry provides a reliable strategy to investigate oral mucosal epithelial disorders. This approach presents a minimally invasive, highly accurate and non-technically demanding method for the surveillance of oral potentially malignant disorders and squamous cell carcinoma.
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Affiliation(s)
- Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Neeraj Anand
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Brandon Soh
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Elton Wong
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia.,Head and Neck Pathology, Australian Clinical Labs, Subiaco, WA, Australia
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14
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Bello IO, Wennerstrand PM, Suleymanova I, Siponen M, Qannam A, Nieminen P, Leivo I, Almangush A, Salo T. Biopsy quality is essential for preoperative prognostication in oral tongue cancer. APMIS 2020; 129:118-127. [PMID: 33320967 DOI: 10.1111/apm.13104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022]
Abstract
A role for incisional biopsy in preoperative prognostication is increasingly being advocated in oral tongue squamous cell carcinomas (OTSCC). Biopsies at two locations were compared, and prognostic factors in biopsies and their corresponding resections were evaluated. A total of 138 OTSCC biopsy slides from Finland and Saudi Arabia were compared for size (horizontal and vertical) and invasive front. The Finnish cases were assessed for tumor stroma ratio (TSR) and tumor-infiltrating lymphocytes (TILs) using light microscopy and digital image analysis assessment and compared. Furthermore, TSR, TILs, and previously analyzed budding and depth of invasion (BD) score in biopsies were compared with their evaluation in the corresponding resections. Fifty-nine percent of Finnish and 42% of Saudi Arabian biopsies were ≥ 5 mm deep, while 98% of Saudi Arabian and 76% of Finnish biopsies were ≥ 5 mm wide. Assessment of invasion front was possible in 72% of Finnish in comparison with 40% of Saudi Arabian biopsies. There was 86.8% agreement between TSR and 75% agreement between TIL evaluation using light microscopy and digital assessment. Significant agreement was obtained on comparing the TSR (p = 0.04) and BD (p < 0.001) values in biopsies and resections. Biopsies of ≥ 5 mm depth from representative OTSCC areas are essential for prognostic information. Clinical pathologists are advised to assess BD score and TSR for prognostic features in such biopsies.
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Affiliation(s)
- Ibrahim O Bello
- Department of Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, University of Helsinki, Helsinki, Finland
| | | | - Ilida Suleymanova
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maria Siponen
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Oral Health Teaching Clinic and Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Ahmed Qannam
- Department of Oral Medicine and Diagnostic Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Pentti Nieminen
- Medical Informatics and Data Analysis Research Group, University of Oulu, Oulu, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.,Faculty of Dentistry, University of Misurata, Misurata, Libya
| | - Tuula Salo
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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15
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Wei T, Lu M, Wang L, Jiang Z, Wu M, Li J, Hu Z, Cheng X, Li T, Zhang Z, Wu X, Tan B, Liao J. Contrast-Enhanced Ultrasound Guided Transoral Core Needle Biopsy: A Novel, Safe and Well-Tolerated Procedure for Obtaining High-Quality Tissue in Patients with Oral Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3210-3217. [PMID: 32988670 DOI: 10.1016/j.ultrasmedbio.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
The aim of the prospective study described here was to compare the tolerability, safety and diagnostic value of contrast-enhanced ultrasound-guided transoral core needle biopsy (CEUS-CNB) with that of conventional US-guided transoral CNB (US-CNB) and standard incisional biopsy in patients with oral masses. Between June 2017 and November 2019, consecutive patients with oral masses referred for biopsy were randomly assigned to undergo incisional biopsy, US-CNB or CEUS-CNB. Procedure time, intra‑operative blood loss volume, diagnostic performance and pain level before and after the procedure assessed by visual analogue score (VAS) were recorded and compared among the three procedures. Finally, 238 patients with pathology confirmation were analyzed: 80 patients underwent incisional biopsy, 78 patients US-CNB and 80 patients CEUS-CNB. In this study, no significant difference was found in biopsy time between CEUS-CNB, US-CNB and incisional biopsy (75 ± 11 s vs. 73.6 ± 12 s vs. 77 ± 13 s, p = 0.24). CEUS-CNB achieved the highest sensitivity (CEUS-CNB: 100%, US-CNB: 88.5%, incisional biopsy: 84.3%), negative predictive value (CEUS-CNB: 100%, US-CNB: 81.3%, incisional biopsy: 78.4%) and accuracy (CEUS-CNB: 100%, US-CNB: 92.3%, incisional biopsy: 90%). The VAS score for incision biopsy was higher (p = 0.01) and the amount of bleeding was larger (p < 0.001), yet there was no significant difference between CEUS-CNB and US-CNB. Our results indicate CEUS-guided transoral CNB is an efficient, safe and well-tolerated procedure, with biopsy time comparable to and diagnostic performance better than those of conventional US-guided transoral CNB and incisional biopsy.
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Affiliation(s)
- Ting Wei
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Lu Wang
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zirui Jiang
- Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Minggang Wu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziyue Hu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xueqing Cheng
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tingting Li
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenqi Zhang
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaobo Wu
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Tan
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jifen Liao
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
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16
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Yang EC, Brenes DR, Vohra IS, Schwarz RA, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Algorithm to quantify nuclear features and confidence intervals for classification of oral neoplasia from high-resolution optical images. J Med Imaging (Bellingham) 2020; 7:054502. [PMID: 32999894 PMCID: PMC7503985 DOI: 10.1117/1.jmi.7.5.054502] [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: 01/05/2020] [Accepted: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: In vivo optical imaging technologies like high-resolution microendoscopy (HRME) can image nuclei of the oral epithelium. In principle, automated algorithms can then calculate nuclear features to distinguish neoplastic from benign tissue. However, images frequently contain regions without visible nuclei, due to biological and technical factors, decreasing the data available to and accuracy of image analysis algorithms. Approach: We developed the nuclear density-confidence interval (ND-CI) algorithm to determine if an HRME image contains sufficient nuclei for classification, or if a better image is required. The algorithm uses a convolutional neural network to exclude image regions without visible nuclei. Then the remaining regions are used to estimate a confidence interval (CI) for the number of abnormal nuclei per mm 2 , a feature used by a previously developed algorithm (called the ND algorithm), to classify images as benign or neoplastic. The range of the CI determines whether the ND-CI algorithm can classify an image with confidence, and if so, the predicted category. The ND and ND-CI algorithm were compared by calculating their positive predictive value (PPV) and negative predictive value (NPV) on 82 oral biopsies with histopathologically confirmed diagnoses. Results: After excluding the images that could not be classified with confidence, the ND-CI algorithm had higher PPV (65% versus 59%) and NPV (78% versus 75%) than the ND algorithm. Conclusions: The ND-CI algorithm could improve the real-time classification of HRME images of the oral epithelium by informing the user if an improved image is required for diagnosis.
