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Viet CT, Zhang M, Dharmaraj N, Li GY, Pearson AT, Manon VA, Grandhi A, Xu K, Aouizerat BE, Young S. Artificial Intelligence Applications in Oral Cancer and Oral Dysplasia. Tissue Eng Part A 2024. [PMID: 39041628 DOI: 10.1089/ten.tea.2024.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a highly unpredictable disease with devastating mortality rates that have not changed over the past decades, in the face of advancements in treatments and biomarkers, which have improved survival for other cancers. Delays in diagnosis are frequent, leading to more disfiguring treatments and poor outcomes in patients. The clinical challenge lies in identifying those patients at highest risk for developing OSCC. Oral epithelial dysplasia (OED) is a precursor of OSCC with highly variable behavior across patients. There is no reliable clinical, pathologic, histologic or molecular biomarker to determine individual risk in OED patients. Similarly, there are no robust biomarkers to predict treatment outcomes or mortality of OSCC patients. This review aims to highlight advancements in artificial intelligence (AI)-based methods to develop predictive biomarkers of OED transformation to OSCC or predictive biomarkers of OSCC mortality and treatment response. Machine-learning based biomarkers, such as S100A7, demonstrate promising appraisal for the risk of malignant transformation of OED. Machine learning-enhanced multiplex immunohistochemistry (mIHC) workflows examine immune cell patterns and organization within the tumor immune microenvironment to generate outcome predictions in immunotherapy. Deep learning (DL) is an AI-based method using an extended neural network or related architecture with multiple "hidden" layers of simulated neurons to combine simple visual features into complex patterns. DL-based digital pathology is currently being developed to assess OED and OSCC outcomes. The integration of machine learning in epigenomics aims to examine the epigenetic modification of diseases and improve our ability to detect, classify, and predict outcomes associated with epigenetic marks. Collectively, these tools showcase promising advancements in discovery and technology, which may provide a potential solution to addressing the current limitations in predicting OED transformation and OSCC behavior, both of which are clinical challenges that must be addressed in order to improve OSCC survival.
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Affiliation(s)
- Chi Tonglien Viet
- Loma Linda University, Department of Oral and Maxillofacial Surgery, Loma Linda, California, United States;
| | - Michael Zhang
- Loma Linda University, Department of Oral and Maxillofacial Surgery, Loma Linda, California, United States;
| | - Neeraja Dharmaraj
- The University of Texas Health Science Center at Houston School of Dentistry, Bernard & Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, Houston, Texas, United States;
| | - Grace Y Li
- The University of Chicago Medical Center, Department of Medicine, Section of Hematology/Oncology,, Chicago, Illinois, United States;
| | - Alexander T Pearson
- The University of Chicago Medical Center, Department of Medicine, Section of Hematology/Oncology,, Chicago, Illinois, United States;
| | - Victoria A Manon
- The University of Texas Health Science Center at Houston School of Dentistry, Bernard & Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, Houston, Texas, United States;
| | - Anupama Grandhi
- Loma Linda University, Department of Oral and Maxillofacial Surgery, Loma Linda, California, United States;
| | - Ke Xu
- Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, United States
- VA Connecticut Healthcare System - West Haven Campus, West Haven, Connecticut, United States;
| | - Bradley E Aouizerat
- New York University College of Dentistry, Translational Research Center, New York, New York, United States;
| | - Simon Young
- The University of Texas Health Science Center at Houston School of Dentistry, Bernard & Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, Houston, Texas, United States;
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McCord C, Achita P, Kiss A, Magalhaes MA, Darling M, Bradley G. Progression to malignancy in oral potentially malignant disorders: a retrospective study of 5,036 patients in Ontario, Canada. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:466-477. [PMID: 37563059 DOI: 10.1016/j.oooo.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/27/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Determine the rate of malignant transformation (MT) of oral potentially malignant disorders (OPMDs) and risk factors for transformation. STUDY DESIGN The OPMD database (2001-2015) from 2 biopsy services in Ontario, Canada, was linked to the Ontario Cancer Registry to determine the rate of progression to oral squamous cell carcinoma (OSCC). Clinical and histologic features of progressed and non-progressed cases were compared to determine risk factors for progression. RESULTS The MT rate was 6.4% (322/5,036 cases). The mean time for cancer development was 51.2 months. 33.6% of cases (107/322) progressed after over 60 months. The risk of cancer increased with age and was higher in non-smokers. The MT rate was highest in the tongue (11.4%), followed by the floor of mouth (7.1%) and gingiva (6.5%). Histologic grade was associated with progression to cancer (P < .0001). Atypical verrucous-papillary lesions with no or mild dysplasia predominantly affected older patients' gingiva, and the progression rate was significantly higher than conventional mild dysplasia (9.2% vs 3.2%, P = .0002). CONCLUSIONS Our population-based retrospective study showed that <10% of OPMDs progressed to cancer, which could take many years. Atypical papillary-verrucous proliferation without high-grade dysplasia is a subtype of OPMD requiring further study.
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Affiliation(s)
- Christina McCord
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Paulina Achita
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marco A Magalhaes
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Darling
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Grace Bradley
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Zhou S, Zhang X, Liu W, Chen W. Evaluating surgical excision to prevent progression of oral precancerous lesions: Highlighting randomized controlled trials and cohort studies. J Dent Sci 2023; 18:1876-1882. [PMID: 37799862 PMCID: PMC10547983 DOI: 10.1016/j.jds.2023.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/27/2023] [Indexed: 10/07/2023] Open
Abstract
Currently, surgical excision remains a common intervention for oral precancerous lesions (OPL). However, the studies focusing on conventional surgery by scalpel for OPL are not analyzed collectively in detail. Therefore, the objective of this short communication is to summarize and evaluate the evidence on scalpel surgery in preventing the progression of OPL patients. There are 16 eligible studies on surgery management of the recurrence (13 studies) or malignant transformation (13 studies) of OPL. The pooled recurrence rate (95% confidence interval) of OPL patients received scalpel surgery and laser therapy is 29.5% (26.3-33.0%) and 32.2% (26.1-38.9%), respectively. The pooled rate of malignant transformation of OPL patients received scalpel surgery, laser therapy, and clinical observation is 8.9% (7.3-10.9%), 6.0% (3.5-10.1%), and 10.2% (8.6-12.1%), respectively. The important limitation of current evidence available for prognosis of dysplastic OPL is based on retrospective observational studies. It highlights that surgical management of OPL needs more randomized controlled trials and cohort studies to explore more reliable methods for routine clinical use to facilitate high- or low-risk stratification and further select more appropriate treatment option.
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Affiliation(s)
- Shanxin Zhou
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Xinyu Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Center of Head and Neck Oncology Clinical and Translational Science, 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
| | - Wei Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Center of Head and Neck Oncology Clinical and Translational Science, 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
| | - Weishi Chen
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Zhejiang, China
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Liu W, Yang X, Shi L, Shen X. Surgery management of oral cavity premalignancy needs risk stratification and randomized controlled trials. Int J Surg 2023; 109:2551-2554. [PMID: 37222678 PMCID: PMC10442132 DOI: 10.1097/js9.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
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
- 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
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Fengcheng Hospital of Fengxian District, Shanghai Ninth People's Hospital Fengcheng Branch Hospital
- 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
| | - 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
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuemin Shen
- 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
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wolk R, Lingen MW. Proceedings of the North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Oral Cavity Dysplasia: Why Does Histologic Grading Continue to be Contentious? Head Neck Pathol 2023; 17:292-298. [PMID: 37184731 PMCID: PMC10293486 DOI: 10.1007/s12105-023-01544-y] [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: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the world's 6th most common malignancy. Oral cavity SCC (OCSCC) represents approximately one third of the HNSCC cases diagnosed annually in the United States. Despite therapeutic advances, OCSCC is frequently lethal, with a modest 5-year survival. Because OCSCC is often preceded by premalignant lesions, it is an ideal disease for screening initiatives. The conventional visual and tactile exam (CVTE), coupled with a tissue biopsy, remains the gold standard. However, CVTE alone cannot reliably differentiate between reactive/inflammatory and dysplastic lesions. Further, the histologic diagnosis of dysplasia is subjective in nature and a highly imperfect predictor of malignant transformation. This prognostic uncertainty creates a significant clinical management dilemma-watchful waiting with increased patient psychological and economic burdens versus unnecessary aggressive treatment. As such, the development and validation of novel diagnostic platforms such as Artificial Intelligence (AI) and prognostic molecular biomarkers may help address these critical unmet clinical needs.
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Affiliation(s)
- Rachelle Wolk
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA.
