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Kadhum SI, Al-Drobie BF. Evaluation of clinical and demographical finding in patients with oral lichen planus: A retrospective cross sectional study. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:1025-1032. [PMID: 39008593 DOI: 10.36740/wlek202405123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Aim: To learn more about Oral Lichen Planus Iraqi patients, including their background information, symptoms, and prognosis. PATIENTS AND METHODS Materials and Methods: From the Oral and Maxillofacial Pathology Department, College of Dentistry, Baghdad University, we retrospectively reviewed the medical records of 68 patients with a histologically confirmed clinical diagnosis of oral lichen planus and subsequently contacted the patients by phone to evaluate their prognosis. RESULTS Results: Females were more likely than males to experience severe pain; the reticular form of Oral Lichen Planus was the most prevalent at 38.2%, but the erosive type was more prevalent among females. Only 53 of 68 patients responded to phone calls. More than 37% of those respondents reported involvement at a second location intra-orally following the first oral manifestation, and 20% had extraoral Lichen Planus, and approximately 22.6% of them observed changes in the morphology and behavior of the lesion after a brief period of time, while 26.4% experienced complete remission. CONCLUSION Conclusions: Females were more likely to have oral lichen planus. Females and elderly persons were more likely to have severe pain than other. The lesion must be monitored for symptomatic flare-ups over time.
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Affiliation(s)
- Shahad Ihsan Kadhum
- DEPARTMENT OF ORAL DIAGNOSIS, COLLEGE OF DENTISTRY, UNIVERSITY OF BAGHDAD, BAGHDAD, IRAQ
| | - Ban Fadhil Al-Drobie
- DEPARTMENT OF ORAL DIAGNOSIS, COLLEGE OF DENTISTRY, UNIVERSITY OF BAGHDAD, BAGHDAD, IRAQ
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2
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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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Sathasivam HP, Sloan P, Thomson PJ, Robinson M. The clinical utility of contemporary oral epithelial dysplasia grading systems. J Oral Pathol Med 2021; 51:180-187. [PMID: 34797585 DOI: 10.1111/jop.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. METHODS Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. RESULTS 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. CONCLUSION This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).
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Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Peter J Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Max Robinson
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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4
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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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5
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Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4329-4340. [PMID: 34050426 DOI: 10.1007/s00784-021-04008-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems. MATERIAL AND METHODS A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED). RESULTS The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I2 = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I2 = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64). CONCLUSIONS Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation. CLINICAL RELEVANCE The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.
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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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7
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Thomson P. The "Peter Principle" revisited-Reflections on science, surgery and research. J Oral Pathol Med 2020; 49:596-600. [PMID: 32162731 DOI: 10.1111/jop.13011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Revisiting the eponymous "Peter Principle," in this article the author reflects upon a professional lifetime as a clinician, surgeon and researcher, and summarises his efforts to improve contemporary understanding of oral cancer development, refine diagnostic procedure and facilitate efficacious, early treatment intervention to halt the process of carcinogenesis. The author reviews the principles underpinning effective translational research. Utilising his own work in oral epithelial cell science, interventional surgery and potentially malignant disorder patient management and surveillance, a number of significant advances in our knowledge base and their specific clinical application and potential impact are discussed. Research remains an active and ongoing process, however, and the author believes it essential for future relevance that hypotheses should always be initiated, led and mentored by experienced clinical practitioners.