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Affiliation(s)
- Eric C Yang
- Baylor College of Medicine, Houston, Texas, United States
| | - David R Brenes
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Imran S Vohra
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Richard A Schwarz
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Michelle D Williams
- The University of Texas, MD Anderson Cancer Center, Department of Pathology, Houston, Texas, United States
| | - Nadarajah Vigneswaran
- The University of Texas, School of Dentistry at Houston, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Ann M Gillenwater
- The University of Texas, MD Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
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17
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Li J, Liu Y, Zhang H, Hua H. Association between hyperglycemia and the malignant transformation of oral leukoplakia in China. Oral Dis 2020; 26:1402-1413. [PMID: 32348606 DOI: 10.1111/odi.13372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to examine the association between hyperglycemia and the malignant transformation of oral leukoplakia (OLK). PATIENTS AND METHODS This retrospective case-control study involved 133 patients with the malignant transformation of OLK into oral squamous cell carcinoma (case group) and 266 patients with untransformed OLK (control group). The clinical history and follow-up data included age, gender, lesion size and location, and fasting plasma glucose. Logistic regression analysis, Kaplan-Meier survival analysis, and univariate and multivariate Cox regression analyses were used to assess the effects of risk factors on the malignant transformation of OLK. RESULTS Hyperglycemia (adjusted hazard ratio [AHR] = 4.7, p = .001), non-homogenous OLK (AHR = 3.0, p < .001), location of the lesion on the ventral surface of the tongue or floor of the mouth (AHR = 3.6, p < .001), and epithelial dysplasia (AHR = 2.8, p = .005) had significant effects on the malignant transformation of OLK. CONCLUSION Hyperglycemia, non-homogenous OLK, location of the lesion on the ventral surface of the tongue or floor of the mouth, and epithelial dysplasia might be associated with malignant transformation of OLK.
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Affiliation(s)
- Jin Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China.,School of Stomatology, Guangdong Province, Jinan University, Guangzhou, P. R. China
| | - Yang Liu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, P. R. China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
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18
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An immuno-MALDI mass spectrometry assay for the oral cancer biomarker, matrix metalloproteinase-1, in dried saliva spot samples. Anal Chim Acta 2020; 1100:118-130. [DOI: 10.1016/j.aca.2019.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/19/2019] [Accepted: 12/01/2019] [Indexed: 01/17/2023]
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19
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McRae MP, Modak SS, Simmons GW, Trochesset DA, Kerr AR, Thornhill MH, Redding SW, Vigneswaran N, Kang SK, Christodoulides NJ, Murdoch C, Dietl SJ, Markham R, McDevitt JT. Point-of-care oral cytology tool for the screening and assessment of potentially malignant oral lesions. Cancer Cytopathol 2020; 128:207-220. [PMID: 32032477 PMCID: PMC7078980 DOI: 10.1002/cncy.22236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effective detection and monitoring of potentially malignant oral lesions (PMOL) are critical to identifying early-stage cancer and improving outcomes. In the current study, the authors described cytopathology tools, including machine learning algorithms, clinical algorithms, and test reports developed to assist pathologists and clinicians with PMOL evaluation. METHODS Data were acquired from a multisite clinical validation study of 999 subjects with PMOLs and oral squamous cell carcinoma (OSCC) using a cytology-on-a-chip approach. A machine learning model was trained to recognize and quantify the distributions of 4 cell phenotypes. A least absolute shrinkage and selection operator (lasso) logistic regression model was trained to distinguish PMOLs and cancer across a spectrum of histopathologic diagnoses ranging from benign, to increasing grades of oral epithelial dysplasia (OED), to OSCC using demographics, lesion characteristics, and cell phenotypes. Cytopathology software was developed to assist pathologists in reviewing brush cytology test results, including high-content cell analyses, data visualization tools, and results reporting. RESULTS Cell phenotypes were determined accurately through an automated cytological assay and machine learning approach (99.3% accuracy). Significant differences in cell phenotype distributions across diagnostic categories were found in 3 phenotypes (type 1 ["mature squamous"], type 2 ["small round"], and type 3 ["leukocytes"]). The clinical algorithms resulted in acceptable performance characteristics (area under the curve of 0.81 for benign vs mild dysplasia and 0.95 for benign vs malignancy). CONCLUSIONS These new cytopathology tools represent a practical solution for rapid PMOL assessment, with the potential to facilitate screening and longitudinal monitoring in primary, secondary, and tertiary clinical care settings.
