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Evaluation of the classification and clinical characteristics of oral lichen planus and its treatment effect in different clinical types: A retrospective study. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Patil MB, Lavanya T, Kumari CM, Shetty SR, Gufran K, Viswanath V, Swarnalatha C, Babu JS, Nayyar AS. Serum ceruloplasmin as cancer marker in oral pre-cancers and cancers. J Carcinog 2021; 20:15. [PMID: 34729047 PMCID: PMC8531576 DOI: 10.4103/jcar.jcar_10_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Oxidative stress leads to a compensatory increase in levels of serum ceruloplasmin in patients with such imbalances. Greater than normal serum ceruloplasmin levels are noticed in numerous cancers including the leukemias and Hodgkin's lymphoma. The purpose of the present study was to estimate and evaluate the efficacy of serum ceruloplasmin levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions (PMELs) including leukoplakia, oral submucous fibrosis (OSMF), and oral squamous cell carcinoma (OSCC) patients. MATERIALS AND METHODS The present observational study was conducted over a period of 2 years wherein 100 subjects aged between 18 to 60 years were divided into four groups with Group A consisting of 25 healthy controls, Group B and C with 25 patients each, clinically diagnosed with oral leukoplakia and OSMF and Group D with 25 patients clinically diagnosed and histopathologically proven OSCC. The patients were subjected to incisional biopsy after routine hematological investigation while the same sera samples were used for analysis of serum ceruloplasmin levels. STATISTICAL ANALYSIS USED Comparison of serum ceruloplasmin levels between the groups was performed using one way analysis of variance (one way ANOVA) test while P < 0.05 was considered statistically significant. RESULTS The mean serum ceruloplasmin levels were found to be 43.19 ± 1.90mg/dl in subjects of group A, 47.68 ± 1.51mg/dl in group B, 47.74 ± 1.45mg/dl in group C and 47.73 ± 0.74mg/dl in group D. Using one-way ANOVA, statistically significant variations were found in the values of mean serum ceruloplasmin levels in subjects of the four groups (F-value = 59.58, P = 0.0001). CONCLUSIONS The observations of the present study revealed that serum ceruloplasmin levels were found to be raised in all 3 study groups including oral leukoplakia, OSMF and OSCC as compared to the controls while the results were found to be statistically significant.
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Affiliation(s)
- Manisha B Patil
- Department of Oral Pathology and Microbiology, Nanded Rural Dental College and Research Center, Nanded, Maharashtra, India
| | - T Lavanya
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Majmaah University, Al Majma'ah, Kingdom of Saudi Arabia
| | - C Meena Kumari
- Department of Restorative Dentistry, College of Dentistry, Majmaah University, Al Majma'ah, Kingdom of Saudi Arabia
| | - Shishir Ram Shetty
- Department of Oral and Craniofacial Health Sciences, Division of Oral Radiology, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khalid Gufran
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Vipin Viswanath
- Department of Oral and Maxillofacial Surgery, Azeezia College of Dental Science and Research, Kollam, Kerala, India
| | - C Swarnalatha
- Department of Preventive Dental Sciences, Division of Periodontology, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - J Suresh Babu
- Department of Preventive Dental Sciences, Division of Periodontology, College of Dentistry, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Abhishek Singh Nayyar
- Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra, India
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Seoane J, Warnakulasuriya S, Bagán JV, Aguirre-Urizar JM, López-Jornet P, Hernández-Vallejo G, González-Moles MÁ, Pereiro-Ferreiros M, Seoane-Romero J, Varela-Centelles P. Assembling a consensus on actinic cheilitis: A Delphi study. J Oral Pathol Med 2021; 50:962-970. [PMID: 33998055 DOI: 10.1111/jop.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 01/18/2023]
Abstract
AIMS To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. METHODS Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). RESULTS A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC < 50). CONCLUSIONS AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.