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Affiliation(s)
- Peter Thomson
- Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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8
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Sundberg J, Korytowska M, Holmberg E, Bratel J, Wallström M, Kjellström E, Blomgren J, Kovács A, Öhman J, Sand L, Hirsch JM, Giglio D, Kjeller G, Hasséus B. Recurrence rates after surgical removal of oral leukoplakia-A prospective longitudinal multi-centre study. PLoS One 2019; 14:e0225682. [PMID: 31810078 PMCID: PMC6897554 DOI: 10.1371/journal.pone.0225682] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/11/2019] [Indexed: 01/03/2023] Open
Abstract
Oral leukoplakia (OL) is a potentially malignant oral disorder. The Gold Standard treatment is to remove surgically the OL. Despite optimal surgery, the recurrence rates are estimated to be 30%. The reason for this is unknown. The aim of this study was to investigate the clinical factors that correlate with recurrence after surgical removal of OL. In a prospective study data were collected from 226 patients with OL. Forty-six patients were excluded due to incomplete records or concomitant presence of other oral mucosal diseases. Overall, 180 patients proceeded to analysis (94 women and 86 men; mean age, 62 years; age range, 28–92 years). Clinical data, such as gender, diagnosis (homogeneous/non-homogeneous leukoplakia), location, size, tobacco and alcohol use, verified histopathological diagnosis, and clinical photograph, were obtained. In patients who were eligible for surgery, the OL was surgically removed with a margin. To establish recurrence, a healthy mucosa between the surgery and recurrence had to be confirmed in the records or clinical photographs. Statistical analysis was performed with the level of significance set at P<0.05. Of the 180 patients diagnosed with OL, 57% (N = 103) underwent surgical removal in toto. Recurrence was observed in 43 OL. The cumulative incidence of recurrence of OL was 45% after 4 years and 49% after 5 years. Fifty-six percent (N = 23) of the non-homogeneous type recurred. Among snuff-users 73% (N = 8) cases of OL recurred. A non-homogeneous type of OL and the use of snuff were significantly associated with recurrence after surgical excision (P = 0.021 and P = 0.003, respectively). Recurrence was also significantly associated with cancer transformation (P<0.001). No significant differences were found between recurrence and any of the following: dysplasia, site of lesion, size, multiple vs. solitary OL, gender, age, use of alcohol or smoking. In conclusion, clinical factors that predict recurrence of OL are non-homogeneous type and use of snuff.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cell Transformation, Neoplastic/pathology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Leukoplakia, Oral/epidemiology
- Leukoplakia, Oral/etiology
- Leukoplakia, Oral/pathology
- Leukoplakia, Oral/surgery
- Longitudinal Studies
- Male
- Middle Aged
- Mouth Mucosa/pathology
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/etiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Oral Surgical Procedures
- Prospective Studies
- Risk Factors
- Tobacco, Smokeless/adverse effects
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Jonas Sundberg
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magdalena Korytowska
- Clinic of Orofacial Medicine, NÄL Hospital, Region Västra Götaland, Trollhättan, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Bratel
- Clinic of Oral Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Mats Wallström
- Clinic of Oral and Maxillofacial Surgery, Region Västra Götaland, Gothenburg, Sweden
| | - Ebba Kjellström
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Johan Blomgren
- Clinic of Oral Medicine, Sahlgrenska University Hospital/East, Region Västra Götaland, Gothenburg, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Sand
- Department of Oral Biology, Faculty of Odontology, University of Oslo, Oslo, Norway
| | - Jan-Michaél Hirsch
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Daniel Giglio
- Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Kjeller
- Clinic of Oral and Maxillofacial Surgery, Region Västra Götaland, Gothenburg, Sweden
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Oral Medicine, Region Västra Götaland, Gothenburg, Sweden
- * E-mail:
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9
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Pineiro-Donis S, Torres-López M, García-García A, Marichalar-Mendía X, Gándara-Vila P, Lorenzo-Pouso AI, Blanco-Carrión A, Pérez-Sáyans M. The impact of clinicopathological aspects on the recurrence of oral leukoplakia: A retrospective study in a cohort of 83 patients from the north of Spain. Indian J Cancer 2019; 56:375-378. [PMID: 31607714 DOI: 10.4103/ijc.ijc_230_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sergio Pineiro-Donis
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Torres-López
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Abel García-García
- GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Xavier Marichalar-Mendía
- Oral Medicine and Pathology, Department of Stomatology II, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Pilar Gándara-Vila
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Alejandro-Ismael Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Blanco-Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Mario Pérez-Sáyans
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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10
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Goodson ML, Smith DR, Thomson PJ. The"Newcastle Nomogram"-Statistical modelling predicts malignant transformation in potentially malignant disorders. J Oral Pathol Med 2019; 48:662-668. [PMID: 31125457 DOI: 10.1111/jop.12881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nomograms are graphical calculating devices used to predict risk of malignant transformation (MT) or response to treatment during cancer management. To date, a nomogram has not been used to predict clinical outcome during oral potentially malignant disorder (PMD) treatment. The aim of this study was to create a nomogram for use by clinicians to predict the probability of MT, thereby facilitating accurate assessment of risk and objective decision-making during individual patient management. METHODS Clinico-pathological data from a previously treated cohort of 590 newly presenting PMD patients were reviewed and clinical outcomes categorized as disease free, persistent PMD or MT. Multiple logistic regression was used to predict the probability of MT in the cohort using age, gender, lesion type, site and incision biopsy histopathological diagnoses. Internal validation and calibration of the model was performed using the bootstrap method (n = 1000), and bias-corrected indices of model performance were computed. RESULTS Potentially malignant disorders were predominantly leukoplakias (79%), presenting most frequently at floor of mouth and lateral tongue sites (51%); 99 patients (17%) developed oral squamous cell carcinoma during the study period. The nomogram performed well when MT predictions were compared with patient outcome data, demonstrating good bias-corrected discrimination and calibration (Dxy = 0.58; C = 0.790), with a sensitivity of 87% and specificity 63%, and a positive predictive value of 32% and negative predictive value 96%. CONCLUSION The "Newcastle Nomogram" has been developed to predict the probability of MT in PMD, based on an internally validated statistical model. Based upon readily available and patient-specific clinico-pathological data, it provides clinicians with a pragmatic diagrammatic aid for clinical decision-making during diagnosis and management of PMD.
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Affiliation(s)
| | | | - Peter J Thomson
- Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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11
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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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12
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Vu J, Coleman HG, Palme CE, Riffat F, Schifter M, Zoellner H. Diagnostic utility of microsurgical carbon dioxide laser excision of oral potentially malignant lesions vs incisional biopsy: a retrospective histopathological review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:516-525. [PMID: 30948343 DOI: 10.1016/j.oooo.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/07/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral microsurgical carbon dioxide laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation, reduced postoperative morbidity, and easier postoperative clinical surveillance. STUDY DESIGN Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPMLs demonstrated the following histopathologic diagnoses on conventional incisional biopsy (CIB): verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently, these patients went on to have laser excision biopsy (LEB) of their OPMLs. RESULTS Histologic diagnosis was upgraded after LEB in 14 (45%) patients (P < .001), with unexpected findings of cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%). CONCLUSIONS Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs compared with use of CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regard to earlier detection of oral squamous cell and/or verrucous carcinoma.
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Affiliation(s)
- Jacinta Vu
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Perth Oral Medicine & Dental Sleep Centre, Perth, Western Australia, Australia; UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Hedley G Coleman
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Tissue Pathology and Diagnostic Oncology, Level 3, Institute for Clinical Pathology and Medical Research (ICPMR), Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Schifter
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia; Department of Otolaryngology/Head and Neck Surgery, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.