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Affiliation(s)
- Michael P. McRae
- Department of Biomaterials, Bioengineering InstituteNew York UniversityNew YorkNew York
| | - Sayli S. Modak
- Department of Biomaterials, Bioengineering InstituteNew York UniversityNew YorkNew York
| | - Glennon W. Simmons
- Department of Biomaterials, Bioengineering InstituteNew York UniversityNew YorkNew York
| | - Denise A. Trochesset
- Department of Oral and Maxillofacial Pathology, Radiology and MedicineNew York University College of DentistryNew YorkNew York
| | - A. Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and MedicineNew York University College of DentistryNew YorkNew York
| | - Martin H. Thornhill
- Department of Oral and Maxillofacial Medicine, Surgery, and PathologySchool of Clinical DentistryUniversity of SheffieldSheffieldUnited Kingdom
| | - Spencer W. Redding
- Department of Comprehensive Dentistry and Mays Cancer CenterThe University of Texas Health Science Center at San AntonioSan AntonioTexas
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical SciencesThe University of Texas Health Science Center at HoustonHoustonTexas
| | - Stella K. Kang
- Department of RadiologyNew York University School of MedicineNew YorkNew York
- Department of Population HealthNew York University School of MedicineNew YorkNew York
| | | | - Craig Murdoch
- Department of Oral and Maxillofacial Medicine, Surgery, and PathologySchool of Clinical DentistryUniversity of SheffieldSheffieldUnited Kingdom
| | | | | | - John T. McDevitt
- Department of Biomaterials, Bioengineering InstituteNew York UniversityNew YorkNew York
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20
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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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21
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Yang EC, Vohra IS, Badaoui H, Schwarz RA, Cherry KD, Jacob J, Rodriguez J, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Prospective evaluation of oral premalignant lesions using a multimodal imaging system: a pilot study. Head Neck 2019; 42:171-179. [PMID: 31621979 PMCID: PMC7003735 DOI: 10.1002/hed.25978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/03/2019] [Accepted: 09/17/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Multimodal optical imaging, incorporating reflectance and fluorescence modalities, is a promising tool to detect oral premalignant lesions in real-time. METHODS Images were acquired from 171 sites in 66 patient visits for clinical evaluation of oral lesions. An automated algorithm was used to classify lesions as high- or low-risk for neoplasia. Biopsies were acquired at clinically indicated sites and those classified as high-risk by imaging, at the surgeon's discretion. RESULTS Twenty sites were biopsied based on clinical examination or imaging. Of these, 12 were indicated clinically and by imaging; 58% were moderate dysplasia or worse. Four biopsies were indicated by imaging evaluation only; 75% were moderate dysplasia or worse. Finally, four biopsies were indicated by clinical evaluation only; 75% were moderate dysplasia or worse. CONCLUSION Multimodal imaging identified more cases of high-grade dysplasia than clinical evaluation, and can improve detection of high grade precancer in patients with oral lesions.
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Affiliation(s)
- Eric C Yang
- MD/PhD Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
| | - Imran S Vohra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Hawraa Badaoui
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Katelin D Cherry
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Justin Jacob
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jessica Rodriguez
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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22
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Matulić N, Bago I, Sušić M, Gjorgievska E, Kotarac Knežević A, Gabrić D. Comparison of Er:YAG and Er,Cr:YSGG Laser in the Treatment of Oral Leukoplakia Lesions Refractory to the Local Retinoid Therapy. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:362-368. [PMID: 31081716 DOI: 10.1089/photob.2018.4560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The aim of this study was to compare the efficacy of Er:YAG and Er,Cr:YSGG laser in the treatment of oral leukoplakia refractory to conventional retinoid therapy. Materials and methods: The study sample consisted of 54 patients (16 men and 38 women) who were histopathologically diagnosed with oral leukoplakia that was refractory to conventional retinoid therapy. Patients were randomly allocated into two groups according to the type of the laser used for treatment of oral leukoplakia: Group 1. Er:YAG laser; Group 2. Er,Cr:YSGG laser. Patients were recalled at 6 months and 1 year after treatment to evaluate possible recurrence and assess the patients' postoperative quality of life. Results: After initial ablation, the degree of residual lesion was significantly greater in the Er:YAG laser group (74.1%), compared with the Er,Cr:YSGG group (18.5%) (p = 0.0001). Six months and 1 year after the second ablation, there was no lesion recurrence in either laser group. Fourteen days after the initial ablation, the visual analog scale (VAS) pain rating and the total oral health impact profile score fell significantly in both groups (p < 0.0001). However, in the Er,Cr:YSGG laser group, the average value of the VAS rating was significantly lower than in the Er:YAG laser group (p = 0.039). Conclusions: The Er:YAG and Er,Cr:YSGG lasers showed similar efficacy in the treatment of oral leukoplakia and resulted in full postoperative recovery without recurrence after 1 year of follow-up.
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Affiliation(s)
- Nena Matulić
- 1 School of Dental Medicine, Department of Oral Surgery, University of Zagreb, Zagreb, Croatia
| | - Ivona Bago
- 2 Department of Endodontics and Restorative Dentistry and School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Mato Sušić
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Elizabeta Gjorgievska
- 4 Department of Pediatric and Preventive Dentistry, School of Dental Medicine, St Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Ana Kotarac Knežević
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Dragana Gabrić
- 3 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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23
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Yang EC, Vohra IS, Badaoui H, Schwarz RA, Cherry KD, Quang T, Jacob J, Lang A, Bass N, Rodriguez J, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Development of an integrated multimodal optical imaging system with real-time image analysis for the evaluation of oral premalignant lesions. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-10. [PMID: 30793567 PMCID: PMC6383051 DOI: 10.1117/1.jbo.24.2.025003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 05/11/2023]
Abstract
Oral premalignant lesions (OPLs), such as leukoplakia, are at risk of malignant transformation to oral cancer. Clinicians can elect to biopsy OPLs and assess them for dysplasia, a marker of increased risk. However, it is challenging to decide which OPLs need a biopsy and to select a biopsy site. We developed a multimodal optical imaging system (MMIS) that fully integrates the acquisition, display, and analysis of macroscopic white-light (WL), autofluorescence (AF), and high-resolution microendoscopy (HRME) images to noninvasively evaluate OPLs. WL and AF images identify suspicious regions with high sensitivity, which are explored at higher resolution with the HRME to improve specificity. Key features include a heat map that delineates suspicious regions according to AF images, and real-time image analysis algorithms that predict pathologic diagnosis at imaged sites. Representative examples from ongoing studies of the MMIS demonstrate its ability to identify high-grade dysplasia in OPLs that are not clinically suspicious, and to avoid unnecessary biopsies of benign OPLs that are clinically suspicious. The MMIS successfully integrates optical imaging approaches (WL, AF, and HRME) at multiple scales for the noninvasive evaluation of OPLs.
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Affiliation(s)
- Eric C. Yang
- Rice University, Department of Bioengineering, Houston, Texas, United States
- Baylor College of Medicine, MD/PhD Medical Scientist Training Program, Houston, Texas, United States
| | - Imran S. Vohra
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Hawraa Badaoui
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Richard A. Schwarz
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Katelin D. Cherry
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Timothy Quang
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Justin Jacob
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Alex Lang
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Nancy Bass
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Jessica Rodriguez
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Michelle D. Williams
- University of Texas M.D. Anderson Cancer Center, Department of Pathology, Houston, Texas, United States
| | - Nadarajah Vigneswaran
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Ann M. Gillenwater
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
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Vu J, Coleman HG, Palme CE, Riffat F, Schifter M, Zoellner H. Diagnostic utility of microsurgical carbon dioxide laser excision of oral potentially malignant lesions vs incisional biopsy: a retrospective histopathological review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:516-525. [PMID: 30948343 DOI: 10.1016/j.oooo.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/07/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral microsurgical carbon dioxide laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation, reduced postoperative morbidity, and easier postoperative clinical surveillance. STUDY DESIGN Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPMLs demonstrated the following histopathologic diagnoses on conventional incisional biopsy (CIB): verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently, these patients went on to have laser excision biopsy (LEB) of their OPMLs. RESULTS Histologic diagnosis was upgraded after LEB in 14 (45%) patients (P < .001), with unexpected findings of cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%). CONCLUSIONS Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs compared with use of CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regard to earlier detection of oral squamous cell and/or verrucous carcinoma.