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Affiliation(s)
- Juan Seoane
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Pía López-Jornet
- Department of Oral Medicine, University of Murcia, Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | - Javier Seoane-Romero
- USC International School of Doctorate, Ciudad Real University Hospital, Ciudad Real, Spain
| | - Pablo Varela-Centelles
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain.,CS Praza do Ferrol. EOXI Lugo, Cervo e Monforte, Department of Surgery and Medical-Surgical Specialities, Galician Health Service, Univeristy of Santiago de Compostela, Lugo, Spain
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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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Deuerling L, Gaida K, Neumann H, Remmerbach TW. Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11111813. [PMID: 31752196 PMCID: PMC6896118 DOI: 10.3390/cancers11111813] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from an identical number of oral lesions, then cytological diagnoses were made using liquid-based cytology. The final diagnoses in the study were 105 histologically proven squamous cell carcinomas (SCCs), 744 potentially malignant lesions and 503 cases of traumatic, inflammatory or benign hyperplastic oral lesions. The sensitivity and specificity of the liquid-based brush biopsy were 95.6% (95% CI 94.5–96.7%) and 84.9% (95% CI 83.0–86.8%), respectively. This led to the conclusion that brush biopsy is potentially a highly sensitive and reliable method to make cytological diagnoses of oral neoplasia. The main advantage of a brush biopsy over a scalpel biopsy is that it is less invasive and is more tolerated by the patients. Therefore, more lesions can be screened and more cancers can be detected at an early stage.
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Affiliation(s)
- Lena Deuerling
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Kristin Gaida
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
| | - Heinrich Neumann
- Medical Care Center for Histology, Cytology and Molecular Diagnostics, 52351 Düren, Germany;
| | - Torsten W. Remmerbach
- Section of Clinical and Experimental Oral Medicine, University of Leipzig, Liebigstraße 10-14, 04103 Leipzig, Germany; (L.D.); (K.G.)
- German Association of Oral Diagnostics (DGOD mbH), Wettiner Str. 10, 04105 Leipzig, Germany
- Correspondence:
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Mendes GG, Servato JPS, Borges FC, Rosa RR, Siqueira CS, de Faria PR, Loyola AM, Cardoso SV. Differential metallothionein expression in oral lichen planus and amalgam-associated oral lichenoid lesions. Med Oral Patol Oral Cir Bucal 2018; 23:e262-e268. [PMID: 29680841 PMCID: PMC5945242 DOI: 10.4317/medoral.22144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 04/25/2018] [Indexed: 01/20/2023] Open
Abstract
Background Oral lichen planus (OLP) is a chronic inflammatory disease mediated by T cells, which manifests as reticular (white) or erosive (red) lesions, that are eventually painful. Oral lichenoid lesion (OLL) are distinguished from OLP by the presence of precipitating factors. The aim of this study was to evaluate whether the presence of metallothionein, which is involved in anti-apoptotic pathways and the anti-oxidative response, could serve as a differential diagnostic for OLP and OLL. Material and Methods We evaluated the expression of metallothionein in 40 cases of OLP and 20 cases of OLL using immunohistochemistry. Results and Conclusions White OLP has higher concentrations of metallothionein than red OLP in basal and parabasal layers. Moreover, metallothionein was more frequently observed in the cytoplasm and nuclei of basal cells in OLP patients compared to the same regions of OLL cases. Metallothionein levels are related to OLP severity and may contribute to a differential diagnosis between OLP and OLL. Key words:Oral lichen planus, oral lichenoid lesions, autoimmune disorders, metallothionein, immunohistochemistry.
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Affiliation(s)
- G-G Mendes
- Universidade Federal de Uberlândia, Faculdade de Odontologia, Área de Patologia. Av. Pará, 1720, Campus Umuarama. CEP: 38405-320, Uberlândia - MG Brazil,
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Hadzic S, Gojkov-Vukelic M, Pasic E, Dervisevic A. Importance of Early Detection of Potentially Malignant Lesions in the Prevention of Oral Cancer. Mater Sociomed 2017; 29:129-133. [PMID: 28883777 PMCID: PMC5544450 DOI: 10.5455/msm.2017.29.129-133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: The aim of this study was to assess the importance of early diagnosis of potentially malignant lesions in the prevention of oral cancer. Material and methods: In order to achieve the set objectives, we selected our participant pool. Of the 340 patients who came to the initial examination at the Clinic for Oral Medicine and Periodontology, we selected 40 patients with potentially malignant oral lesions (PMOL) of both sexes and of different ages. After an extensive anamnesis and a clinical examination of all mucous membranes, we documented potentially malignant lesions, their localization, subjective and objective symptoms, duration of pathological lesion, and bad habits (smoking and alcohol). All lesions were colored with Toluidine blue, which indicates malignancy in 75% of cases. Patients who had a positive Toluidine blue staining test were sent to biopsy and pathohistological analysis. Results: The most common potentially malignant lesions are Lichen reticularis (25%), Lichen erosivus (20%), and Leukoplakia (15%). The most common localization of lesions is the buccal mucosa bilaterally (26%), buccal mucosa unilaterally (10%), and the lower lip (10%). The staining test with Toluidine blue was positive at 23% PMOLs. In patients with positive Toluidine staining findings, biopsy and pathohistological analysis were performed, which showed that 20% of all lesions are carcinoma (CIS, Baseocellular Carcinoma, Squamocellular Carcinoma), while 14% are mucosal epithelial dysplasia. Statistical analysis confirmed the significance of positive staining of Toluidine blue and Leukoplakia (Spearman’s coefficient = 0.427, p = 0.006, N = 40), and statistically significant positive association of Squamocellular Carcinoma and Toluidine blue staining (Spearman’s coefficient = 0.619, p = 0.000, N = 40). Conclusion: Most oral cancers are caused by potentially malignant lesions, which is why a very detailed clinical examination with the visualization of pathological lesions is very important. Toluidine blue test can be an auxiliary tool for clinical diagnosis but does not replace the pathohistological finding. Biopsy and pathohistological findings are the gold standard in the diagnosis of oral cancers, as confirmed in our research.
