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Pošta P, Kolk A, Pivovarčíková K, Liška J, Genčur J, Moztarzadeh O, Micopulos C, Pěnkava A, Frolo M, Bissinger O, Hauer L. Clinical Experience with Autofluorescence Guided Oral Squamous Cell Carcinoma Surgery. Diagnostics (Basel) 2023; 13:3161. [PMID: 37891982 PMCID: PMC10605623 DOI: 10.3390/diagnostics13203161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
In our study, the effect of the use of autofluorescence (Visually Enhanced Lesion Scope-VELscope) on increasing the success rate of surgical treatment in oral squamous carcinoma (OSCC) was investigated. Our hypothesis was tested on a group of 122 patients suffering from OSCC, randomized into a study and a control group enrolled in our study after meeting the inclusion criteria. The preoperative checkup via VELscope, accompanied by the marking of the range of a loss of fluorescence in the study group, was performed before the surgery. We developed a unique mucosal tattoo marking technique for this purpose. The histopathological results after surgical treatment, i.e., the margin status, were then compared. In the study group, we achieved pathological free margin (pFM) in 55 patients, pathological close margin (pCM) in 6 cases, and we encountered no cases of pathological positive margin (pPM) in the mucosal layer. In comparison, the control group results revealed pPM in 7 cases, pCM in 14 cases, and pFM in 40 of all cases in the mucosal layer. This study demonstrated that preoperative autofluorescence assessment of the mucosal surroundings of OSCC increased the ability to achieve pFM resection 4.8 times in terms of lateral margins.
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Affiliation(s)
- Petr Pošta
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Kristýna Pivovarčíková
- Sikl’s Department of Pathology, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic;
- Bioptic Laboratory Ltd., 32600 Pilsen, Czech Republic
| | - Jan Liška
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Jiří Genčur
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Omid Moztarzadeh
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
- Department of Anatomy, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic
| | - Christos Micopulos
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Adam Pěnkava
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Maria Frolo
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Oliver Bissinger
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Lukáš Hauer
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
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Cowpe JG, Longmore RB, Green MW. Quantitative Exfoliative Cytology of Abnormal Oral Mucosal Smears. J R Soc Med 2018; 81:509-13. [PMID: 3184106 PMCID: PMC1291758 DOI: 10.1177/014107688808100905] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study quantitative techniques have been applied to smears collected from the buccal mucosa and floor of the mouth. The results display an encouraging success rate for identifying premalignant and malignant lesions. ‘Intrapatient’ normal smears provide a satisfactory control for comparison with pathological smears. Early results indicate that quantitative cytology could be of great value for monitoring and follow-up of suspicious lesions and provide an excellent additional diagnostic test for detecting early oral malignancy.
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Affiliation(s)
- J G Cowpe
- Department of Dental Surgery, University of Dundee
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Application of direct oral microscopy in evaluating mucosal margins around invasive oral squamous cell carcinoma. Postepy Dermatol Alergol 2016; 32:349-57. [PMID: 26759543 PMCID: PMC4692809 DOI: 10.5114/pdia.2014.40792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/10/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Direct oral microscopy constitutes a novel, non-invasive diagnostic technique, which aids clinical examination of the oral cavity. The oral mucosa is examined at multiple magnifications and features such as sub-epithelial mucosal vessels, surface patterns, colour tone, transparency and the exact demarcation of mucosal lesions are estimated. The incidence of oral squamous cell carcinoma (OSCC) oscillates between 1.9% and 3.5%, which makes it the eighth most common carcinoma occurring around the world and in Poland. The 5-year survival rates oscillate between 20% and 30%. AIM The aim of the study was to evaluate clinically unchanged mucosal margins around OSCC by direct oral microscopy. The authors approached the question whether the borders of mucosal margins around OSCC established via direct oral microscopy differ from those established based on clinical examination. MATERIAL AND METHODS Fifteen patients diagnosed with OSCC were enrolled. Patients were first clinically examined to evaluate the extent of the tumour and to plan resection margins. Eventually, direct oral microscopy was performed to establish the width of the subclinically unchanged mucosal margins based on a standard picture of healthy oral mucosae, followed by comparison with those established by clinical evaluation. RESULTS Histopathologic results of biopsies from areas indicated by direct oral microscopy revealed dysplasia in 86.7% of patients, whereas biopsies from areas indicated by clinical examination revealed dysplasia only in 40% of individuals, resulting in the need for widening of mucosal margins. CONCLUSIONS Direct oral microscopy enables detection of dysplasia within clinically unaltered mucosal margins around OSCC, which results in more precise establishing of resection boundaries, contributing to improvement of resection totality.