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Affiliation(s)
- Jacinta Vu
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Perth Oral Medicine & Dental Sleep Centre, Perth, Western Australia, Australia; UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Hedley G Coleman
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Tissue Pathology and Diagnostic Oncology, Level 3, Institute for Clinical Pathology and Medical Research (ICPMR), Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Schifter
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.
| | - Hans Zoellner
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia
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Burkhardt A, Schwarz-Furlan S. Abrasive cytohistology of squamous epithelial lesions. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2018. [DOI: 10.1177/2057178x18808671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To describe a method to retrieve cellular and tissue elements of oral squamous epithelium obtained by abrasive methods and to conduct investigations by cytohistology. Method: We developed a special gelatine pocket suitable for paraffin embedding of sparse material obtained from brush biopsies (BBs). This was subjected to combined evaluation of a cytological (smear) and histological examination of the ‘tissue sections’ – referred as cytohistology. Four diagnostic categories were applied for evaluation. Other special diagnostic methods were also applied in addition to recording dysplasia. Results: A total of 51, 755 BBs from suspicious lesions of the oral mucosa (mostly oral potentially malignant disorders – OPMD) were evaluated for the presence of carcinoma or dysplasia; in all, 1.7% were positive, 78.2% were negative for any epithelial atypia, 16.8% atypical and 3.3% inadequate. All BBs also had cytohistological evaluation. A ‘positive’ diagnosis by cytohistology was a reliable indicator of dysplasia or carcinoma, requiring further incisional/excisional biopsy. In the ‘atypical’ category, a variety of lesions were found, about half being dysplasia or carcinoma. This category challenges the clinician for further clinical, therapeutic and/or excisional examination. In ‘negative’ cases with persistence of the lesion, a re-examination in 1-year sequence is recommended. Conclusion: Cytohistology of material derived by abrasive methods allows earlier detection of dysplasia/carcinoma. A number of additional oncological and non-oncological findings make this method a valuable non-invasive diagnostic procedure for oral mucosal lesions.
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Affiliation(s)
- Arne Burkhardt
- University of Tuebingen, Tuebingen, Germany
- Institute of Pathology Kaufbeuren-Ravensburg-Reutlingen, Kaufbeuren, Germany
| | - Stephan Schwarz-Furlan
- Institute of Pathology Kaufbeuren-Ravensburg-Reutlingen, Kaufbeuren, Germany
- Department of Pathology, University of Erlangen, Erlangen, Germany
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Villa A, Sonis S. Oral leukoplakia remains a challenging condition. Oral Dis 2018; 24:179-183. [PMID: 29480606 DOI: 10.1111/odi.12781] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
Crispian Scully had many interests in the realm of oral diseases. But oral leukoplakia was one that piqued his curiosity when he was still an academic neophyte and remained a topic which he studied throughout his enormously productive career. It is easy to understand why. While the clinical manifestations of oral leukoplakia are common, we still do not fully understand why one version of the condition is benign, while another, similar in appearance, progresses to a malignancy. The diagnosis of oral leukoplakia is based on expert clinical and histopathological examamination. Management and treatment of leukoplakia remain challenging especially for large lesions and the proliferative subtype. This review aims to provide a general overview on leukoplakia, explore current challenges in its diagnosis and management and discuss the opportunities to better understand the condition.
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Affiliation(s)
- A Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - S Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Biomodels LLC, Watertown, MA, USA
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Yang EC, Tan MT, Schwarz RA, Richards-Kortum RR, Gillenwater AM, Vigneswaran N. Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:670-681. [PMID: 29631985 PMCID: PMC6083875 DOI: 10.1016/j.oooo.2018.02.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 02/23/2018] [Indexed: 12/15/2022]
Abstract
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.
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Affiliation(s)
- Eric C Yang
- Department of Bioengineering, Rice University, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Melody T Tan
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | | | - Ann M Gillenwater
- Department of Head and Neck Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, TX, USA.
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Thomson PJ. Potentially malignant disorders-The case for intervention. J Oral Pathol Med 2017; 46:883-887. [DOI: 10.1111/jop.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Affiliation(s)
- P. J. Thomson
- Oral & Maxillofacial Surgery; School of Dentistry; University of Queensland; Oral Health Centre; QLD Australia
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McGee S, Mardirossian V, Elackattu A, Mirkovic J, Pistey R, Gallagher G, Kabani S, Yu CC, Wang Z, Badizadegan K, Grillone G, Feld MS. Anatomy-Based Algorithms for Detecting Oral Cancer Using Reflectance and Fluorescence Spectroscopy. Ann Otol Rhinol Laryngol 2017. [DOI: 10.1177/000348940911801112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective We used reflectance and fluorescence spectroscopy to noninvasively and quantitatively distinguish benign from dysplastic/malignant oral lesions. We designed diagnostic algorithms to account for differences in the spectral properties among anatomic sites (gingiva, buccal mucosa, etc). Methods In vivo reflectance and fluorescence spectra were collected from 71 patients with oral lesions. The tissue was then biopsied and the specimen evaluated by histopathology. Quantitative parameters related to tissue morphology and biochemistry were extracted from the spectra. Diagnostic algorithms specific for combinations of sites with similar spectral properties were developed. Results Discrimination of benign from dysplastic/malignant lesions was most successful when algorithms were designed for individual sites (area under the receiver operator characteristic curve [ROC-AUC], 0.75 for the lateral surface of the tongue) and was least accurate when all sites were combined (ROC-AUC, 0.60). The combination of sites with similar spectral properties (floor of mouth and lateral surface of the tongue) yielded an ROC-AUC of 0.71. Conclusions Accurate spectroscopic detection of oral disease must account for spectral variations among anatomic sites. Anatomy-based algorithms for single sites or combinations of sites demonstrated good diagnostic performance in distinguishing benign lesions from dysplastic/malignant lesions and consistently performed better than algorithms developed for all sites combined.