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Affiliation(s)
- Sanja Hadzic
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, University of Sarajevo, Bosnia and Hercegovina
| | - Mirjana Gojkov-Vukelic
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, University of Sarajevo, Bosnia and Hercegovina
| | - Enes Pasic
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, University of Sarajevo, Bosnia and Hercegovina
| | - Almir Dervisevic
- Maxillofacial surgery Clinical Center of Sarajevo, Bosnia and Hercegovina
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Curra M, Salvadori G, Junges R, Filho MS, Hugo FN, Martins MD. Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions. Braz Oral Res 2016; 30:e135. [PMID: 28001243 DOI: 10.1590/1807-3107bor-2016.vol30.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability.
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Affiliation(s)
- Marina Curra
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Gabriela Salvadori
- University of Oslo, Faculty of Dentistry, Department of Oral Biology, Oslo, Norway
| | - Roger Junges
- University of Oslo, Faculty of Dentistry, Department of Oral Biology, Oslo, Norway
| | - Manoel Sant'ana Filho
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Center of Community Dental Health Research, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
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Abidullah M, Raghunath V, Karpe T, Akifuddin S, Imran S, Dhurjati VNN, Aleem MA, Khatoon F. Clinicopathologic Correlation of White, Non scrapable Oral Mucosal Surface Lesions: A Study of 100 Cases. J Clin Diagn Res 2016; 10:ZC38-41. [PMID: 27042583 DOI: 10.7860/jcdr/2016/16950.7226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/07/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION White, non scrapable lesions are commonly seen in the oral cavity. Based on their history and clinical appearance, most of these lesions can be easily diagnosed, but sometimes diagnosis may go wrong. In order to arrive to a confirmative diagnosis, histopathological assessment is needed in many cases, if not all. AIMS 1) To find out the prevalence of clinically diagnosed oral white, non scrapable lesions. 2) To find out the prevalence of histopathologically diagnosed oral white, non scrapable lesions. 3) To correlate the clinical and histopathological diagnosis in the above lesions. MATERIALS AND METHODS A total of 100 cases of oral white, non scrapable lesions were included in the study. Based on their history and clinical presentation, clinical provisional diagnosis was made. Then biopsy was done and confirmatory histopathological diagnosis was given and both were correlated. In order to correlate clinical and histopathological diagnosis Discrepancy Index (DI) was calculated for all the cases. RESULTS Based on clinical diagnosis, there were 59 cases (59%) of leukoplakia, 29 cases (29%) of lichen planus and six cases (6%) of lichenoid reaction; whereas, based on histopathological diagnosis, there were 66 cases (66%) of leukoplakia epithelial hyperplasia and hyperkeratosis (leukoplakia) and 30 cases (30%) of lichen planus. Seventy eight clinically diagnosed cases (78%) correlated with the histopathological diagnosis and 22 cases (22%) did not correlate. The total discrepancy index was 22%. CONCLUSION A clinician needs to be aware of oral white, non scrapable lesions. Due to the overlapping of many clinical features in some of these lesions and also due to their malignant potential, a histopathological confirmative diagnosis is recommended.