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Polverini PJ, Nör F, Nör JE. Crosstalk between cancer stem cells and the tumor microenvironment drives progression of premalignant oral epithelium. FRONTIERS IN ORAL HEALTH 2023; 3:1095842. [PMID: 36704239 PMCID: PMC9872128 DOI: 10.3389/froh.2022.1095842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Cancer stem cells (CSC) are a subpopulation of cancer cells that exhibit properties of self-renewal and differentiation and have been implicated in metastasis and treatment failures. There is mounting evidence that carcinogen-initiated mucosal epithelial stem cells acquire the CSC phenotype following exposure to environmental or infectious mutagens and are responsible for promoting the malignant transformation of premalignant (dysplastic) epithelium. CSC further contribute to the progression of dysplasia by activating signaling pathways through crosstalk with various cell populations in the tumor microenvironment. Two cell types, tumor-associated macrophages (TAM) and vascular endothelial cells (EC) nurture CSC development, support CSC stemness, and contribute to tumor progression. Despite mounting evidence implicating CSC in the initiation and progression of dysplastic oral epithelium to squamous cell carcinoma (SCC), the molecular mechanisms underlying these synergistic biological processes remain unclear. This review will examine the mechanisms that underlie the transformation of normal epithelial stem cells into CSC and the mechanistic link between CSC, TAM, and EC in the growth and the malignant conversation of dysplastic oral epithelium.
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Affiliation(s)
- Peter J. Polverini
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States,Correspondence: Peter J. Polverini
| | - Felipe Nör
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Jacques E. Nör
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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Ellonen R, Suominen A, Kelppe J, Willberg J, Rautava J, Laine H. Histopathological findings of oral epithelial dysplasias and their relation to malignant transformation. Cancer Treat Res Commun 2023; 34:100664. [PMID: 36481601 DOI: 10.1016/j.ctarc.2022.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Oral squamous cell carcinomas (OSCCs) are often diagnosed late. This study aimed to determine how frequently oral epithelial dysplasia (OED) transforms to OSCC and to identify histological features that could influence the rate of malignant transformation. MATERIALS AND METHODS The study was a retrospective analysis of OED over 29 years at the Institute of Dentistry, University of Turku, Finland. OEDs with co-existing carcinomas were excluded from the data (5.8%). OED patients who developed carcinoma were identified from the Finnish Cancer Registry database. RESULTS Altogether 681 OED patients had a mean age of 59.0 years, and the male:female ratio was 0.67. Of all OED samples, 21.8% were on the tongue, followed by lining mucosa (21.3%), lip (5.3%), and masticatory mucosa (4.85%). In addition, 46.7% had no location cited. The prevalence of mild dysplasia was 62.4%, moderate dysplasia 29.1%, and severe dysplasia 3.2%. Of the patients, 94.7% had an additional histological diagnosis alongside OED. Candidiasis, lichenoid inflammation, and ulcer were found in 18.2%, 0.0%, and 22.7% of severe dysplasias, in 12.1%, 12.2%, and 22.7% of moderate dysplasias, and in 6.6%, 12.2%, and 15.8% of mild dysplasias, respectively. An additional histopathological diagnosis did not increase the risk for OED to transform to OSCC. In a mean time of 5.2 (range 0.7-29.0) years, 7.5% of OED patients developed OSCC. CONCLUSIONS Location on the tongue and the more severe OED grades increased the risk of malignant transformation of OED. These patients may benefit from an intensified follow-up schedule to ensure early diagnosis of OSCC.
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Affiliation(s)
- Riikka Ellonen
- Department of Oral Pathology and Radiology, University of Turku and Turku University Hospital, Turku, Finland.
| | - Auli Suominen
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Jetta Kelppe
- Department of Pathology, HUSLAB, Helsinki, Finland
| | - Jaana Willberg
- Department of Oral Pathology and Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Rautava
- Department of Oral Pathology and Radiology, University of Turku and Turku University Hospital, Turku, Finland; Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland; Department of Pathology, HUSLAB, Helsinki, Finland
| | - Hanna Laine
- Department of Oral Pathology and Radiology, University of Turku and Turku University Hospital, Turku, Finland; Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland
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Paglioni MDP, Khurram SA, Ruiz BII, Lauby-Secretan B, Normando AG, Ribeiro ACP, Brandão TB, Palmier NR, Lopes MA, da Silva Guerra EN, Meleti M, Migliorati CA, Carvalho AL, de Matos LL, Kowalski LP, Santos-Silva AR. Clinical predictors of malignant transformation and recurrence in oral potentially malignant disorders: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:573-587. [PMID: 36153299 DOI: 10.1016/j.oooo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We performed a systematic review dedicated to pooling evidence for the associations of clinical features with malignant transformation (MT) and recurrence of 3 oral potentially malignant disorders (OPMDs) (actinic cheilitis [AC], oral leukoplakia [OL], and proliferative verrucous leukoplakia [PVL]). STUDY DESIGN We selected studies that included clinical features and risk factors (age, sex, site, size, appearance, alcohol intake, tobacco use, and sun exposure) of OL, PVL, and AC associated with recurrence and/or MT. RESULTS Based on the meta-analysis results, non-homogeneous OL appears to have a 4.53 times higher chance of recurrence after treatment. We also found 6.52 higher chances of MT of non-homogeneous OL. Another clinical feature related to higher MT chances is the location (floor of the mouth and tongue has 4.48 higher chances) and the size (OL with >200 mm2 in size has 4.10 higher chances of MT). Regarding habits, nonsmoking patients with OL have a 3.20 higher chance of MT. The only clinical feature related to higher chances of MT in patients with PVL was sex (females have a 2.50 higher chance of MT). CONCLUSIONS Our study showed that some clinical features may indicate greater chances of recurrence after treatment and MT of OPMD.
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Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Blanca Iciar Indave Ruiz
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Béatrice Lauby-Secretan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Ana Gabriela Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Thais Bianca Brandão
- São Paulo Cancer Institute (ICESP), Dentistry Department, São Paulo, Brazil; Odontologia Oncológica D'or, São Paulo, Brazil
| | - Natália Rangel Palmier
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Marco Meleti
- Cantro Universitario di Odontoiatria-Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Leandro Luongo de Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School, São Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Ishii S, Sakaguchi W, Sugai M, Nagumo T, Koeda S, Ozawa M, Kitamura T, Yamamura M, Akiyama H, Tsukinoki K, Nakamura A. Analysis of false-negatives in exfoliative cytology in oral potentially malignant disorders: A retrospective cohort study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e390-e395. [PMID: 35134591 DOI: 10.1016/j.jormas.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Keratinized lesions have been a conceivable false-negative (FN) factor in oral exfoliative cytology (OEC); however, other factors are poorly analyzed. In this study, we aimed to identify the factors influencing the accuracy of OEC and FNs focusing on the lesion characteristics, patient background, and surgeon factors in oral potentially malignant disorders (OPMD). MATERIAL AND METHODS We retrospectively studied 44 patients who underwent both OEC and histopathological diagnosis. Sensitivity, specificity, FN rate, false-positive (FP) rate, and prevalence of both methods were compared. Similarly, accuracy indices were compared among clinical diagnosis groups (leukoplakia vs. other diagnosis). The association between patient and surgeon-related factors influencing FN OEC results were investigated using Fisher's exact test and a multiple logistic regression analysis. RESULTS Overall, the sensitivity; specificity; and FN, FP, and prevalence rates of OEC were 31.8%, 82.1%, and 68.8%, 17.9%, and 36.4%, respectively. Leukoplakia was significantly more common in clinical diagnosis (P = 0.007) with sensitivity, specificity, and FN rates of 20.0%, 95.2%, and 80.0%, respectively. Contrarily, non-keratinized lesions had sensitivity, specificity, and FN of 83.3%, 85.7%, and 16.7%, respectively. In the prevalent group, leukoplakia and anucleate squamous cells were significantly associated with FN cases (P = 0.013, P = 0.050). On multivariate analysis in OEC negative patients, age ≤64 (P = 0.050) and location on the tongue (P = 0.047) was independently associated with FNs. CONCLUSION FN of OEC was conceivable to be due to poor deep-seated cell sampling, which was associated with leukoplakia, age, and location. Therefore, these factors may be considered in the evaluation of OEC results.
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Affiliation(s)
- Shigeru Ishii
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Wakako Sakaguchi
- Department of Environmental Pathology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan.
| | - Masafune Sugai
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Tatsuhito Nagumo
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Satoko Koeda
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Manami Ozawa
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Toru Kitamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Makiko Yamamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Hiroki Akiyama
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
| | - Keiichi Tsukinoki
- Department of Environmental Pathology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan.
| | - Atsushi Nakamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama, Kanagawa 221-0835, Japan.
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Nevanpää TT, Terävä AE, Laine HK, Rautava J. Malignant transformation of oral epithelial dysplasia in Southwest Finland. Sci Rep 2022; 12:8261. [PMID: 35585112 PMCID: PMC9117212 DOI: 10.1038/s41598-022-12441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
Oral epithelial dysplasia (OED) is considered a risk for oral squamous cell carcinoma (OSCC). A meta-analysis estimated a mean malignant transformation rate of 12.1% (95% CI 8.1-17.9). The main target of this study was to define how many OED patients develop OSCC in the hospital district of Southwest Finland. A total of 571 patients diagnosed with OED were identified. Their potential subsequent diagnosis of OSCC was derived from the Finnish Cancer Registry. The risk of OSCC development in OED patients was compared with that of the general population without OED. During a mean follow-up of 5.5 (range 0.1-29.0) years 10.9% of OED patients developed OSCC. OED patients had a 44.7-fold higher risk (95% CI 34.4-56.7) of developing OSCC than the general population. The risk was at its highest within two years of OED diagnosis. OED patients in Southwest Finland have a significantly increased risk of developing OSCC relative to the general population, especially within the first two years of dysplasia diagnosis.