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Affiliation(s)
- Sasha McGee
- G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
| | | | - Alphi Elackattu
- Departments of Otolaryngology–Head and Neck Surgery, Boston, Massachusetts
| | - Jelena Mirkovic
- G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
| | - Robert Pistey
- Departments of Anatomic Pathology, Boston, Massachusetts
| | - George Gallagher
- Boston Medical Center, the Department of Oral and Maxillofacial Pathology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts
| | - Sadru Kabani
- Boston Medical Center, the Department of Oral and Maxillofacial Pathology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts
| | - Chung-Chieh Yu
- G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
| | - Zimmern Wang
- Departments of Otolaryngology–Head and Neck Surgery, Boston, Massachusetts
| | - Kamran Badizadegan
- G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory Grillone
- Departments of Otolaryngology–Head and Neck Surgery, Boston, Massachusetts
| | - Michael S. Feld
- G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Boston, Massachusetts
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Improving accuracy of RNA-based diagnosis and prognosis of oral cancer by using noninvasive methods. Oral Oncol 2017; 69:62-67. [PMID: 28559022 DOI: 10.1016/j.oraloncology.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/23/2017] [Accepted: 04/01/2017] [Indexed: 12/13/2022]
Abstract
RNA-based diagnosis and prognosis of squamous cell carcinoma has been slow to come to the clinic. Improvements in RNA measurement, statistical evaluation, and sample preservation, along with increased sample numbers, have not made these methods reproducible enough to be used clinically. We propose that, in the case of squamous cell carcinoma of the oral cavity, a chief source of variability is sample dissection, which leads to variable amounts of stroma mixed in with tumor epithelium. This heterogeneity of the samples, which requires great care to avoid, makes it difficult to see changes in RNA levels specific to tumor cells. An evaluation of the data suggests that, paradoxically, brush biopsy samples of oral lesions may provide a more reproducible method than surgical acquisition of samples for miRNA measurement. The evidence also indicates that body fluid samples can show similar changes in miRNAs with oral squamous cell carcinoma (OSCC) as those seen in tumor brush biopsy samples - suggesting much of the miRNA in these samples is coming from the same source: tumor epithelium. We conclude that brush biopsy or body fluid samples may be superior to surgical samples in allowing miRNA-based diagnosis and prognosis of OSCC in that they feature a rapid method to obtain homogeneous tumor cells and/or RNA.
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Villa A, Woo SB. Leukoplakia—A Diagnostic and Management Algorithm. J Oral Maxillofac Surg 2017; 75:723-734. [DOI: 10.1016/j.joms.2016.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023]
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Zhou Y, Kolokythas A, Schwartz JL, Epstein JB, Adami GR. microRNA from brush biopsy to characterize oral squamous cell carcinoma epithelium. Cancer Med 2016; 6:67-78. [PMID: 27989009 PMCID: PMC5275769 DOI: 10.1002/cam4.951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 12/24/2022] Open
Abstract
Few cancers are diagnosed based on RNA expression signatures. Oral squamous cell carcinoma (OSCC) is no exception; it is currently diagnosed by scalpel biopsy followed by histopathology. This study sought to identify oral tumor epithelial microRNA (miRNA) expression changes to determine if these changes could be used to diagnose the disease noninvasively. Analysis of miRNA profiles from surgically obtained OSCC tissue, collected under highly standardized conditions for The Cancer Genome Atlas, was done to determine the potential accuracy in differentiating tumor from normal mucosal tissue. Even when using small 20 subject datasets, classification based on miRNA was 90 to 100% accurate. To develop a noninvasive classifier for OSSC, analysis of brush biopsy miRNA was done and showed 87% accuracy in differentiating tumor from normal epithelium when using RT‐qPCR or miRNAseq to measure miRNAs. An extensive overlap was seen in differentially expressed miRNAs in oral squamous cell carcinoma epithelium obtained using brush biopsy and those reported in saliva and serum of oral squamous cell carcinoma patients in several studies. This suggested that nonselective release of these miRNAs into body fluids from tumor epithelium was largely responsible for the changes in levels in these fluids seen with this disease. Using a variation in mirRPath we identified the KEGG pathway of neurotrophin signaling as a target of these miRNAs disregulated in tumor epithelium. This highlights the utility of brush biopsy of oral mucosa to allow simple acquisition of cancer relevant miRNA information from tumor epithelium.
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Affiliation(s)
- Yalu Zhou
- Department of Oral Medicine and Oral Diagnostics, Center for Molecular Biology of Oral Diseases, University of Illinois at Chicago, 801 South Paulina Street, Chicago, Illinois, 60610.,Arphion Ltd, 2242 W Harrison Street, Chicago, Illinois, 60612
| | - Antonia Kolokythas
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Chicago, Illinois, 60610
| | - Joel L Schwartz
- Department of Oral Medicine and Oral Diagnostics, Center for Molecular Biology of Oral Diseases, University of Illinois at Chicago, 801 South Paulina Street, Chicago, Illinois, 60610
| | - Joel B Epstein
- Cancer Dentistry Program, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Guy R Adami
- Department of Oral Medicine and Oral Diagnostics, Center for Molecular Biology of Oral Diseases, University of Illinois at Chicago, 801 South Paulina Street, Chicago, Illinois, 60610
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Vu AN, Matias M, Farah CS. Diagnostic accuracy of Narrow Band Imaging for the detection of oral potentially malignant disorders. Oral Dis 2016; 21:519-29. [PMID: 25619340 DOI: 10.1111/odi.12315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the clinical diagnostic accuracy of Narrow Band Imaging(™) for the detection of oral potentially malignant disorders in a prospective series of patients. MATERIALS AND METHODS New and existing patients referred to an oral medicine and pathology specialist clinic for assessment of at least one white, red or red-white oral mucosal lesion underwent conventional oral examination, followed by examination with the white light mode and then narrow band imaging mode of a Narrow Band Imaging(™) system. The clinical presentation, microvascular architecture and relevant histopathology of all lesions were recorded. RESULTS A total of 272 lesions from 95 patients were observed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of oral potentially malignant disorders or worse by Narrow Band Imaging(™) were 100%, 74.63%, 92.38%, 100% and 93.77%, respectively, when compared with conventional oral examination. Narrow Band Imaging(™) aided the detection of 24 lesions undetected by conventional oral examination and 13 lesions undetected by white light endoscopy. CONCLUSION Narrow Band Imaging(™) demonstrates great utility as a visualisation adjunct for detecting and monitoring oral potentially malignant diseases, particularly lesions not identified by conventional oral examination or white light examination alone.