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Affiliation(s)
- Mohammed Abidullah
- Assistant Professor, Department of Oral & Maxillofacial Pathology, S.B Patil Dental College and Hospital , Bidar, Karnataka, India
| | - Vandana Raghunath
- Professor and HOD, Department of Oral & Maxillofacial Pathology, Narayana Dental College & Hospital , Nellore, AP, India
| | - Tanveer Karpe
- Professor, Department of Oral & Maxillofacial Surgery, S.B Patil Dental College and Hospital , Bidar, Karnataka, India
| | - Syed Akifuddin
- Reader, Department of Oral & Maxillofacial Surgery, Daswani Dental College & Hospital , Kota, Rajasthan, India
| | - Shahid Imran
- Post Graduate Student, Department of Oral Medicine & Radiology, MNR Dental College , Sanga Reddy, Telagana, India
| | | | - Mohammed Ahtesham Aleem
- Consulting Oral & Maxillofacial Surgeon, Life Prime Dental Hospital , Hyderabad, Telangana, India
| | - Farheen Khatoon
- Director, Dentomax Dental & Maxillofacial Solutions , Hyderabad, Telangana, India
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Fatima S, Basu R, Hallur NH. Lugol's iodine identifies dysplastic tissue in precancerous lesions: A clinical trial. Ann Maxillofac Surg 2016; 6:172-174. [PMID: 28299253 PMCID: PMC5343623 DOI: 10.4103/2231-0746.200333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Intraepithelial dysplasia, or “invisible” precancerous lesions, provides a challenge for visualization to the surgical team. The prognostic relevance of dysplasia and carcinoma in situ at surgical margins is well documented. Materials and Methods: We evaluated the use of Lugol's iodine in visualizing the surgical margins of dysplastic tissue by an observational study of 100 patients having oral precancerous lesions between June 2013 and March 2016. Conclusion: Lugol's iodine is a simple, inexpensive, and apparently effective means of diagnosing and visualizing the surgical margins of the dysplastic tissue in oral precancerous lesions.
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Affiliation(s)
- Shereen Fatima
- Department of Oral and Maxillofacial Surgery, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
| | - Rajarshi Basu
- Department of Oral and Maxillofacial Surgery, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
| | - Neelakamal H Hallur
- Department of Oral and Maxillofacial Surgery, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
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Shakeel MK, Daniel MJ, Srinivasan SV, Koliyan R, Kumar JV. Comparative analysis of detecting cervical lymph node metastasis with fine needle aspiration cytology. J Nat Sci Biol Med 2015; 6:S7-9. [PMID: 26604624 PMCID: PMC4630768 DOI: 10.4103/0976-9668.166050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: We correlated the results of cervical lymph node (LN) status by T-tumor size, N-nodal metastasis, M-distant metastasis (TNM) staging, and fine needle aspiration cytology (FNAC) in oral cancer patients to assess the discrepancy index (DI) between nodal metastasis (N) and FNAC results of cervicofacial LNs. Materials and Methods: A total of 63 patients (29 females and 34 males) aged from 30 to 85 years were included in our study. Cervical LN status through TNM staging and FNAC results were matched and DI was calculated. Results: DI in case of nodal status was 64.10% and 43.47% for TNMN1 and N2, respectively, indicating that tendency for observation of positive result on FNAC increased from N1 to N2. Conclusion: Hence, we suggest that relying solely on clinical examination and routine diagnostic tests like FNAC may not be appropriate and additional diagnostic imaging modalities should be considered.
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Affiliation(s)
- Mohammed Kamran Shakeel
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | - Mariappan Jonathan Daniel
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | | | - Ramadoss Koliyan
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | - Jimsha Vannathan Kumar
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
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Abadie WM, Partington EJ, Fowler CB, Schmalbach CE. Optimal Management of Proliferative Verrucous Leukoplakia. Otolaryngol Head Neck Surg 2015; 153:504-11. [DOI: 10.1177/0194599815586779] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 04/23/2015] [Indexed: 11/16/2022]
Abstract
Objective Proliferative verrucous leukoplakia (PVL) is a rare and recalcitrant form of leukoplakia. The purpose of this review is to further characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant lesion. Data Sources Twenty-six articles on PVL with a total of 329 PVL cases. Review Methods A systematic review of the literature using Ovid, PubMed, Cochrane Database, and gray literature was conducted of all PVL cases reported between 1985 and 2014. Inclusion criteria required reporting of patient follow-up and recurrence rates. Data were analyzed using descriptive statistics. Student t test and Fisher exact test were used to identify factors associated with malignant transformation. Results The mean patient age was 63.9 years. Most patients were female (66.9%) and nontobacco users (65.22%). Mean follow-up was 7.4 years, with an average of 9.0 biopsies per patient during this period. Proliferative verrucous leukoplakia exhibited histopathologic features along a progressive spectrum, evolving from leukoplakia to verrucous hyperplasia and ultimately invasive carcinoma. Surgery was the most common treatment implemented, but recurrence rates among 222 patients reached 71.2%. Subgroup analysis of 277 patients identified a 63.9% malignant transformation rate, and 39.6% of patients died of their disease. Age, sex, and tobacco use were not identified as risk factors associated with progression to cancer. Conclusions Proliferative verrucous leukoplakia is a rare form of leukoplakia with a high rate of malignant transformation. It necessitates high clinical suspicion, to include a lifetime of close follow-up and repeat biopsies by a health care provider well versed in oral carcinoma.