| | - Hans Zoellner
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia; Department of Oral Medicine Oral Pathology and Special Care Dentistry, Level 3, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia
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13
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Thomson PJ. Perspectives on oral squamous cell carcinoma prevention-proliferation, position, progression and prediction. J Oral Pathol Med 2018; 47:803-807. [PMID: 29752860 DOI: 10.1111/jop.12733] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 11/27/2022]
Abstract
Squamous cell carcinoma arising from oral mucosal epithelium remains a lethal and deforming disease due to tumour invasion, oro-facial destruction, cervical lymph node metastasis and ultimate blood-borne dissemination. Worldwide, 300 000 new cases are seen each year, with a recent and significant rise in incidence affecting particularly the young. To rationalize perspectives on preventive strategies in oral cancer management, this study addresses a number of fundamental questions regarding carcinogenesis: proliferation-what epithelial cell changes precede tumour development? Position-why are certain oral sites so predisposed to cancer? Progression-why do some precursor lesions progress to invasive carcinoma and others do not? Prediction-how can we predict individual patient and/or lesion behaviour to prevent disease progression? By improving our understanding of oral carcinogenesis, can we thereby facilitate more effective primary, secondary and tertiary preventive strategies and ultimately reduce the global burden of oral squamous cell carcinoma (OSCC)?
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Affiliation(s)
- P J Thomson
- Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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14
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Thomson PJ, Goodson ML, Smith DR. Treatment resistance in potentially malignant disorders-'Nature' or 'Nurture'…? J Oral Pathol Med 2017; 46:902-910. [PMID: 28891106 DOI: 10.1111/jop.12641] [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] [Accepted: 09/06/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Contemporary potentially malignant disorder management is based upon provisional histological diagnosis followed by interventional surgery to excise or ablate 'high-risk' mucosal lesions. Although the majority of patients achieve disease-free status post-treatment, others develop further or persistent disease unresponsive to intervention. METHODS A detailed, retrospective clinico-pathological review of treatment resistant potentially malignant lesions, from a 590 patient cohort treated by CO2 laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was determined at study census date (31 December 2014). RESULTS A total of 87 patients (15%) exhibited PMD disease resistant to treatment: 34 (6%) became disease free following further treatment, whilst 53 (9%) had persistent disease despite intervention. Disease-free patients were younger, changed lesion appearance from erythroleukoplakia to leukoplakia (P = .004), developed further lesions at new sites, demonstrated reduction in dysplasia severity with time and required multiple treatments to achieve disease-free status (P = .0005). In contrast, persistent disease patients were older, male, often presented with proliferative verrucous leukoplakia (PVL) on gingival and alveolar sites, displayed less severe dysplasia initially and underwent laser ablation rather than excision (P = .027). CONCLUSION Despite clinico-pathological profiling of treatment resistant patients, the precise inter-relationship between the inherent nature of potentially malignant disease and the external influence of treatment intervention remains obscure.
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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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15
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Thomson PJ. Potentially malignant disorders-The case for intervention. J Oral Pathol Med 2017; 46:883-887. [DOI: 10.1111/jop.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Affiliation(s)
- P. J. Thomson
- Oral & Maxillofacial Surgery; School of Dentistry; University of Queensland; Oral Health Centre; QLD Australia
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16
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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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17
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Goodson ML, Smith DR, Thomson PJ. Efficacy of oral brush biopsy in potentially malignant disorder management. J Oral Pathol Med 2017; 46:896-901. [PMID: 28833675 DOI: 10.1111/jop.12627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral potentially malignant disorders (PMD) harbour unpredictable risk for squamous cell carcinoma development. Current management requires tissue biopsy for histopathology characterisation, dysplasia grading and targeted intervention to "high-risk" lesions, although evidence-based guidelines are limited and diagnoses subjective. This study investigated the use of adjunctive oral brush biopsy techniques during the management of PMD in a UK hospital population. METHODS Retrospective review of a 310 PMD patient cohort presenting to Maxillofacial Surgery in Newcastle upon Tyne with new, single-site lesions between December 2009 and May 2014. Patients underwent Orcellex® brush biopsy and liquid-based cytology examination in addition to conventional biopsy techniques, with management proceeding along established care pathways. Patient demographics, cytology data, most significant histopathology diagnoses and clinical outcome were all documented at the study census date (31.12.15). RESULTS A total of 170 male & 140 female patients (age range 18-91 years), exhibiting primarily leukoplakia (86.5%) at floor of mouth and ventrolateral tongue sites (44.9%), were identified. Management comprised: observation (49.7%), laser surgery (44.9%), antifungal treatment (3.5%) and Head & Neck clinic referral following cancer diagnosis (1.9%). Clinical outcomes were as follows: disease free (51.3%), persistent PMD (42.3%) and malignant transformation (6.4%). Histology and cytology diagnoses strongly correlated (r = .305). Treatment modality, lesion site, histology and cytology diagnoses were the best predictors of clinical outcome. CONCLUSIONS Orcellex® brush cytology provides reliable diagnoses consistent with conventional histopathology and offers less invasive, adjunctive assessment appropriate for long-term monitoring of patients in specialist clinics.