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Affiliation(s)
- Toni T Nevanpää
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Antti E Terävä
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna K Laine
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland.
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland.
| | - Jaana Rautava
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland
- Department of Pathology, Medicum, Faculty of Medicine, University of Helsinki and HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
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11
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Sandhu S, Klein BA, Al-Hadlaq M, Chirravur P, Bajonaid A, Xu Y, Intini R, Hussein M, Vacharotayangul P, Sroussi H, Treister N, Sonis S. Oral lichen planus: comparative efficacy and treatment costs-a systematic review. BMC Oral Health 2022; 22:161. [PMID: 35524296 PMCID: PMC9074269 DOI: 10.1186/s12903-022-02168-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). Materials and methods A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.
Results Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. Conclusion Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02168-4.
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Affiliation(s)
- Shaiba Sandhu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. .,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA. .,Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Brittany A Klein
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Malak Al-Hadlaq
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Prazwala Chirravur
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Amal Bajonaid
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Yuanming Xu
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Rossella Intini
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Mai Hussein
- Harvard Medical School, Boston, MA, USA.,Ministry of Health and Population, Cairo, Egypt
| | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, USA
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12
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Ellis BG, Whitley CA, Triantafyllou A, Gunning PJ, Smith CI, Barrett SD, Gardner P, Shaw RJ, Weightman P, Risk JM. Prediction of malignant transformation in oral epithelial dysplasia using infrared absorbance spectra. PLoS One 2022; 17:e0266043. [PMID: 35333891 PMCID: PMC8956195 DOI: 10.1371/journal.pone.0266043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Oral epithelial dysplasia (OED) is a histopathologically-defined, potentially premalignant condition of the oral cavity. The rate of transformation to frank carcinoma is relatively low (12% within 2 years) and prediction based on histopathological grade is unreliable, leading to both over- and under-treatment. Alternative approaches include infrared (IR) spectroscopy, which is able to classify cancerous and non-cancerous tissue in a number of cancers, including oral. The aim of this study was to explore the capability of FTIR (Fourier-transform IR) microscopy and machine learning as a means of predicting malignant transformation of OED. Supervised, retrospective analysis of longitudinally-collected OED biopsy samples from 17 patients with high risk OED lesions: 10 lesions transformed and 7 did not over a follow-up period of more than 3 years. FTIR spectra were collected from routine, unstained histopathological sections and machine learning used to predict malignant transformation, irrespective of OED classification. PCA-LDA (principal component analysis followed by linear discriminant analysis) provided evidence that the subsequent transforming status of these 17 lesions could be predicted from FTIR data with a sensitivity of 79 ± 5% and a specificity of 76 ± 5%. Six key wavenumbers were identified as most important in this classification. Although this pilot study used a small cohort, the strict inclusion criteria and classification based on known outcome, rather than OED grade, make this a novel study in the field of FTIR in oral cancer and support the clinical potential of this technology in the surveillance of OED.
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Affiliation(s)
- Barnaby G. Ellis
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - Conor A. Whitley
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories, University of Liverpool, Liverpool, United Kingdom
| | - Philip J. Gunning
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Caroline I. Smith
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - Steve D. Barrett
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - Peter Gardner
- Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Richard J. Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- * E-mail:
| | - Peter Weightman
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - Janet M. Risk
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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13
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Kawaharada M, Yamazaki M, Maruyama S, AbÉ T, Chan NN, Kitano T, Kobayashi T, Maeda T, Tanuma JI. Novel cytological model for the identification of early oral cancer diagnostic markers: The carcinoma sequence model. Oncol Lett 2022; 23:76. [PMID: 35111245 PMCID: PMC8771650 DOI: 10.3892/ol.2022.13196] [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: 10/07/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023] Open
Abstract
Most oral squamous cell carcinomas (OSCCs) arise from a premalignant lesion, oral epithelial dysplasia; however, useful markers for the early detection of OSCC are lacking. The present study aimed to establish a novel experimental model to observe changes in the sequential expression patterns of mRNAs and proteins in a rat model of tongue cancer using liquid-based cytology techniques. Cytology specimens were collected at 2, 5, 8, 11, 14, 17 and 21 weeks from rats treated with 4-nitroquinoline 1-oxide to induce tongue cancer. The expression of candidate biomarkers was examined by performing immunocytochemistry and reverse transcription-quantitative PCR. The percentage of positively stained nuclei was calculated as the labeling index (LI). All rats developed OSCC of the tongue at 21 weeks. The mRNA expression levels of bromodomain protein 4 (Brd4), c-Myc and Tp53 were upregulated during the progression from negative for intraepithelial lesion or malignancy to squamous cell carcinoma (SCC). Brd4- and c-Myc-LI increased in low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion and SCC specimens. p53-LI was significantly increased in SCC specimens. This novel experimental model allowed the observation of sequential morphological changes and the expression patterns of mRNAs and proteins during carcinogenesis. Combining immunocytochemistry with cytology-based diagnoses may potentially improve the diagnostic accuracy of OSCC.
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Affiliation(s)
- Masami Kawaharada
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan.,Division of Oral Pathology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Manabu Yamazaki
- Division of Oral Pathology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Satoshi Maruyama
- Oral Pathology Section, Department of Surgical Pathology, Niigata University Hospital, Chuo-ku, Niigata 951-8520, Japan
| | - Tatsuya AbÉ
- Division of Oral Pathology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Nyein Nyein Chan
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan.,Division of Oral Pathology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Taiichi Kitano
- Oral Pathology Section, Department of Surgical Pathology, Niigata University Hospital, Chuo-ku, Niigata 951-8520, Japan
| | - Tadaharu Kobayashi
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Takeyasu Maeda
- Research Center for Advanced Oral Science, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
| | - Jun-Ichi Tanuma
- Division of Oral Pathology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Chuo-ku, Niigata 951-8514, Japan
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14
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Goyal R, Goyal MK. Influence of Life Style Factors on Oral Potentially Malignant and Malignant Disorders: A Cross Sectional Study. Indian J Otolaryngol Head Neck Surg 2021; 73:443-446. [PMID: 34692456 DOI: 10.1007/s12070-020-02084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022] Open
Abstract
The incidence of oral cancer has risen in the past decades and is usually recognised when symptomatic and at a late stage. A premalignant lesion is like smoldering volcano, which if not taken care of, may erupt, often with disastrous consequences. Early detection is therefore very important to reduce morbidity and mortality. A descriptive cross-sectional study was done to assess the prevalence, clinical presentation, and association of various addiction habits in the patients who presented with potentially malignant and malignant lesions of the oral cavity in outdoor clinics of ENT and HNS department of a tertiary care center in Jaipur (Rajasthan). 351 patients of different oral mucosal lesions were examined from August 2019 to January 2020 among which 173(49.2%) patients of potentially malignant and malignant lesions comprise the study group. Clinical findings and detailed history including addiction habits with frequency and duration were noted. Cytological and histopathological examinations were done to conclude the diagnosis. Out of 173 patients of the study group, 146(84.4%) were diagnosed with potentially malignant lesions (PMLs) and 27(15.6%) with malignant lesions (MLs). The most prevalent PML was Oral submucous fibrosis (23%) followed by leukoplakia (7.6%). The most common involved site was buccal mucosa (45.0%) followed by the tongue (26.5%). Tobacco consumption was the most prevalent addiction habit (80%) in the study group. High prevalence of tobacco abuse in patients with potentially malignant and malignant lesions suggested a strong relationship between two. It necessitates adequate awareness in the general population as well as early detection and management of these lesions by an expert Otolaryngologist.
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15
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Chaurasia A, Alam SI, Singh N. Oral cancer diagnostics: An overview. Natl J Maxillofac Surg 2021; 12:324-332. [PMID: 35153426 PMCID: PMC8820315 DOI: 10.4103/njms.njms_130_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/02/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
Cancer was first mentioned in medicine texts by Egyptians. Ancient Indians studied oral cancer in great detail under Susruta. Cancer has continued to be a challenge to physicians from ancient times to the present. Over the years, cancer underwent a shift in management from radical surgeries toward a more preventive approach. Early diagnosis is vital in reducing cancer-associated mortality especially with oral cancer. Even though the mainstay of oral cancer diagnosis still continues to be a trained clinician and histopathologic examination of malignant tissues. Translating innovation in technological advancements in diagnostic aids for oral cancer will require both improved decision-making and a commitment toward optimizing cost, skills, turnover time between capturing data and obtaining a useful result. The present review describes the conventional to most advanced diagnostic modalities used as oral cancer diagnostics. It also includes the new technologies available and the future trends in oral cancer diagnostics.