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Affiliation(s)
- Wesley M. Abadie
- Department of Otolaryngology, Mike O’Callaghan Federal Medical Center, Nellis AFB, Nevada, USA
| | - Erin J. Partington
- Division of Otolaryngology, University of Alabama–Birmingham, Birmingham, Alabama, USA
| | - Craig B. Fowler
- Division of Oral and Maxillofacial Pathology, University of Kentucky School of Dentistry, Lexington, Kentucky, USA
| | - Cecelia E. Schmalbach
- Division of Otolaryngology, University of Alabama–Birmingham, Birmingham, Alabama, USA
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Calixto G, Bernegossi J, Fonseca-Santos B, Chorilli M. Nanotechnology-based drug delivery systems for treatment of oral cancer: a review. Int J Nanomedicine 2014; 9:3719-35. [PMID: 25143724 PMCID: PMC4134022 DOI: 10.2147/ijn.s61670] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oral cancer (oral cavity and oropharynx) is a common and aggressive cancer that invades local tissue, can cause metastasis, and has a high mortality rate. Conventional treatment strategies, such as surgery and chemoradiotherapy, have improved over the past few decades; however, they remain far from optimal. Currently, cancer research is focused on improving cancer diagnosis and treatment methods (oral cavity and oropharynx) nanotechnology, which involves the design, characterization, production, and application of nanoscale drug delivery systems. In medicine, nanotechnologies, such as polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carriers, gold nanoparticles, hydrogels, cyclodextrin complexes, and liquid crystals, are promising tools for diagnostic probes and therapeutic devices. The objective of this study is to present a systematic review of nanotechnology-based drug delivery systems for oral cancers.
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Affiliation(s)
- Giovana Calixto
- School of Pharmaceutical Sciences, Department of Drugs and Pharmaceuticals, São Paulo State University (UNESP), São Paulo, Brazil
| | - Jéssica Bernegossi
- School of Pharmaceutical Sciences, Department of Drugs and Pharmaceuticals, São Paulo State University (UNESP), São Paulo, Brazil
| | - Bruno Fonseca-Santos
- School of Pharmaceutical Sciences, Department of Drugs and Pharmaceuticals, São Paulo State University (UNESP), São Paulo, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, Department of Drugs and Pharmaceuticals, São Paulo State University (UNESP), São Paulo, Brazil
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The malignant transformation of oral lichen planus and oral lichenoid lesions. J Am Dent Assoc 2014; 145:45-56. [DOI: 10.14219/jada.2013.10] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma. J Am Dent Assoc 2013. [PMID: 23204089 DOI: 10.14219/jada.archive.2012.0096] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC. METHODS The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC. CLINICAL IMPLICATIONS On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.
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Kazemi HH, Mortazavi N. Comment on “Association of periodontitis with the risk of oral leukoplakia” by Peter Meisel et al. [Oral Oncol 48 (2012) 859–863]. Oral Oncol 2013. [DOI: 10.1016/j.oraloncology.2012.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Jadotte YT, Schwartz RA. Solar cheilosis: An ominous precursor. J Am Acad Dermatol 2012; 66:187-98; quiz 199-200. [DOI: 10.1016/j.jaad.2011.09.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 08/31/2011] [Accepted: 09/04/2011] [Indexed: 11/15/2022]
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18
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Diagnostic efficiency of differentiating small cancerous and precancerous lesions using mucosal brush smears of the oral cavity--a prospective and blinded study. Clin Oral Investig 2010; 15:763-9. [PMID: 20593209 DOI: 10.1007/s00784-010-0434-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 06/07/2010] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the diagnostic accuracy of oral brush biopsy to identify early malignancy. One hundred and eighty-six brush biopsies of suspicious mucosal lesions were obtained, haematoxilin and eosin (H&E)-stained and compared with the histology of conventional excision biopsies of the same site performed concomitantly. The sensitivity for identifying squamous cell carcinoma (SCC) was 88.5%. High-risk lesions including squamous intraepithelial neoplasia (SIN II, SIN III) and SCC were identified with a sensitivity of 86.4%, using a pap-analogous classification, which is considered to be carcinomatous, as well as moderate and severe dysplastic cells positive. Depending on the cytopathologic definition for malignancy and the tumour size, the test accuracy varied: Extending the cytopathologic criteria for malignancy by defining all dysplastic or malignant cytopathologic findings as positive, the sensitivity was increased to 95.2% at the expense of the specificity, which was reduced from 94.9% to 82.3%. Separately analysing SCCs of less than 20 mm, the sensitivity was reduced by 9.5% to 78%. Although small malignant lesions seem to be less reliable by the conventional oral brush biopsy, it is a useful screening instrument for early diagnosis of suspicious, epithelial lesions and could therefore contribute to improved cancer prognosis.