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Affiliation(s)
- M L Goodson
- Oral & Maxillofacial Surgery, Oral Health Centre, School of Dentistry, University of Queensland, Brisbane, QLD, Australia.,Newcastle University Medicine Malaysia, Johor, Malaysia
| | - D R Smith
- Newcastle University Medicine Malaysia, Johor, Malaysia
| | - P J Thomson
- Oral & Maxillofacial Surgery, Oral Health Centre, School of Dentistry, University of Queensland, Brisbane, QLD, Australia
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18
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Özçaka Ö, Epstein JB, Güneri P. Inflammation in the assessment of salivary cytokines in oral squamous cell carcinoma diagnosis. Oral Oncol 2017; 71:96-98. [PMID: 28688699 DOI: 10.1016/j.oraloncology.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Özgün Özçaka
- Department of Periodontology Ege University, School of Dentistry, Bornova 35100, İzmir, 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
| | - Pelin Güneri
- Department of Oral and Maxillofacial Radiology, Ege University, School of Dentistry, Bornova 35100, İzmir, Turkey
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19
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Bates T, Kennedy M, Diajil A, Goodson M, Thomson P, Doran E, Farrimond H, Thavaraj S, Sloan P, Kist R, Robinson M. Changes in Epidermal Growth Factor Receptor Gene Copy Number during Oral Carcinogenesis. Cancer Epidemiol Biomarkers Prev 2016; 25:927-35. [PMID: 27197272 DOI: 10.1158/1055-9965.epi-15-0949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a global healthcare problem associated with poor clinical outcomes. Early detection is key to improving patient survival. OSCC may be preceded by clinically recognizable lesions, termed oral potentially malignant disorders (OPMD). As histologic assessment of OPMD does not accurately predict their clinical behavior, biomarkers are required to detect cases at risk of malignant transformation. Epidermal growth factor receptor gene copy number (EGFR GCN) is a validated biomarker in lung non-small cell carcinoma. We examined EGFR GCN in OPMD and OSCC to determine its potential as a biomarker in oral carcinogenesis. METHODS EGFR GCN was examined by in situ hybridization (ISH) in biopsies from 78 patients with OPMD and 92 patients with early-stage (stages I and II) OSCC. EGFR ISH signals were scored by two pathologists and a category assigned by consensus. The data were correlated with patient demographics and clinical outcomes. RESULTS OPMD with abnormal EGFR GCN were more likely to undergo malignant transformation than diploid cases. EGFR genomic gain was detected in a quarter of early-stage OSCC, but did not correlate with clinical outcomes. CONCLUSION These data suggest that abnormal EGFR GCN has clinical utility as a biomarker for the detection of OPMD destined to undergo malignant transformation. Prospective studies are required to verify this finding. It remains to be determined if EGFR GCN could be used to select patients for EGFR-targeted therapies. IMPACT Abnormal EGFR GCN is a potential biomarker for identifying OPMD that are at risk of malignant transformation. Cancer Epidemiol Biomarkers Prev; 25(6); 927-35. ©2016 AACR.