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Affiliation(s)
- Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Saman Ishrat Alam
- Department of Oral Medicine and Radiology, Rama Dental College, Rama University, Kanpur, Uttar Pradesh, India
| | - Navin Singh
- Department of Radiotherapy, King George Medical University, Lucknow, Uttar Pradesh, India
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16
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Sahoo PK, Sarkar S, Ghosh D, Mahata S, Pal R, Mistry T, Ghosh S, Roy A, Bucha H, Mandal S, Nasare VD. Premalignant and malignant lesions of oral cavity in eastern India: a hospital-based study. Eur J Cancer Prev 2021; 30:393-399. [PMID: 33252366 DOI: 10.1097/cej.0000000000000640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Oral carcinoma and precancers are major public health challenges in India and other developing countries. OBJECTIVES Aim of the study was to assess the associations of demographic characteristics, addictions, chief complaints of mouth/oral and clinical diagnosis by cytology smear and punch biopsy in early detection of oral premalignant and malignant lesions. Methods Study was designed on retrospective data of case files of CDC, CNCI, Kolkata, from patients attended from January 1996 to September 2016. History was taken, histopathology and Pap smear were performed. Descriptive statistical analysis, cross-tabulation and Pearson's Chi-square test were done. RESULTS Total participants (n = 692); 110 (15.9%) having history of swallowing betel leaf, nut lime, dokta, jarda, catecheu with an average of 11 years. Three hundred twenty-five (46.9%) had multiple addiction (cigarette/bidi/tobacco/all). Ninety-eight (12.1%), 99 (12.2%) and 68 (8.4%) were addicted to cigarette, bidi and chewing tobacco, respectively. Twenty-nine participants were addicted to alcohol; 18 (2.6%) and 11 (1.5%) took country and foreign alcohol correspondingly. Clinicians thoroughly examined lips (4.1%), buccal mucosa (27.3%), gingival (2.8%), tongue (23.1%), hard and soft palate (4.9%), mouth loor (5.2%) and other parts (32.3%); diagnosed participants as normal (22.8%)/benign (23.1%)/premalignant (39.1%)/malignant (14.8%). Smears confirmed 60, 131, 42, 9 and 8 cases as carcinoma, mild, moderate, severe dysplasia and inflammation, respectively. The punch biopsy identified 11 carcinomas, two severe, two moderate and seveeen mild dysplasia's. Chi-square test showed significant association between smear and examination (P = 0.022), diagnosis and examinations of the oral cancer patients (P = 0.0001). CONCLUSION The study provided strong evidence that betel leaf, chewing tobacco, smoking and alcohol are independent risk factors for oral cancer. Cytological smear and biopsy are cost-effective approaches for early detection.
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Affiliation(s)
| | | | | | | | - Ranita Pal
- Departments of Pathology and Cancer Screening
| | | | | | - Asoke Roy
- Departments of Pathology and Cancer Screening
| | | | - Syamsundar Mandal
- Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, India
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17
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Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021; 27:1947-1976. [PMID: 34418233 DOI: 10.1111/odi.13993] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
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Affiliation(s)
- Edward Odell
- King's College London and Head and Neck Pathology Guy's Hospital, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King's College London and The WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Chief Histopathologist, AMLo Biosciences, Newcastle upon Tyne, UK
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18
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Kerr AR, Lodi G. Management of Oral Potentially Malignant Disorders. Oral Dis 2021; 27:2008-2025. [PMID: 34324758 DOI: 10.1111/odi.13980] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
Patients with oral potentially malignant disorders (OPMDs), including oral leukoplakia and erythroplakia, proliferative verrucous leukoplakia, oral submucous fibrosis, and oral lichen planus/lichenoid lesions can be challenging to manage. A small proportion will undergo cancer development and determining a patient's cancer risk is key to making management decisions. Yet, our understanding of the natural history of OPMDs has not been fully elucidated, and a precision approach based on the integration of numerous predictive markers has not been validated by prospective studies. Evidence-based health promotion by clinicians and healthcare systems is not embraced universally. Medical and surgical interventions evaluated by rigorous research measuring important endpoints, such as cancer development, mortality, or survival are difficult and expensive to run. Most of these studies employ non-ideal surrogate endpoints and have deep methodologic flaws. Diagnostic criteria for enrolling research subjects are not uniform, and patients with the highest risk for cancer development comprise small proportions of those enrolled. Few studies explore quality of life and patient preferences. It is time to rethink how we approach the management of these patients, across each OPMD, and considering the healthcare infrastructure and cost effectiveness. Global networks with well-characterized patient populations with OPMDs and well-designed interventional trials using validated outcome measures are needed.
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Affiliation(s)
- A Ross Kerr
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine.,New York University College of Dentistry, New York, NY, USA
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milano, Italia
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19
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Gilvetti C, Soneji C, Bisase B, Barrett AW. Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit. Oral Oncol 2021; 121:105462. [PMID: 34303087 DOI: 10.1016/j.oraloncology.2021.105462] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). MATERIALS & METHODS A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). RESULTS Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). CONCLUSION Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
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Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Chandni Soneji
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew William Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
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20
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RODRİGUEZ-ARCHİLLA A, FUENTES-PEREZ C. Clinicopathological parameters related to malignant transformation of oral leukoplakia: a meta-analysis. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.853865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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Sarode GS, Sarode SC, Sengupta N, Sharma NK, Patil S. Readdressing dysplasia at surgical margins as predictive biomarker of malignant transformation. Oral Oncol 2021; 117:105181. [PMID: 33500183 DOI: 10.1016/j.oraloncology.2021.105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/27/2022]
Abstract
Clinical, histological and molecular alterations observed at surgical margins could be regarded as predictive markers of malignant transformation. However, there are contrasting views on usefulness of oral epithelial dysplasia (OED) in predicting malignant transformation. In this regard, investigation of OED status at surgical margins could give an interesting perspective to this notion. We searched the reputed databases to retrieve the original research articles wherein the OED status was investigated at the mucosal surgical margins of oral squamous cell carcinoma (OSCC). Intriguingly, in all the studies, number of cases in 'no dysplasia' category was higher than other grades of dysplasia. In our institutional experience of 92 cases of OSCC, 75 (82%) cases showed no evidence of dysplasia at surgical margins. Thus, we conclude that dysplasia status at surgical margins does not support the OED as potential marker of malignant transformation.
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Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, MH, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, MH, India.
| | - Namrata Sengupta
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, MH, India
| | - Nilesh Kumar Sharma
- Cancer and Translational Research Lab, Dr. D.Y. Patil Biotechnology & Bioinformatics Institute, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra 411033, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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22
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McCarthy CE, Fedele S, Ho M, Shaw R. UK consensus recommendations on the management of oral epithelial dysplasia during COVID-19 pandemic outbreaks. Oral Oncol 2021; 112:105110. [PMID: 33232878 PMCID: PMC7674996 DOI: 10.1016/j.oraloncology.2020.105110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Oral Epithelial Dysplasia (OED) is associated with an increased risk of oral cancer development. The SARS-CoV-2 pandemic is necessitating the suspension or dramatic reduction of face-to-face non-urgent elective services, including OED clinics. Little is known regarding the potential impact of elective services suspension upon the risk of OED progression, and whether alternative strategies (e.g. remote consultations) may be introduced to ensure OED surveillance. The aim of this paper is to provide expert-opinion consensus recommendations for the management of OED during the current and future pandemic outbreaks. MATERIALS AND METHODS A working group of nine UK-based senior clinicians and academics in Oral and Maxillofacial Surgery and Oral Medicine was created and twelve consensus statements were developed using a modified-Delphi process. Greater than 80% agreement was considered a consensus. RESULTS Consensus was achieved for all twelve statements (89-100% agreement). The group agreed that, during the temporary suspension of elective services associated with COVID-19 pandemic outbreaks, patients with OED can be risk stratified to determine the length of accepted delay in face-to-face consultation. Remote consultations with patient-provided clinical photographs may be a useful way of maintaining a level of surveillance in this group of patients. CONCLUSIONS Using an expert working group methodology, we have developed consensus recommendations for the monitoring of individuals with OED during pandemic outbreaks associated with temporary suspension of elective services. This has identified areas of future research and highlighted the need for a stronger evidence base to inform the set-up and delivery of surveillance regimens for patients with OED.
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Affiliation(s)
- Caroline Elizabeth McCarthy
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Roy Castle Building, 200 London Road, Liverpool L3 9TA, UK.
| | - Stefano Fedele
- University College London, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR UCLH Biomedical Research Centre, Maple House Suite A 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Michael Ho
- Leeds Teaching Hospitals NHS Trust, Clarendon Way, LS2 9LU Leeds, UK
| | - Richard Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Roy Castle Building, 200 London Road, Liverpool L3 9TA, UK
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Yan F, Reddy PD, Nguyen SA, Chi AC, Neville BW, Day TA. Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 277:2967-2976. [PMID: 32447493 DOI: 10.1007/s00405-020-06036-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/05/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Oral potentially malignant disorders (OPMDs) may have varying degrees of oral epithelial dysplasia (OED). Traditional grading schemes separate OED into three-tiers (mild, moderate, and severe). Alternatively, a binary grading system has been previously proposed that stratifies OED into low-risk and high-risk categories based on a quantitative threshold of dysplastic pathologic characteristics. This systematic review evaluates the predictive value of a binary OED grading system and examines agreement between pathologists. METHODS This meta-analysis queried 4 databases (PubMed, Ovid-MEDLINE, Cochrane, and SCOPUS) and includes 4 studies evaluating binary OED grading systems. Meta-analysis of proportions and correlations was performed to pool malignant transformation rates (MTR), risk of malignant transformation between OED categories, and measures of interobserver agreement. RESULTS Pooled analysis of 629 lesions from 4 different studies found a six-time increased odds of malignant transformation in high-risk lesions over low-risk lesions [odds ratio (OR) 6.14, 95% 1.18-15.38]. Reported ORs ranged from 2.8 to 22.4. The overall MTR was 26.8%, with the high-risk and low-risk lesions having MTRs of 57.9% (95% CI 0.386-0.723) and 12.7% (95% CI - 0.210 to 0.438), respectively. Pooled unweighted interobserver kappa values for the binary grading system and three-tiered system were 0.693 (95% CI 0.640-0.740) and 0.388 (95% CI 0.195-0.552), respectively. CONCLUSION Binary grading of OED into low-risk and high-risk categories may effectively determine malignant potential, with improved interobserver agreement over three-tiered grading. Improved grading schemes of OED may help guide management (watchful waiting vs. excision) of these OPMDs.