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Affiliation(s)
- A N Vu
- UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia
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Gopinath D, Thannikunnath BV, Neermunda SF. Prevalence of Carcinomatous Foci in Oral Leukoplakia: A Clinicopathologic Study of 546 Indian Samples. J Clin Diagn Res 2016; 10:ZC78-83. [PMID: 27656569 PMCID: PMC5028553 DOI: 10.7860/jcdr/2016/16815.8305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oral Leukoplakia (OL), the most common potentially malignant disorder, is diagnosed clinically on the basis of exclusion of other lesions. In a country like India, where prevalence of oral cancer is very high, the issue of carcinomatous foci within OL at the time of initial diagnosis of leukoplakia has never been addressed before. AIM To estimate the prevalence and risk factors for epithelial dysplasia as well as carcinoma within OL lesions at the time of initial clinical presentation in an Indian population with high prevalence of tobacco use. MATERIALS AND METHODS Clinical and pathologic data (age, sex, lesion location and histopathologic grading) of 546 cases of leukoplakia were analyzed. The prevalence rate of dysplasia and carcinoma in 546 oral leukoplakia cases was calculated. Univariate analysis was performed to examine risk factors associated with the presence of carcinoma and dysplasia within the lesions. RESULTS The male to female ratio in this study was 2:1. Majority of the patients irrespective of sex had a history of tobacco use. Of the total 85% of non-homogeneous lesions and 70% for the homogeneous lesions were illustrating, features of epithelial dysplasia. The prevalence rate of carcinoma was 11.9%. In univariate analysis it was found that lesion site, clinical appearance, tobacco use were strongly correlated with the presence of carcinoma within OL. CONCLUSION Our results demonstrate that majority of leukoplakia irrespective of its clinical appearance contain a dysplastic component and significant proportion contains carcinomatous foci. Lesions with certain features are more prone to have carcinomatous foci. However there is always a chance of finding foci of carcinoma in OL anywhere in the oral cavity. Therefore, excision biopsy is always mandatory before long term follow-up and treatment is planned.
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Affiliation(s)
- Divya Gopinath
- Senior Lecturer, Department of Oral Pathology and Microbiology, Malabar Dental College and Research Centre Edappal, Malappuram, Kerala, India
| | - Beena Valappil Thannikunnath
- Professor and Head, Department of Oral and Maxillofacial Pathology, Government Dental College, Kottayam, Kerala, India
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Vu A, Farah CS. Narrow band imaging: clinical applications in oral and oropharyngeal cancer. Oral Dis 2016; 22:383-90. [PMID: 26713751 DOI: 10.1111/odi.12430] [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] [Received: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 01/19/2023]
Abstract
Narrow Band Imaging (NBI) is an endoscopic optical imaging enhancement technology that improves the contrast of mucosal surface texture, and enhances visualisation of mucosal and submucosal vasculature. White light is filtered to emit two 30-nm narrow bands of blue (415 nm) and green light (540 nm) light simultaneously, the former corresponding to the main peak absorption spectrum of haemoglobin, and the latter allowing visualisation of blood vessels in the deeper mucosal and submucosal layers. NBI has been used to better assess oral potentially malignant disorders (OPMD), identify oral and oropharyngeal squamous cell carcinoma (SCC), and to define surgical margins of head and neck malignancies. NBI shows great potential in improving detection rates of OPMD, facilitating better assessment of oral and oropharyngeal SCC, and reducing the risk of recurrence for oral SCC. Although further research is required to better understand and define intrapapillary capillary loop (IPCL) patterns and to relate these with clinical, histopathological and molecular parameters especially for early mucosal changes, there is building evidence to recommend its use as the new gold standard for endoscopic assessment in head and neck oncology.
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Affiliation(s)
- A Vu
- The Australian Centre for Oral Oncology Research & Education, School of Dentistry, University of Western Australia, Nedlands, Australia
| | - C S Farah
- The Australian Centre for Oral Oncology Research & Education, School of Dentistry, University of Western Australia, Nedlands, Australia
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Chen S, Forman M, Sadow PM, August M. The Diagnostic Accuracy of Incisional Biopsy in the Oral Cavity. J Oral Maxillofac Surg 2015; 74:959-64. [PMID: 26682520 DOI: 10.1016/j.joms.2015.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the accuracy of incisional biopsy examination to diagnose oral lesions. MATERIALS AND METHODS This retrospective cohort study was performed to determine the concordance rate between incisional biopsy examination and definitive resection diagnosis for different oral lesions. The study sample was derived from the population of patients who presented to the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital (Boston, MA) from January 2005 through December 2012. Inclusion criteria were the diagnosis of an oral lesion from an incisional biopsy examination, subsequent diagnosis from the definitive resection of the same lesion, and complete clinical and pathologic patient records. The predictor variables were the origin and size of the lesion. The primary outcome variable was concordance between the provisional incisional biopsy diagnosis and definitive pathologic resection diagnosis. The secondary outcome variable was type of biopsy error for the discordant cases. Incisional biopsy errors were assessed and grouped into 5 categories: 1) sampling error; 2) insufficient tissue for diagnosis; 3) presence of inflammation making diagnosis difficult; 4) artifact; and 5) pathologist discordance. RESULTS A total of 272 patients met the inclusion criteria. The study sample had a mean age of 47.4 years and 55.7% were women. Of these cases, 242 (88.9%) were concordant when comparing the biopsy and final resection pathology reports. At histologic evaluation, 60.0% of discordant findings were attributed to sampling error, 23.3% to pathologist discrepancy, 13.3% to insufficient tissue provided in the biopsy specimen, and 3.4% to inflammation obscuring diagnosis. Overall, concordant cases had a larger average biopsy volume (1.53 cm(3)) than discordant cases (0.42 cm(3)). CONCLUSION The data collected indicate an 88.9% diagnostic concordance with final pathologic results for incisional oral biopsy diagnoses. Sixty percent of discordance was attributed to sampling error when sampled tissue was not representative of the lesion in toto. Multiple-site biopsy specimens and larger-volume samples allowed for a more accurate diagnosis.