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de Godoy Peres FF, Aigotti Haberbeck Brandão A, Rodarte Carvalho Y, Dória Filho U, Plapler H. A study of actinic cheilitis treatment by two low-morbidity CO2 laser vaporization one-pass protocols. Lasers Med Sci 2008; 24:375-85. [DOI: 10.1007/s10103-008-0574-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 05/15/2008] [Indexed: 10/22/2022]
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20
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Cavalcante ASR, Anbinder AL, Carvalho YR. Actinic cheilitis: clinical and histological features. J Oral Maxillofac Surg 2008; 66:498-503. [PMID: 18280383 DOI: 10.1016/j.joms.2006.09.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Revised: 09/25/2006] [Accepted: 09/27/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to analyze the clinical and histological features of actinic cheilitis (AC). PATIENTS AND METHODS A total of 29 patients with AC were clinically evaluated, and incisional biopsies were performed to confirm the clinical diagnosis. Histological features were analyzed, and dysplasia was classified as mild, moderate, or severe. The chi(2) test was used for the following variables: gender, age, race, and smoking habits. The degree of dysplasia was related to these variables (Fisher's test) to test for independence between them (P < .05). RESULTS Of the patient group, 72.41% were male, 75.86% were over age 40 years, 93.10% were white, and 72.41% were nonsmokers. Clinically, all patients presented with multifocal lesions. The following manifestations were seen: dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor. Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia were found in the epithelial tissue; elastosis, inflammatory infiltrate, and vasodilatation were found in the connective tissue. Dysplasia was mild in 10.34% of the patients, moderate in 27.59%, and severe in 62.07%. Absence of sample homogeneity was observed in regard to gender, age, race, and smoking habits. It was not possible to reject the hypothesis of independence between mild, moderate, or severe dysplasia and gender, age, race, and smoking habits. CONCLUSIONS Dryness, atrophy, and scaly lesions were the most common clinical findings observed. Dysplasia, inflammatory infiltrate, and vasodilatation, as well as elastosis, were the most common histological findings observed. Gender, age, race, or smoking habits were not related to the degree of dysplasia in the sample.
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Affiliation(s)
- Ana Sueli Rodrigues Cavalcante
- Department of Bioscience and Oral Diagnosis, School of Dentistry of São José dos Campos, São Paulo State University, São José dos Campos, São Paulo, Brazil.
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Lee JJ, Hung HC, Cheng SJ, Chiang CP, Liu BY, Yu CH, Jeng JH, Chang HH, Kok SH. Factors associated with underdiagnosis from incisional biopsy of oral leukoplakic lesions. ACTA ACUST UNITED AC 2007; 104:217-25. [PMID: 17560138 DOI: 10.1016/j.tripleo.2007.02.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/23/2007] [Accepted: 02/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Incisional biopsy is accepted by most clinicians as a dependable way of assessing the nature of oral leukoplakia (OL). The aim of the present study was to investigate its reliability and analyze risk factors associated with underdiagnosis from incisional biopsy. STUDY DESIGN A cross-sectional retrospective study was conducted in 242 patients with a clinical diagnosis of OL. The discrepancy between provisional diagnosis (from incisional biopsy) and definitive diagnosis (from resection specimen) was analyzed and correlated with clinical variables. Patients who had incisional biopsy taken from a single location and those who received multiple-site biopsies were analyzed separately. RESULTS In the 200 cases receiving single-site biopsy, the agreement rate between provisional and definitive diagnoses was only 56%, and underdiagnosis from incisional biopsy was noted in 29.5% of patients. Underdiagnosis rate in the 42 patients receiving multiple-site biopsies was significantly lower (11.9%; P < .05). The rate of unexpected carcinoma in resection specimen was also significantly lower in the multiple-biopsy patients than in the single-biopsy patients (2.4% vs. 12.0%; P < .05). For the single-biopsy group, multivariate analysis revealed that clinical appearance significantly influenced the risk of underdiagnosis and unexpected carcinoma (both P < .05). Compared with homogeneous lesions, nonhomogeneous OL were more prone to be underdiagnosed (adjusted odds ratio [AOR] 2.36, 95% confidence interval [CI] 1.16-4.82) and have carcinoma undetected by incisional specimen (AOR 15.94, 95% CI 2.09-121.72). CONCLUSIONS Incisional biopsy was found to have limitations in the assessment of OL, especially for nonhomogeneous lesions. Clinicians should be conscious of the possible underdiagnosis from incisional biopsy, and multiple biopsies should be taken whenever they think that it is necessary.