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Affiliation(s)
- Flora Yan
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Priyanka D Reddy
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
| | - Angela C Chi
- Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Brad W Neville
- Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
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24
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Jaber MA, Elameen EM. Long-term follow-up of oral epithelial dysplasia: A hospital based cross-sectional study. J Dent Sci 2020; 16:304-310. [PMID: 33384813 PMCID: PMC7770253 DOI: 10.1016/j.jds.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/12/2020] [Indexed: 10/28/2022] Open
Abstract
Background/purpose Oral epithelial dysplasia (OED) is characterized histopathologically by cellular and morphological changes that remain the single most important factor predicting risk for subsequent development of invasive neoplasia. Hence the aims of the present study were to determine the rate of malignant change of OED in a group of patients followed-up for a number of years, and hence determine factors likely to influence this malignant change, and to describe the clinical characteristics of patients who developed recurrence of OED and second dysplastic lesions. Materials and methods This is hospital based cross-sectional study of all biopsy reports with histologically confirmed OED between 2012 and 2018 were retrospectivelly reviewed. Results A total of 359 patients with histologically confirmed OED were reviewed, twenty (5.5%) of the 359 patients developed an invasive squamous cell carcinoma (SCC) of the oral mucosa over a period of 2 to 274 months with mean transformation time of 3.3 years. Conclusion The high risk of malignant transformation of OED seems to be related to patients older than 50 years when lesions were on the floor of mouth with severe dysplastic changes.
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Affiliation(s)
- Mohamed Abdullah Jaber
- Surgical Sciences Department, College of Dentistry, Ajman University, Ajman, United Arab Emirates
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25
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Pinto AC, Caramês J, Francisco H, Chen A, Azul AM, Marques D. Malignant transformation rate of oral leukoplakia-systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:600-611.e2. [PMID: 32249069 DOI: 10.1016/j.oooo.2020.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/06/2020] [Accepted: 02/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review of prevalence studies to determine the rate of malignant transformation of oral leukoplakia and assess the influence of demographic factors (age, gender, and geographic region) on the overall transformation rate. STUDY DESIGN A search was conducted for publications until July 2019 in 4 electronic databases and peer-reviewed journals. A manual search was performed on the bibliographies of the collected articles, and the authors were contacted for additional information. This study was previously registered with the trial number CRD42019126909 and study quality assessed through established methods. The results were expressed by means of proportions or odds ratios with a 95% confidence interval. Meta-regression was undertaken to evaluate possible sources of heterogeneity, and funnel plot visual analysis was performed to assess publication bias. RESULTS The 34 observational epidemiologic studies included reported data on 26,209 patients with oral leukoplakia from 18 different countries. Meta-analysis of 32 studies (23,489 patients) presented an estimated overall mean proportion of malignant transformation rate of 9.70% (7.80-11.70) (I2 = 98.66%; τ2 < 0.001; χ2 = 23.18; degrees of freedom [df] = 31). When comparing genders, the odds ratio favored males with 0.622 (0.468-0.826) (I2 = 29.77%; τ2 = 0.089; χ2 = 22.78; df = 16). CONCLUSIONS Within the limitations of the included studies in this systematic review, the results suggest that the malignant transformation rate was dependent on demographic factors and follow-up time. Future studies should include the development of guidelines to standardize the methodology for long-term follow-up assessment, thus reducing the risk of bias.
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Affiliation(s)
- Ana Catarina Pinto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal
| | - João Caramês
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal
| | - Helena Francisco
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal
| | - André Chen
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal
| | - António Mano Azul
- Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Gandra, Portugal; Universidade Católica Portuguesa, Viseu, Portugal; Clínica Integrada de Medicina Oral, Lisbon, Portugal
| | - Duarte Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal; Evidence Based Dentistry Research Center, Lisbon, Portugal.
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26
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Yang SW, Lee YS, Chang LC, Hwang CC, Chen TA. Clincopathological characteristics and treatment outcomes of oral leukoplakia by carbon dioxide laser excision in the elderly patients. Head Neck 2020; 42:1014-1023. [PMID: 31930772 PMCID: PMC7216872 DOI: 10.1002/hed.26074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/19/2019] [Accepted: 12/31/2019] [Indexed: 12/17/2022] Open
Abstract
Background Older age is one of the factors associated with malignant transformation of oral leukoplakia (OL). The purpose of this study is to analyze the clincopathological features and treatment outcomes of OL in the elderly patients. Methods The demographic data and histopathological results of the patients (age ≥ 65) who received carbon dioxide laser surgery for OL from 2002 to 2017 were analyzed statistically. Results There were 53 males and 16 females, with a mean age 71.2 ± 4.9. The follow‐up time was 42.5 ± 35.2 months. In the univariate analysis, morphology, pathology, and area were found to be factors associated with postoperative recurrence. Among these factors, pathology and area were the independent predictive factors for recurrence in the multivariate logistic regression model. Malignant transformation occurred in 8 of 69 patients (11.6%). Conclusions The pathological high‐risk dysplasia and area of OL were the two prognostic factors for postoperative recurrence.
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Affiliation(s)
- Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC.,Department of Biotechnology, Ming Chuan University, Tao-Yuan, Taiwan, ROC
| | - Liang-Che Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Cheng-Cheng Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Tai-An Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
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27
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Singh S, Singh J, Chandra S, Samadi FM. Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study. J Oral Maxillofac Pathol 2020; 24:87-92. [PMID: 32508454 PMCID: PMC7269288 DOI: 10.4103/jomfp.jomfp_347_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite our sincere and serious efforts, oral cancer (particularly oral squamous cell carcinoma [OSCC]) is the major cause of morbidity and mortality in the Indian population. Oral precancerous lesions show quite high malignant transformation rate. Epidemiological data of oral epithelial dysplasia (OED) and OSCC could help in early diagnosis and thus may improve the prognosis. The current study aims to retrospectively analyze the epidemiological profile of patients with different grades of OED and OSCCs. MATERIALS AND METHODS The current study is a retrospective analysis of OED and OSCC reported in 5 years in our institution from 2014 to 2018. Data for the analysis were attained from the case sheets from the patients diagnosed with OED and OSCC. RESULTS The mean prevalence of OED and OSCC was 5.71% and 9.85%, respectively. Among the dysplastic lesions, severe dysplasia was more common, while well-differentiated squamous cell carcinoma was more common among the carcinomatous lesions. The peak age prevalence of both the lesions was third to fifth decade. Males were more frequently affected than females, with buccal mucosa being the most common site. CONCLUSION The data attained from this study highlight the need for community-based screening and awareness programs for general population and thus obtain a healthier society.
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Affiliation(s)
- Shruti Singh
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jaya Singh
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shaleen Chandra
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Fahad Mansoor Samadi
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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28
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Lingen MW. We have a “ring around the collar” problem. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:1-2. [DOI: 10.1016/j.oooo.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/16/2022]
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29
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Lou J, Liu L, Zhang W, Zhou Z, Fan Y. Differential expression of ghrelin and GHSR via the mTOR pathway during the dynamic carcinogenic process involving oral, potentially malignant disorders. Biosci Rep 2019; 39:BSR20192102. [PMID: 31750884 PMCID: PMC6923334 DOI: 10.1042/bsr20192102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/12/2019] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
The purpose was to explore the sequence changes in ghrelin and GHSR in the mTOR signaling pathway during carcinogenesis involving oral, potentially malignant disorders (OPMD). The samples were confirmed through in vivo pathologic tissue screening and diagnosis. The immunohistochemical method was used to detect the expression of the ghrelin/growth hormone secretagogue receptor (GHSR) protein. The expression of ghrelin, GHSR 1α, GHSR 1β, and mammalian target of rapamycin (mTOR) RNA were detected by real-time PCR. The expression of ghrelin, GHSR, mTOR, and phosphorylated mTOR (phosphor-mTOR) protein were detected by Western blot. The expression of ghrelin/GHSR increased gradually in the dynamic process of OPMD carcinogenesis. There was a correlation between the increase in ghrelin, GHSR, mTOR, and phospho-mTOR. The in vivo expression of ghrelin/GHSR protein was the most apparent pathologic change from normal-to-mild, moderate, and severe dysplasia, and finally to the dynamic process from normal-to-mild-to-moderate dysplasia. The in vitro cell experiments based on QPCR results also proved that GHSR 1a functional receptor of ghrelin had a peak expression in LEUK-1 cells. In conclusioin, the close relationship between ghrelin and OPMD carcinogenesis can be used as a new biological target to assess the carcinogenesis of OPMD.