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Affiliation(s)
- Sara Chen
- Resident PGY1, Department of Restorative Dentistry (Prosthodontics), University of Illinois at Chicago, Chicago, IL; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael Forman
- Student, Harvard School of Dental Medicine, Boston, MA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Peter M Sadow
- Associate Director, Head and Neck Pathology; Assistant Professor, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Meredith August
- Associate Professor, Massachusetts General Hospital and Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Boston MA.
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Montague L, Bhattacharyya I, Islam M, Cohen D, Fitzpatrick S. Direct immunofluorescence testing results in cases of premalignant and malignant oral lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:675-83. [DOI: 10.1016/j.oooo.2015.02.478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 01/03/2023]
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Mapping of healthy oral mucosal tissue using diffuse reflectance spectroscopy: ratiometric-based total hemoglobin comparative study. Lasers Med Sci 2015; 30:2135-41. [DOI: 10.1007/s10103-015-1765-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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Varoni E, Decani S, Franchini R, Baruzzi E, Lodi G. Macchie bianche o leucoplachia? Quando preoccuparsi? DENTAL CADMOS 2014. [DOI: 10.1016/s0011-8524(14)70229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mutalik S, Mutalik VS, Pai KM, Naikmasur VG, Phaik KS. Oral leukoplakia - is biopsy at the initial appointment a must? J Clin Diagn Res 2014; 8:ZC04-7. [PMID: 25302256 DOI: 10.7860/jcdr/2014/8717.4659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/18/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient's initial visit. MATERIALS AND METHODS Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination. RESULTS A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia. CONCLUSION The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.
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Affiliation(s)
- Sunil Mutalik
- Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry, International Medical University , Jalan Jalil Perkasa, Kuala Lumpur, Malaysia
| | - Vimi S Mutalik
- Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry, International Medical University , Jalan Jalil Perkasa, Kuala Lumpur, Malaysia
| | - Keerthilatha M Pai
- Professor and Head, Department of Oral Medicine and Radiology, MCODS , Manipal, India
| | - Venkatesh G Naikmasur
- Professor and Head, Department of Oral Medicine and Radiology, SDM college of dental sciences , Dharwad, India
| | - Khoo Suan Phaik
- Professor and Associate Dean, Division of Oral Diagnostic Sciences, International Medical University , Malaysia
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Woo SB, Grammer RL, Lerman MA. Keratosis of unknown significance and leukoplakia: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:713-24. [PMID: 25457889 DOI: 10.1016/j.oooo.2014.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/05/2014] [Accepted: 09/12/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objectives were to (1) determine the frequency of specific diagnoses in a series of white lesions, and (2) describe the nature of keratotic lesions that are neither reactive nor dysplastic. STUDY DESIGN White lesions were analyzed and diagnosed as reactive keratoses, dysplastic/malignant, or keratoses of unknown significance (KUS). RESULTS Of the 1251 specimens that were evaluated, 703 met criteria for inclusion, and approximately 75% were reactive, 10% dysplastic/malignant, and 14% KUS. Excluding reactive keratoses, 43% were dysplastic/malignant and 57% were KUS. CONCLUSIONS Reactive keratoses were the most common white lesions followed by lichen planus. Dysplastic/malignant lesions constituted almost 50% of all true leukoplakias. KUS constituted the remaining cases and do not show typical reactive histopathology as well as clear dysplasia. They may represent evolving or devolving reactive keratoses but may also represent the very earliest dysplasia phenotype. Clinical findings may be helpful in differentiating the two.
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Affiliation(s)
- Sook-Bin Woo
- Associate Professor, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Associate Pathologist, StrataDx, Lexington, MA, USA; Attending Dentist, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca L Grammer
- Resident in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mark A Lerman
- Associate Professor, Department of Oral Pathology, Oral Medicine, and Craniofacial Pain, Tufts University School of Dental Medicine, Boston, MA, USA.
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Oral cancer and oral potentially malignant disorders. Int J Dent 2014; 2014:853479. [PMID: 24891850 PMCID: PMC4033498 DOI: 10.1155/2014/853479] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 12/20/2022] Open
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Nathan CAO, Kaskas NM, Ma X, Chaudhery S, Lian T, Moore-Medlin T, Shi R, Mehta V. Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions. Otolaryngol Head Neck Surg 2014; 151:73-80. [DOI: 10.1177/0194599814528660] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/28/2014] [Indexed: 12/20/2022]
Abstract
Objective This study aimed to determine the feasibility of using probe-based confocal laser endomicroscopy (pCLE) in the diagnostic differentiation of non-neoplastic lesions from precancerous and cancerous lesions of head and neck patients. Study Design Diagnostic test evaluation. Setting Louisiana State University Health Shreveport. Subjects and Methods Intravenous injection of fluorescein was given to patients with precancerous and cancerous head and neck lesions (n = 21) followed by the use of a 1.8-mm GastroFlex probe in the oral cavity with subsequent biopsies of selected areas. Probe-based confocal laser endomicroscopy images were compared to histologic evaluation of visualized sites using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Results The dorsal surface of the tongue was not well visualized. The remaining nonkeratinized subsites, including the buccal mucosa, floor of mouth, and ventral tongue, were well visualized. Diagnoses based on pCLE images correlated well with the gold standard diagnoses based on tissue histology. The overall sensitivity for diagnosis of dysplasia versus nondysplasia was 80.0% (95% confidence interval [CI], 62.0-98.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). The overall specificity, sensitivity, PPV, and NPV for pCLE diagnosis of carcinoma versus nondysplasia were 100%. The overall sensitivity for diagnosis of carcinoma versus dysplasia was 85.7% (95% CI, 73.0-99.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). Conclusion The pCLE is a promising method for differentiating between nondysplastic, precancerous, and cancerous lesions of the head and neck.