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Affiliation(s)
- Jang-Jaer Lee
- School of Dentistry, National Taiwan University College of Medicine, Taipei, Taiwan
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Campisi G, Di Fede O, Giovannelli L, Capra G, Greco I, Calvino F, Maria Florena A, Lo Muzio L. Use of fuzzy neural networks in modeling relationships of HPV infection with apoptotic and proliferation markers in potentially malignant oral lesions. Oral Oncol 2005; 41:994-1004. [PMID: 16129653 DOI: 10.1016/j.oraloncology.2005.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2005] [Accepted: 05/27/2005] [Indexed: 10/25/2022]
Abstract
To evaluate in oral leukoplakia the relationship between HPV infection and markers of apoptosis (bcl-2, survivin) and proliferation (PCNA), also conditionally to age, gender, smoking and drinking habits of patients, by means of Fuzzy neural networks (FNN) system 21 cases of oral leukopakia, clinically and histologically diagnosed, were examined for HPV DNA presence, bcl-2, survivin and PCNA expression. HPV DNA was investigated in exfoliated oral mucosa cells by nested PCR (nPCR: MY09-MY11/GP5-GP6), and the HPV genotype determined by direct DNA sequencing. All markers were investigated by means of standardised immunohistochemistry procedure. Data were analysed by chi-square test, crude OR and the 95% CI; in blindness, FNN was applied. HPV DNA was found in 8/21 OL (38.1%); survivin, PCNA, and tobacco smoking were associated in univariate analysis (p = 0.04) with HPV DNA status. HPV-18 was the most frequently detected genotype (6/8), followed by HPV-16 (2/8). FNN revealed that survivin and PCNA, both being expressed in all of OL HPV+ve, were associated with HPV infection. In conclusion, the FNN allowed to hypothesise a model of specific variables associated to HPV infection in OL. The relevance of survivin and PCNA suggest that they may be involved in HPV-mediated deregulation of epithelial maturation and, conversely, that HPV may have a role in the expression level of these two markers. FNN system seems to be an effective tool in the analysis of correlates of OL and HPV infection.
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Affiliation(s)
- Giuseppina Campisi
- Department of Oral Sciences, University of Palermo, 90127 Palermo, Italy
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van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med 2003; 32:507-12. [PMID: 12969224 DOI: 10.1034/j.1600-0714.2003.00125.x] [Citation(s) in RCA: 482] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation was to study the correlation between the clinical and histopathologic assessment of OLP, and to propose diagnostic refinements, if appropriate. METHODS Clinical and histopathologic data of two previously published studies were used for this purpose. The number of clinical cases in which all clinicians agreed as well as the number of microscopic slides on which all reviewing pathologists agreed were calculated and compared with each other in order to assess the clinicopathologic correlation. RESULTS In 42% of the cases in which all clinicians agreed about the clinical diagnosis being diagnostic of OLP, there appeared to be no consensus on the histopathologic diagnosis. Conversely, in 50% of the cases in which all pathologists agreed about the histopathologic diagnosis being diagnostic of OLP there was a lack of consensus on the clinical diagnosis. CONCLUSION Based on the findings of the present study, there appears to be a lack of clinicopathologic correlation in the diagnostic assessment of OLP. We therefore propose a set of revised diagnostic criteria of OLP and oral lichenoid lesions, based on the WHO definition of OLP, including clinical as well as histopathologic aspects.