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Clinical diagnosis of oral erosive lichen planus by direct oral microscopy. Postepy Dermatol Alergol 2014; 31:222-8. [PMID: 25254007 PMCID: PMC4171669 DOI: 10.5114/pdia.2014.40926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/07/2013] [Accepted: 08/27/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction Direct oral microscopy is a novel, non-invasive diagnostic technique that aids clinical examination of the oral cavity. The basic principles of this method derive from colposcopy and dermoscopy. The principle is to reveal precancerous lesions of oral mucosae in their subclinical phase in order to begin their treatment as early as possible and prevent malignant transformation. Oral lichen planus (OLP) is an autoimmune, inflammatory, chronic disease affecting oral mucous membranes. Buccal mucosae are most often affected. Aim To describe the in vivo picture of erosive OLP in direct oral microscopy in terms of the pattern and density of subepithelial blood vessels, surface texture, color, transparency and borders of the lesions. The study also demonstrates the utility of the method in the selection of the most appropriate biopsy site. Material and methods A total of 30 patients with erosive OLP were examined. Clinical examination of the oral cavity with the naked eye was performed, followed by direct oral microscopy. The most appropriate biopsy sites based on both examinations were chosen for every individual and biopsies were taken for histopathological evaluation. Results Biopsies obtained based on direct oral microscopy revealed dysplasia in 16 patients (53.3%). Biopsies obtained based on clinical examination with the naked eye revealed dysplasia in 3 cases (10%). Conclusions Direct oral microscopy makes it possible to obtain a repeated picture of erosive OLP and constitutes an alternative to the clinical examination with the naked eye in election of the most appropriate biopsy site. Thus, introduction of the most accurate and early therapy is possible.
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Hedge MC, Kamath PM, Shreedharan S, Dannana NK, Raju RM. Supravital staining: It's role in detecting early malignancies. Indian J Otolaryngol Head Neck Surg 2012; 58:31-4. [PMID: 23120232 DOI: 10.1007/bf02907735] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The efficacy of supravital staining in the detection of malignancies in oro and oropharyngeal lesions and its role in the detection of malignant changes in premalignant lesions were studied. This prospective study comprises 90 cases of clinically suspicious lesions and it was done over a period of 3 years. Most of the patients had multiple risk factors for the development of malignancy. All underwent staining with a modified solution of 1% toluidine blue (TB). In our study the overall sensitivity was 97.29% and the specificity was 62.5%.
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Affiliation(s)
- Mahesh Chandra Hedge
- Department of ORLHNS, Kasturba Medical College, Attavara, 575 001 Mangalore, Karnataka India
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Warnakulasuriya KA, Johnson NW. Sensitivity and specificity of OraScan (R) toluidine blue mouthrinse in the detection of oral cancer and precancer. J Oral Pathol Med 1996; 25:97-103. [PMID: 9148038 DOI: 10.1111/j.1600-0714.1996.tb00201.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The efficacy of 1% toluidine blue in the identification of oral malignancies and potentially malignant oral lesions was evaluated among a group of Asian patients (n = 102) with undiagnosed oral mucosal lesions and conditions (n = 145). The trial, utilising a ready-to-use kit, was controlled by histopathologic evaluation of a total of 87 dye-retained or dye-negative lesions. Eighteen oral carcinomas all retained the dye and there were no false negatives, yielding a test sensitivity of 100%. Eight of 39 oral epithelial dysplasias were toluidine blue-negative, giving a false negative rate of 20.5% and a sensitivity of 79.5% for oral epithelial dysplasias. The specificity of the technique was low (62%). Five dysplastic lesions were detected solely by the kit and this suggests that the method is valuable for surveillance of high-risk subjects in addition to its remarkable sensitivity in the detection of invasive carcinoma.