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Affiliation(s)
- Jianing Lou
- Department of Stomatology, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Oral Medicine, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Lin Liu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Oral Medicine, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Weizhen Zhang
- Department of Surgery, Medical School, University of Michigan, Ann Arbor, MI 48109, U.S.A
| | - Zengtong Zhou
- Department of Oral Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Yuan Fan
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Oral Medicine, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
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30
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Iocca O, Sollecito TP, Alawi F, Weinstein GS, Newman JG, De Virgilio A, Di Maio P, Spriano G, Pardiñas López S, Shanti RM. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck 2019; 42:539-555. [PMID: 31803979 DOI: 10.1002/hed.26006] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not. OBJECTIVE To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions. STUDY DESIGN We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed. MAIN OUTCOME AND MEASURES Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia. RESULTS Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value <.001). CONCLUSIONS AND RELEVANCE OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.
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Affiliation(s)
- Oreste Iocca
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Faizan Alawi
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Gregory S Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Armando De Virgilio
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Pasquale Di Maio
- Giovanni Borea Civil Hospital, Department of Otolaryngology-Head and Neck Surgery, Sanremo, Italy
| | - Giuseppe Spriano
- Department of Otorhinolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Simón Pardiñas López
- Periodontology and Oral Surgery, Clínica Médico Dental Pardiñas, Cell Therapy and Regenerative Medicine Group, Centre for Advanced Scientific Research (CICA) and Biomedical Research Institute of A Coruña (INIBIC) Strategic Group, Universidade da Coruña (UDC), University Hospital Complex of A Coruña (CHUAC), Galician Health Service (SERGAS), A Coruña, Spain
| | - Rabie M Shanti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
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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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Ishikawa S, Wong DTW, Sugimoto M, Gleber-Netto FO, Li F, Tu M, Zhang Y, Akin D, Iino M. Identification of salivary metabolites for oral squamous cell carcinoma and oral epithelial dysplasia screening from persistent suspicious oral mucosal lesions. Clin Oral Investig 2019; 23:3557-3563. [PMID: 30539290 DOI: 10.1007/s00784-018-2777-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/05/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify salivary metabolite biomarkers to differentiate patients with oral squamous cell carcinoma and oral epithelial dysplasia (OSCC/OED) from those with persistent suspicious oral mucosal lesions (PSOML). SUBJECTS AND METHODS Whole unstimulated saliva samples were collected from age-, sex-, and race-matched patients who had a lesion in the oral cavity and for whom open biopsies were performed. The patients included OSCC (n = 6), OED (n = 10), and PSOML (n = 32). Hydrophilic metabolites in saliva samples were comprehensively analyzed using capillary electrophoresis mass spectrometry. To evaluate the discrimination ability of a combination of multiple markers, a multiple logistic regression (MLR) model was developed to differentiate OSCC/OED from PSOML. RESULTS Six metabolites were significantly different in OSCC/OED compared with PSOML. From these six metabolites, ornithine, o-hydroxybenzoate, and ribose 5-phosphate (R5P) were used to develop the MLR model, which resulted in a high value for the area under receiver operating characteristic curve (AUC 0.871, 95% confidential interval (CI) 0.760-0.982; p < 0.001) to discriminate OSCC/OED from PSOML. CONCLUSIONS This is the first study to identify salivary metabolites that discriminate OSCC/OED from PSOML rather than from healthy controls. The profiles of salivary metabolites were significantly different between OSCC/OED and PSOML. The ability to discriminate OSCC/OED from PSOML is important for dentists who are not oral surgery specialists. These salivary metabolites showed potential for non-invasive screening to discriminate OSCC/OED from PSOML. CLINICAL RELEVANCE Salivary metabolites in this study showed potential for non-invasive screening to discriminate OSCC/OED from PSOML.
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Affiliation(s)
- Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - David T W Wong
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - Masahiro Sugimoto
- Health Promotion and Pre-emptive Medicine, Research and Development Center for Minimally Invasive Therapies, Tokyo Medical University, Shinjuku, Tokyo, 160-8402, Japan.
| | | | - Feng Li
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - Michael Tu
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - Yong Zhang
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - David Akin
- School of Dentistry, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095-1668, USA
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
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Impact of dysplastic surgical margins for patients with oral squamous cell carcinoma. Oral Oncol 2019; 97:1-6. [PMID: 31421465 DOI: 10.1016/j.oraloncology.2019.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/14/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Dysplastic changes at the surgical margin of oral squamous cell carcinoma (OSCC) could be encountered frequently. However, the impact of a dysplastic surgical margin on patients with OSCC remains unclear. MATERIALS AND METHODS Retrospectively, we reviewed patients with OSCC who were diagnosed and treated at the National Taiwan University Hospital between January 2010 and December 2015. Patients were divided into four groups: clear (≥5 mm), close (<5 mm), positive, and dysplastic margins. RESULTS Of 1642 patients, 596 had clear margin, 169 had positive margin, 707 had close margin, and 170 had dysplastic margin. The mean age at diagnosis was 55 ± 11 years (range, 16-97 years). Dysplastic margins were frequently present in patients with primary T1/T2 OSCC (odds ratio [OR] = 1.7, p = 0.009), tumor without perineural invasion (OR = 1.48, p = 0.04), and tumor thickness ≤10 mm (OR = 1.94, p = 0.001). In patients with clear, close, positive, and dysplastic margins, the 5-year disease-free survival rates were 63.1%, 51%, 37.2%, and 54.7%, respectively; overall survival (OS) rates were 71.1%, 61.9%, 49%, and 72%, respectively. Disease-free and overall survival were not significantly different in patients with dysplastic and clear margins (p = 0.37 and p = 0.38, respectively). Adjuvant radiotherapy had no significant benefit for patients with dysplastic margins. Finally, a multivariate analysis showed that the presence of a dysplastic margin was not an independent risk factor for disease-free (p = 0.43) and overall survival (p = 0.71). CONCLUSIONS The survival rates of the patients with OSCC who had dysplastic margin were significantly better than those with positive margin.
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Shearston K, Fateh B, Tai S, Hove D, Farah CS. Malignant transformation rate of oral leukoplakia in an Australian population. J Oral Pathol Med 2019; 48:530-537. [DOI: 10.1111/jop.12899] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Kate Shearston
- UWA Dental School University of Western Australia Nedlands Western Australia Australia
| | - Behrooz Fateh
- UWA Dental School University of Western Australia Nedlands Western Australia Australia
| | - Shixiong Tai
- UWA Dental School University of Western Australia Nedlands Western Australia Australia
| | - Dzikamai Hove
- UWA Dental School University of Western Australia Nedlands Western Australia Australia
| | - Camile S. Farah
- UWA Dental School University of Western Australia Nedlands Western Australia Australia
- Australian Centre for Oral Oncology Research & Education Nedlands Western Australia Australia
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Polverini PJ, Lingen MW. A History of Innovations in the Diagnosis and Treatment of Oral and Head and Neck Cancer. J Dent Res 2019; 98:489-497. [PMID: 31008698 DOI: 10.1177/0022034519833645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Historical records as far back as 3000 BCE show that oral and head and neck cancer was a disease process well known to Egyptian physicians. Luminaries such as Hippocrates, Galen, Pott, and Virchow were instrumental in shaping our understanding of the etiology and pathogenesis of cancer. During the 20th century, evidence-based medicine catalyzed the development of rigorous science-based diagnostic and treatment protocols. The use of surgery, therapeutic radiation, and chemotherapy as single-treatment agents or in combination with one another gradually emerged as the preferred approach to cancer therapy. The recognition of tobacco, alcohol, and human papillomavirus as etiological agents in oral and head and neck cancer prompted the development of new diagnostic aids and treatment strategies to mitigate cancer progression. More in-depth mechanistic insights into the multistep process of oral and head and neck cancer were made possible by the use of the hamster buccal pouch and mouse models. New technologies, such as the sequencing of the human genome, metabolomics, and proteomics, have provided the foundation for what we today call precision medicine. The future success of tailored medical treatment for cancer patients will depend on the discovery of new druggable targets with improved therapeutic efficacy. As the precision and sensitivity of existing tools for prevention and risk assessment improve, greater accuracy will be achieved in predicting health outcomes.