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Affiliation(s)
- Cherie-Ann O. Nathan
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Nadine M. Kaskas
- Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Xiaohui Ma
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Shubnum Chaudhery
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Department of Pathology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Timothy Lian
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Tara Moore-Medlin
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Runhua Shi
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Vikas Mehta
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
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Abstract
Oral potentially malignant disorders are mucosal diseases with a significantly increased risk of squamous carcinoma development – a lethal and deforming disease with rising incidence, especially in young people. Despite the ability to recognise pre-cancer disorders in patients, clinicians remain unable to predict individual mucosal lesion behaviour or quantify the risk of malignant transformation. No clear management guidelines exist and the available scientific literature is unable to answer the fundamental question: does early diagnosis and interventional management treat pre-cancer effectively and prevent malignant transformation?
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Affiliation(s)
- Peter Thomson
- Professor of Oral & Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW
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Pentenero M, Marino R, Tempia Valenta G, Navone R, Gandolfo S. Microbiopsy a novel sampling technique to early detect dysplastic/malignant alterations in oral mucosal lesions: practicability by general dentists. J Oral Pathol Med 2014; 43:435-40. [DOI: 10.1111/jop.12161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Pentenero
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Roberto Marino
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Guido Tempia Valenta
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
| | - Roberto Navone
- Department of Biomedical Sciences and Human Oncology of Pathology Unit; University of Turin; Turin Italy
| | - Sergio Gandolfo
- Department of Oncology; Oral Medicine and Oral Oncology Unit; University of Turin; Turin Italy
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Lucio M, Andrea G, Bartolomeo GD, Fabio C, Dora S. Between-lesion discrepancies in terms of dysplasia, cell turnover and diagnosis in patients with multiple potentially malignant oral lesions. Open Dent J 2013; 7:169-74. [PMID: 24363787 PMCID: PMC3866629 DOI: 10.2174/1874210601307010169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/26/2013] [Indexed: 02/03/2023] Open
Abstract
Objective: The present study assessed patients with multiple oral lesions to evaluate the mis-estimation rate in terms of diagnosis and risk of malignant transformation when only one biopsy is performed.
Study Design: Thirty-five patients presenting at least two white and/or red lesions in different oral mucosa sites with a final diagnosis of leuko/erythroplakias or lichenoid lesions were included, for a total of 70 biopsies.
Results: Nineteen patients (54%) had at least one between-lesion discrepancy considering the presence/absence of dysplasia (10 patients), normal/high cell turnover (13 patients) or diagnosis (5 patients). Discrepancies were not related to clinical aspect or within-patient similarity of lesions.
Conclusions: Multiple oral lesions in the same patient can significantly differ in terms of dysplasia, high cell turnover and, even diagnosis. Multiple biopsies are imperative and diagnosis as well as risk of malignant transformation should be formulated for each single lesion rather than for each individual patient.
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Affiliation(s)
- Montebugnoli Lucio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Gabusi Andrea
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Cervellati Fabio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Servidio Dora
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Er,Cr:YSGG laser therapy for oral leukoplakia minimizes thermal artifacts on surgical margins: a pilot study. Lasers Med Sci 2013; 28:1591-7. [DOI: 10.1007/s10103-013-1266-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/07/2013] [Indexed: 01/21/2023]
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Silva BSDF, Yamamoto FP, Pontes FSC, Cury SEV, Fonseca FP, Pontes HAR, Pinto-Júnior DDS. TWIST and p-Akt immunoexpression in normal oral epithelium, oral dysplasia and in oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2012; 17:e29-34. [PMID: 21743395 PMCID: PMC3448197 DOI: 10.4317/medoral.17344] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/06/2011] [Indexed: 12/21/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the immunoexpression of TWIST and p-Akt proteins in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), correlating their expressions with the histological features of the lesions.
Study design: Immunohistochemical studies were carried out on 10 normal oral epithelium, 30 OL and 20 OSCC formalin-fixed, paraffin-embedded tissue samples. Immunoperoxidase reactions for TWIST and p-Akt proteins were applied on the specimens and the positivity of the reactions was calculated for 1000 epithelial cells.
Results: Kruskal-Wallis and Dunn’s post tests revealed a significant difference in TWIST and p-Akt immunoexpression
among normal oral mucosa, OL and OSCC. In addition, a significant positive correlation was found between TWIST and p-Akt expressions according to the Pearson’s correlation test.
Conclusions: The results obtained in the current study suggest that TWIST and p-Akt may participate of the multi-step process of oral carcinogenesis since its early stages.
Key words: Oral cancer, oral leukoplakia, dysplasia, immunohistochemistry.
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50
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Jeong WJ, Paik JH, Cho SW, Sung MW, Kim KH, Ahn SH. Excisional biopsy for management of lateral tongue leukoplakia. J Oral Pathol Med 2011; 41:384-8. [PMID: 22077669 DOI: 10.1111/j.1600-0714.2011.01106.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Leukoplakia of the lateral tongue is frequently associated with the risk of malignancy. Although incisional biopsy is accepted as a standard technique for evaluation, the possibility of underdiagnosis, and therefore missed diagnosis of malignancy, remains at all times. The aim of this study was to determine the rate of underdiagnosis by incisional biopsy for leukoplakia of the lateral tongue and to elucidate the underlying cause of for underdiagnosis. METHODS Twenty-two patients with leukoplakia in the lateral tongue who had undergone excisional biopsy for suspicion of malignancy were included in the study. Pathology was reviewed and classified into 'no dysplasia,''dysplasia,' and 'carcinoma'. Underdiagnosis was defined as a change of diagnosis to a graver classification following excisional biopsy. To analyze the factors contributing to underdiagnosis, incisional and excisional biopsy specimens were re-evaluated. RESULTS Of the 22 patients with leukoplakia of the lateral tongue, 59.1% had coexistent malignancy, including nine squamous cell carcinomas and four verrucous carcinomas. Incisional biopsy resulted in underdiagnosis in 73.3% of the cases. Underdiagnosis was attributable to three common errors, which were mis-selection of sampling site within a large area of leukoplakia, error in pathology specimen preparation owing to small specimen size, and superficial biopsy frequently associated with punch biopsy. CONCLUSION Leukoplakia of the lateral tongue is highly coexistent with malignancy, and incisional biopsy frequently leads to underdiagnosis. Therefore, complete excision with adequate margin is warranted for leukoplakia of the lateral tongue, preferably under general anesthesia, which could be performed with minimal morbidity and function preservation.
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Affiliation(s)
- Woo-Jin Jeong
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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