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Affiliation(s)
- K A Warnakulasuriya
- RCS Department of Dental Sciences and Department of Oral Medicine and Pathology, King's College School of Medicine and Dentistry, London, England
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Sciubba JJ. Oral leukoplakia. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1995; 6:147-60. [PMID: 7548621 DOI: 10.1177/10454411950060020401] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Leukoplakia has evolved as a clinico-pathologic concept over many years, with the current clinical designation being accepted worldwide. Reflective of the biology of leukoplakia is the concept of cellular atypia and epithelial dysplasia. Adding to a better understanding of leukoplakia in general has been the definition of relevant clinical subsets which, in some cases, includes etiology (snuff), while in other cases a verrucous clinical appearance will suggest a more aggressive anticipated behavior pattern. Tobacco usage, in many of its forms, remains the prime etiologic factor; however, other considerations also apply. More recently, the potential etiologic role of Candida albicans has been stressed, as well as its possible role in carcinogenesis. So-called oral hairy leukoplakia has been defined in relation to a possible Epstein-Barr viral infection, usually in the immunosuppressed patient. Other viruses, human papilloma virus in particular, have been implicated in leukoplakia, while genetic alterations involving tumor suppressor elements (p53) have also been investigated. Finally, the management of this common condition remains a variable and includes local, topical, and systemic therapies such as anti-oxidants, carotenoids, and retinoids.
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MESH Headings
- Candidiasis, Oral
- Epithelium/pathology
- Genes, Tumor Suppressor/genetics
- Herpesviridae Infections
- Herpesvirus 4, Human
- Humans
- Immunocompromised Host
- Leukoplakia, Hairy/virology
- Leukoplakia, Oral/drug therapy
- Leukoplakia, Oral/etiology
- Leukoplakia, Oral/genetics
- Leukoplakia, Oral/microbiology
- Leukoplakia, Oral/virology
- Mouth Neoplasms/microbiology
- Papillomaviridae
- Papillomavirus Infections
- Plants, Toxic
- Nicotiana
- Tobacco, Smokeless/adverse effects
- Tumor Virus Infections
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Affiliation(s)
- J J Sciubba
- Department of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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MacDonald DG, Critchlow HA. Lack of tumour potentiating effect of cryosurgery in hamster cheek pouch after short term carcinogen exposure. Br J Oral Maxillofac Surg 1985; 23:341-5. [PMID: 2932146 DOI: 10.1016/0266-4356(85)90005-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hamster cheek pouch was treated with the topical carcinogen DMBA for 2, 4 or 6 weeks. Cryosurgery to part of the treated area did not produce any alteration in subsequent tumour development. This contrasted with previous studies where cryosurgery following 8 weeks of DMBA application potentiated subsequent tumour development.
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Girard KR, Strahs GR, Chung B. Panoral verrucous dysplasia. Report of a case treated with split-thickness skin graft. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1980; 50:124-6. [PMID: 6994017 DOI: 10.1016/0030-4220(80)90197-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The treatment of panoral verrucous dysplasia involving the maxillary edentulous alveolar ridge, buccal vestibule, and palate is discussed. A case is presented in which a maxillary vestibuloplasty and skin graft were employed in treatment.
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Bekke JP, Baart JA. Six years' experience with cryosurgery in the oral cavity. INTERNATIONAL JOURNAL OF ORAL SURGERY 1979; 8:251-70. [PMID: 94318 DOI: 10.1016/s0300-9785(79)80047-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ninety selected patients with a benign or malignant lesion in the oral cavity were treated by cryosurgery. A clinical study was carried out during a 6-year period to investigate the value of cryosurgery as supplemental or substitute therapy. Good results have been obtained in the treatment of small to moderate, superficially situated angiomas. Cryotherapy has also been found to be satisfactory in the treatment of papillary hyperplasia of the palate. As symptomatic treatment we employed the freezing procedure to painful erosive lichen planus. Until now, a casual treatment has not been possible because of an unknown etiology. Used as symtomatic therapy, cryosurgery may be of some use in these cases, especially to relieve pain. Good results have been obtained in the treatment of oral leukoplakia. The pathologically changed mucous membranes could be completely eliminated in most of the cases without severe scar formation or impairment to functions. Cryosurgery for palliation was employed in 11 incurable tumors. Results have been disappointing. Twenty-one localized malignant neoplasms were treated by cryosurgery to cure. The tumor was completely destroyed in 67% of the cases.
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