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Affiliation(s)
- P J Polverini
- 1 Department of Periodontics and Oral Medicine, Division of Oral Medicine, Pathology, and Radiology, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,2 Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,3 University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - M W Lingen
- 4 Department of Pathology, University of Chicago, Chicago, IL, USA
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Farah CS, Pollaers K, Frydrych A. Management of Premalignant Disease of the Oral Mucosa. HEAD AND NECK CANCER CLINICS 2019. [DOI: 10.1007/978-981-13-2931-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Arduino PG, Cafaro A, Cabras M, Gambino A, Broccoletti R. Treatment Outcome of Oral Leukoplakia with Er:YAG Laser: A 5-Year Follow-Up Prospective Comparative Study. Photomed Laser Surg 2018; 36:631-633. [DOI: 10.1089/pho.2018.4491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Giacomo Arduino
- Oral Medicine Section, Department of Surgical Sciences, CIR–Dental School, University of Turin, Turin, Italy
| | - Adriana Cafaro
- Oral Medicine Section, Department of Surgical Sciences, CIR–Dental School, University of Turin, Turin, Italy
| | - Marco Cabras
- Oral Medicine Section, Department of Surgical Sciences, CIR–Dental School, University of Turin, Turin, Italy
| | - Alessio Gambino
- Oral Medicine Section, Department of Surgical Sciences, CIR–Dental School, University of Turin, Turin, Italy
| | - Roberto Broccoletti
- Oral Medicine Section, Department of Surgical Sciences, CIR–Dental School, University of Turin, Turin, Italy
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Malignant transformation of oral leukoplakia treated with carbon dioxide laser: a meta-analysis. Lasers Med Sci 2018; 34:209-221. [DOI: 10.1007/s10103-018-2674-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/25/2018] [Indexed: 01/11/2023]
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Luiz ST, Modolo F, Mozzer I, dos Santos EC, Nagashima S, Camargo Martins AP, de Azevedo MLV, Azevedo Alanis LR, Hardy AMTG, de Moraes RS, Aguiar MCF, Ignácio SA, Jham BC, Noronha L, Johann ACBR. Immunoexpression of SOX-2 in oral leukoplakia. Oral Dis 2018; 24:1449-1457. [DOI: 10.1111/odi.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/22/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023]
Affiliation(s)
| | - Filipe Modolo
- Universidade Federal de Santa Catarina; Florianópolis Brasil
| | - Izabela Mozzer
- Pontifícia Universidade Católica do Paraná; Curitiba Brasil
| | | | | | | | | | | | | | | | - Maria Cássia Ferreira Aguiar
- Departamento de Patologia Bucal, Av. Antônio Carlos; Universidade Federal de Minas Gerais; Belo Horizonte Brasil
| | | | | | - Lucia Noronha
- Pontifícia Universidade Católica do Paraná; Curitiba Brasil
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Ballivet de Régloix S, Badois N, Bernardeschi C, Jouffroy T, Hofmann C. Risk factors of cancer occurrence after surgery of oral intraepithelial neoplasia: A long-term retrospective study. Laryngoscope 2018; 128:2546-2551. [DOI: 10.1002/lary.27214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/26/2018] [Accepted: 03/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Stanislas Ballivet de Régloix
- Department of Head and Neck Surgery, Institut Curie; Paris France
- Université PSL (Paris Sciences & Lettres); Paris France
| | - Nathalie Badois
- Department of Head and Neck Surgery, Institut Curie; Paris France
- Université PSL (Paris Sciences & Lettres); Paris France
| | - Celine Bernardeschi
- Department of Dermatology, Groupe Hospitalier Paris Saint - Joseph; Paris France
| | - Thomas Jouffroy
- Department of Head and Neck Surgery, Institut Curie; Paris France
- Université PSL (Paris Sciences & Lettres); Paris France
| | - Caroline Hofmann
- Department of Head and Neck Surgery, Institut Curie; Paris France
- INSERM Unit U932, Institut Curie; Paris France
- Université PSL (Paris Sciences & Lettres); Paris France
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Speight PM, Khurram SA, Kujan O. Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:612-627. [PMID: 29396319 DOI: 10.1016/j.oooo.2017.12.011] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Abstract
Oral potentially malignant disorders (OPMDs) have a statistically increased risk of progressing to cancer, but the risk varies according to a range of patient- or lesion-related factors. It is difficult to predict the risk of progression in any individual patient, and the clinician must make a judgment based on assessment of each case. The most commonly encountered OPMD is leukoplakia, but others, including lichen planus, oral submucous fibrosis, and erythroplakia, may also be seen. Factors associated with an increased risk of malignant transformation include sex; site and type of lesion; habits, such as smoking and alcohol consumption; and the presence of epithelial dysplasia on histologic examination. In this review, we attempt to identify important risk factors and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.
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Affiliation(s)
- Paul M Speight
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
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Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners. Br Dent J 2017; 223:655-661. [PMID: 29097794 DOI: 10.1038/sj.bdj.2017.881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Abstract
Objectives To provide an overview of the current thinking in terms of the diagnosis and management of oral leukoplakia and proliferative verrucous leukoplakia as relevant to general dental practitioners.Data sources, data selection, data extraction, data synthesis We searched the MEDLINE Ovid, EMBASE databases and the Cochrane Library, (1990 to 16 April 2017), restricting our search to English language with the following key words: leukoplakia, white patch, proliferative verrucous leukoplakia, precancerous lesion, premalignant lesions, potentially malignant oral conditions and potentially malignant oral disorders. The two authors selected key papers and engaged in collaborative data extraction and synthesis of the selected reference material.Conclusions General dental practitioners (GDPs) are likely to encounter patients with a known or yet undiagnosed oral leukoplakia in their clinical practice. The diagnosis is clinically based as there are no pathognomonic histopathological features. The definition of leukoplakia has evolved over the years. The importance of recognition and appropriate management relating to this condition is described particularly as it is one of the oral potentially malignant lesions. The inferred increased risk of malignant transformation is well documented however controversy still persists in terms of the appropriate management for these lesions. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. A high index of suspicion is important for general dental practitioners in order to identify such lesions that would require onward referral for further investigation and management.
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Abstract
Oral potentially malignant disorders (OPMDs) refer to epithelial lesions and conditions with an increased risk for malignant transformation; oral leukoplakia is the most commonly encountered. Overall, OPMDs have a low risk for malignant transformation, yet the challenge is the difficulty to reliably identify and predict which patients with OPMDs are at the highest risk for malignant transformation. Future research is needed to elucidate the molecular aspects of OPMDs, to improve current diagnostic strategies, leading to personalized management.
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Khoudigian-Sinani S, Blackhouse G, Levine M, Thabane L, O’Reilly D. The premarket assessment of the cost-effectiveness of a predictive technology "Straticyte™" for the early detection of oral cancer: a decision analytic model. HEALTH ECONOMICS REVIEW 2017; 7:35. [PMID: 28971373 PMCID: PMC5624864 DOI: 10.1186/s13561-017-0170-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Approximately half of oral cancers are detected in advanced stages. The current gold standard is histopathological assessment of biopsied tissue, which is subjective and dependent on expertise. Straticyte™, a novel prognostic tool at the pre-market stage, that more accurately identifies patients at high risk for oral cancer than histopathology alone. This study conducts an early cost-effectiveness analysis (CEA) of Straticyte™ and histopathology versus histopathology alone for oral cancer diagnosis in adult patients. METHODS A decision-analytic model was constructed after narrowing the scope of Straticyte™, and defining application paths. Data was gathered using the belief elicitation method, and systematic review and meta-analysis. The early CEA was conducted from private-payer and patient perspectives, capturing both direct and indirect costs over a five-year time horizon. One-way and probabilistic sensitivity analyses were conducted to investigate uncertainty. RESULTS Compared to histopathology alone, histopathology with Straticyte™ was the dominant strategy, resulting in fewer cancer cases (31 versus 36 per 100 patients) and lower total costs per cancer case avoided (3,360 versus 3,553). This remained robust when Straticyte™ was applied to moderate and mild cases, but became slightly more expensive but still more effective than histopathology alone when Straticyte™ was applied to only mild cases. The probabilistic and one-way sensitivity analyses demonstrated that incorporating Straticyte™ to the current algorithm would be cost-effective over a wide range of parameters and willingness-to-pay values. CONCLUSION This study demonstrates high probability that Straticyte™ and histopathology will be cost-effective, which encourages continued investment in the product. The analysis is informed by limited clinical data on Straticyte™, however as more data becomes available, more precise estimates will be generated.