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Affiliation(s)
- E H van der Meij
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry Amsterdam, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Pentenero M, Carrozzo M, Pagano M, Galliano D, Broccoletti R, Scully C, Gandolfo S. Oral mucosal dysplastic lesions and early squamous cell carcinomas: underdiagnosis from incisional biopsy. Oral Dis 2003; 9:68-72. [PMID: 12657031 DOI: 10.1034/j.1601-0825.2003.02875.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the degree and causes of underdiagnosis of incisional biopsy in oral potentially malignant lesions (PML). DESIGN Cross-sectional retrospective study. MATERIALS AND METHODS All pathology slides (incisional biopsy and resection specimen) from 46 patients with oral PML were reviewed and scored blind. The provisional diagnosis was considered in order to provide underdiagnosis or overdiagnosis according to whether this score was lower or higher than the final diagnosis. MAIN OUTCOME MEASURES Concordance between the scores for provisional and final diagnoses was compared for reviewed and unreviewed assessments. RESULTS Upon review, underdiagnosis significantly decreased from 23.9% to 4.4% (P=0.016, chi-square with the Yates' correction). As the underdiagnosis ratio was not significantly influenced by intra- or inter-observer variability, it is likely to be related to pathologists' interpretation difficulties when examining incisional biopsy specimens. CONCLUSIONS The good quality of incisional biopsy samples was demonstrated, but clinicians should be conscious of the possible underdiagnosis by incisional biopsy when planning therapy in suspected early oral squamous cell carcinoma lesions.
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Affiliation(s)
- M Pentenero
- Department of Biomedical Sciences, Oral Medicine Section, University of Turin, Italy
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Myers SL, Rhodus NL, Parsons HM, Hodges JS, Kaimal S. A retrospective survey of oral lichenoid lesions: revisiting the diagnostic process for oral lichen planus. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:676-81. [PMID: 12142874 DOI: 10.1067/moe.2002.121281] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to investigate patient demographics and diagnostic trends in biopsies in patients with final diagnoses of oral lichen planus or lichenoid over 4 decades. METHODS Archived biopsy reports from 248 patients were examined for 1966, 1976, 1986, and 1996. Data were collected for patient age and sex, significant medical and dental history, description of lesion, and clinical and histopathologic diagnoses. RESULTS Oral lichen planus made up a declining portion of total final diagnoses over the decades. The number of cases with less-than-definitive diagnoses and using modifying terminology (eg, probable, possible, suggestive of) increased. In addition, the age at diagnosis for female patients increased by 1.2 years per decade on average, whereas the age for male patients decreased by 3.5 years per decade on average. CONCLUSIONS The diagnosis of oral lichen planus appears to have been extended by the use of modifying terminology to include lesions that have less than definitive features. Comprehensive clinical histories and investigations can help limit the inclusion of such lesions.
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Affiliation(s)
- Sandra L Myers
- Department of Oral Sciences, University of Minnesota School of Dentistry, Minneapolis 55455, USA.
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Onofre MA, Sposto MR, Navarro CM. Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:535-40. [PMID: 11346731 DOI: 10.1067/moe.2001.112949] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the reliability of in vivo staining with toluidine blue in the detection of oral epithelial dysplasia, in situ carcinoma, and invasive squamous cell carcinomas in potentially malignant epithelial lesions (PMELs) and superficial oral ulcerations suggesting malignancy. STUDY DESIGN Fifty patients with PMELs and superficial oral ulcerations suggestive of malignancy were selected from those treated at the Oral Medicine Service, Faculty of Dentistry, Araraquara, Brazil. All lesions were submitted to staining with an aqueous solution of 1% toluidine blue, followed by biopsy and histologic analysis. The sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS Histologic diagnosis revealed that 14% of the lesions analyzed were in situ carcinoma and invasive squamous cell carcinomas, 12% were epithelial dysplasias, 13% were keratosis, 40% were lichen planus, and 8% were other benign lesions. The sensitivity of the staining was 77%, the specificity 67%, and the positive and negative predictive values 43.5% and 88.9%, respectively. CONCLUSIONS Staining with toluidine blue was demonstrated to be highly reliable in the detection of in situ carcinoma and invasive squamous cell carcinoma, because false-negative results for the lesions did not occur. Toluidine blue staining is an adjunct to clinical judgment and not a substitute for either judgment or biopsy.
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Affiliation(s)
- M A Onofre
- Oral Medicine Service, Department of Diagnosis and Surgery, School of Dentistry Araraquara-UNESP, São Paulo, Brazil.
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