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Affiliation(s)
- S. Khoudigian-Sinani
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Health Research Methodology (HRM), specializing in Health Technology Assessment (HTA), Hamilton, Canada
| | - G. Blackhouse
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - M. Levine
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Centre of Evaluation of Medicines, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Patented Medicine Prices Review Board (Canada), Ottawa, Canada
| | - L. Thabane
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Department of Anesthesia/ Pediatrics, Faculty of Health Science, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - D. O’Reilly
- Department of Health Research, Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- PATH Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
- Research Institute of St. Joseph’s, Hamilton, ON Canada
- Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare, Hamilton, Canada
- Early Researcher Award Recipient, Ministry of Research and Innovation, Toronto, Canada
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Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity. J Am Dent Assoc 2017; 148:712-727.e10. [DOI: 10.1016/j.adaj.2017.07.032] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
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46
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Thomson PJ, Goodson ML, Smith DR. Profiling cancer risk in oral potentially malignant disorders-A patient cohort study. J Oral Pathol Med 2017; 46:888-895. [PMID: 28833670 DOI: 10.1111/jop.12625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral potentially malignant disorders harbour variable and unpredictable risk for squamous carcinoma development. Whilst current management strategies utilise histopathological diagnoses, dysplasia grading and targeted intervention for "high-risk" lesions, clinicians are unable to predict malignant potential. METHODS Detailed, retrospective clinico-pathological analysis of potentially malignant lesions undergoing malignant transformation, from a 590 patient cohort treated by interventional laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was documented at study census date (31 December 2014). RESULTS A total of 99 patients (16.8%) developed cancer: 71 (12%) seen "unexpectedly" upon excision and 28 (4.8%) progressing to malignancy at a median of 87.3 months post-surgery. Thirty "unexpected" excisions were micro-invasive (42.3%) arising primarily in severely dysplastic precursors (75%) at ventro-lateral tongue and floor of mouth sites (54.5%); 1 patient (1.4%) had a cancer-related death, whilst 58 (81.7%) were disease free. A total of 19 of 28 "progressive" cancers (67.9%) arose at new sites, with erythroleukoplakia a significant predictor of malignancy (P = .0019). Nine (32.1%) developed at the same precursor site, with 6 (77.7%) on the ventro-lateral tongue and floor of mouth. Three (10.7%) were micro-invasive, 9 patients (32.1%) died from metastatic disease and 12 (42.9%) were disease free (P < .001). CONCLUSION Squamous carcinoma may arise at the site of a precursor lesion as transformation or new-site development via field cancerisation. Whilst interventional surgery facilitates early diagnosis and treatment of occult disease, thus reducing risk from same-site transformation, new-site cancer is a significant long-term risk for patients with potentially malignant disorder.
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Affiliation(s)
- P J Thomson
- Oral & Maxillofacial Surgery, School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, QLD, Australia
| | - M L Goodson
- Oral & Maxillofacial Surgery, School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, QLD, Australia.,Newcastle University Medicine Malaysia, Iskandar Puteri, Malaysia
| | - D R Smith
- Newcastle University Medicine Malaysia, Iskandar Puteri, Malaysia
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Hwang JTK, Gu YR, Dickson BJ, Shen M, Ralhan R, Walfish PG, Mock D, Pritzker KPH. RETRACTED: Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment. Oral Oncol 2017; 72:1-6. [PMID: 28797444 DOI: 10.1016/j.oraloncology.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Straticyte™ was previously shown to be a more effective prognostic assessment than the current standard of care, histopathological dysplasia grading, to assess progression risk of oral epithelial dysplasia to invasive cancer [Hwang JT, Gu YR, Shen M, Ralhan R, Walfish PG, Pritzker KP, et al. Individualized five-year risk assessment for oral premalignant lesion progression to cancer. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123:374-81]. In this follow-up study, our aim is to confirm the prognostic value of Straticyte using an independent cohort of oral biopsy cases previously assessed as epithelial dysplasia of various grades. MATERIALS AND METHODS Using Visiopharm image analysis system, we analyzed an independent retrospective cohort of 51 oral biopsy samples with known outcomes and a follow-up history of up to 12years, to verify Straticyte, an individualized 5-year risk assessment for progression of oral potentially malignant lesions to invasive squamous cell carcinoma. RESULTS Straticyte classified the lesions more accurately than histopathological oral epithelial dysplasia grading for risk for progression to cancer over five years. The sensitivity of low-risk vs. non-low-risk Straticyte groups was 100% compared to 68% for mild vs. non-mild dysplasia. The sensitivity of high-risk vs. non-high-risk Straticyte was 71% compared to 3% for severe vs. non-severe dysplasia. Furthermore, the Negative Predictive Value (NPV) for Straticyte was 100% for low-risk vs. non-low-risk, whereas the NPV for mild vs. non-mild dysplasia was 38%. CONCLUSION In this cohort, Straticyte ascertains as a more useful assessment for risk of cancer progression in oral potentially malignant lesions than oral epithelial dysplasia grade.
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Affiliation(s)
- Jason T K Hwang
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada.
| | - Ying R Gu
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada
| | - Benjamin J Dickson
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada
| | - Mi Shen
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada
| | - Ranju Ralhan
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada; Alexa and Simona Shnaider Research Laboratory in Molecular Oncology, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Otolaryngology-Head and Neck Surgery, Sonshine Family Centre for Head and Neck Diseases, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Paul G Walfish
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada; Alexa and Simona Shnaider Research Laboratory in Molecular Oncology, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Otolaryngology-Head and Neck Surgery, Sonshine Family Centre for Head and Neck Diseases, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada; Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Medicine, Endocrine Division, Mount Sinai Hospital and University of Toronto, 1 Kings College Circle, Toronto, Ontario M5S 1A8, Canada
| | - David Mock
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada; Oral Pathology/Oral Medicine, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario M5G 1G6, Canada
| | - Kenneth P H Pritzker
- Proteocyte Diagnostics Inc., MaRS Centre, South Tower, 101 College Street, Suite 200, Toronto, Ontario M5G 1L7, Canada; Laboratory Medicine and Pathobiology: Surgery, University of Toronto, 1 Kings College Circle, Toronto, Ontario M5S 1A8, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
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Novel Molecular Targets for Chemoprevention in Malignancies of the Head and Neck. Cancers (Basel) 2017; 9:cancers9090113. [PMID: 28858212 PMCID: PMC5615328 DOI: 10.3390/cancers9090113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022] Open
Abstract
Cancers of the head and neck region are among the leading causes of cancer-related mortalities worldwide. Oral leukoplakia and erythroplakia are identified as precursor lesions to malignancy. Patients cured of an initial primary head and neck cancer are also susceptible to developing second primary tumors due to cancerization of their mucosal field. Multi-step acquisition of genetic mutations leading to tumorigenesis and development of invasive cancer has been previously described. Recently, whole exome sequencing of tumor specimens has helped to identify driver mutations in this disease. For these reasons, chemoprevention or the use of systemic or biologic agents to prevent carcinogenesis is an attractive concept in head and neck cancers. Nonetheless, despite extensive clinical research in this field over the past couple decades, no standard of care option has emerged. This review article reports on targeted interventions that have been attempted in clinical trials to date, and focuses on novel molecular pathways and drugs in development that are worthy of being tested for this indication as part of future endeavors.
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Güneri P, Epstein JB. Why are we still unable to accurately determine the malignant potential or the behavior of oral mucosal lesions? Oral Oncol 2017; 71:177-179. [PMID: 28456478 DOI: 10.1016/j.oraloncology.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Pelin Güneri
- Ege University School of Dentistry, Department of Oral and Maxillofacial Radiology, Bornova 35100, Izmir, Turkey.
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Duarte CA, 8500 Whilshire Blvd, Suite 800, Beverly Hills, CA 90211, USA
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50
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Zhang L, Lubpairee T, Laronde DM, Rosin MP. Should severe epithelial dysplasia be treated? Oral Oncol 2016; 60:125-9. [PMID: 27531883 DOI: 10.1016/j.oraloncology.2016.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify clinical features associated with progression of primary severe epithelial dysplasia into invasive squamous cell carcinoma (SCC). DESIGN Longitudinal population-based study. SETTING Oral dysplasia clinics. PATIENTS This study involved 118 patients with 118 severe dysplasia who were prospectively enrolled between 1996 and 2014, and the lesions were either completely removed surgically (treated) or actively followed (untreated). MEASUREMENTS Demographics, habits, clinical information and outcome were compared between the treated and untreated groups. RESULTS Of the 118 lesions, 77 were treated and 41 were not. The treated lesions showed significantly less progression when compared to the untreated: 5/77 (6%) treated lesions progressed into invasive SCC versus 12/41 (29%) untreated (P=0.004). The 5-year probability (confidence interval) of progression into SCC for the treated was 7.6 (1-14) as compared to 38.6 (16-55) for the untreated. Interestingly the clinical changes at the site of the disease also had strong predictive value for cancer progression. If the site showed no lesion after treatment or after incisional biopsy (40 cases), only 1 (3%) progressed into cancer. If the site showed ever disappearance of the lesion or marked decrease in the size of the lesion to ⩽10mm (29 cases), 4 (15%) progressed. If the site showed lesions with fluctuation in size or persistent in size or marked increase in size (25 cases), 18 (58%) progressed (P<0.001). CONCLUSION Treatment significantly reduced cancer progression, and phenotypic changes at the site of the disease had significant predictive value for cancer progression.
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Affiliation(s)
- Lewei Zhang
- Faculty of Dentistry, The University of British Columbia (BC), 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; BC Oral Biopsy Service, Department of Laboratory Medicine and Pathology, Vancouver General Hospital, 910 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; BC Oral Cancer Prevention Program, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada.
| | - Tarinee Lubpairee
- Faculty of Dentistry, The University of British Columbia (BC), 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; BC Oral Cancer Prevention Program, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada.
| | - Denise M Laronde
- Faculty of Dentistry, The University of British Columbia (BC), 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; BC Oral Cancer Prevention Program, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada.
| | - Miriam P Rosin
- BC Oral Cancer Prevention Program, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada; School of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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