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Affiliation(s)
- Timothy Bates
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom. Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom.
| | - Matthew Kennedy
- Department of Oral and Maxillofacial Surgery, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Ameena Diajil
- Oral Diagnosis Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Michaela Goodson
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom. Newcastle University Medicine Malaysia, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Peter Thomson
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom. Department of Oral and Maxillofacial Surgery, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Emma Doran
- Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Heather Farrimond
- Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Selvam Thavaraj
- Oral Pathology, King's College London Dental Institute, London, United Kingdom
| | - Philip Sloan
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom. Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Ralf Kist
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom. Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
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20
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Goodson ML, Sloan P, Robinson CM, Cocks K, Thomson PJ. Oral precursor lesions and malignant transformation--who, where, what, and when? Br J Oral Maxillofac Surg 2015; 53:831-5. [PMID: 26388071 DOI: 10.1016/j.bjoms.2015.08.268] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
Oral potentially malignant disorders (PMD) are recognisable mucosal conditions that have an unpredictable risk of transformation to squamous cell carcinoma (SCC), a lethal and deforming disease of rising incidence. Contemporary management is based on clinical recognition of suspicious lesions and incisional biopsy to enable histopathological assessment and grading of dysplasia, together with excision of high-risk lesions and long-term surveillance. However, it is impossible to predict clinical outcome or risk of malignant transformation. Our aim was to evaluate the relevance of previously identified oral precursor lesions for the development of SCC and staging of disease. We therefore retrospectively reviewed 1248 cases of SCC diagnosed in oral and maxillofacial surgery units at Newcastle upon Tyne and Sunderland hospitals between 1996 and 2009. Of them, 58 identifiable precursor lesions became malignant but only 25 had been dysplastic on initial biopsy; 19 of 33 non-dysplastic lesions exhibited lichenoid inflammation only. SCC arose most often on the ventrolateral tongue and floor of the mouth, with a mean transformation time of 29.2 months. Transformation time was significantly shorter in men (p=0.018) and those over 70 years of age (p=0.010). Patients who consumed more than 21 units of alcohol/week and those who had had interventional laser surgery to treat precursor lesions, had higher-staged tumours (p=0.048). Although retrospective, this study shows that the results of incisional biopsy and grading of dysplasia have limited use as predictive tools, and supports the view that cancer may arise in the absence of recognisable epithelial dysplasia. Our findings confirm the importance of clinical vigilance and active surveillance in the management of all patients with clinically suspicious oral lesions, irrespective of the histological findings.
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Affiliation(s)
- M L Goodson
- Oral & Maxillofacial Surgery, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - P Sloan
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - C M Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - K Cocks
- KC Stats Consultancy, www.kcstats.co.uk
| | - P J Thomson
- Oral & Maxillofacial Surgery, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
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21
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Thomson PJ, McCaul JA, Ridout F, Hutchison IL. To treat...or not to treat? Clinicians' views on the management of oral potentially malignant disorders. Br J Oral Maxillofac Surg 2015; 53:1027-31. [PMID: 26471841 DOI: 10.1016/j.bjoms.2015.08.263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/24/2015] [Indexed: 02/04/2023]
Abstract
Oral potentially malignant disorders (PMD) are recognisable mucosal conditions that have a variable and unpredictable risk of transformation to invasive squamous cell carcinoma (SCC). Modern management relies initially on clinical recognition of suspicious lesions and histopathological assessment and grading after incisional biopsy. However, it then varies from wide excision to observation and review, and depends not only on the severity of dysplasia but also on the clinician's preference as there is no high-level evidence to support best practice. We invited clinicians from oral and maxillofacial surgery, oral medicine, ear, nose, and throat (ENT), and plastic surgery, to complete an online questionnaire on current practice, which included 3 fictitious cases, to ascertain their views on the management of PMD and to find out whether they would be interested in becoming involved in a proposed future randomised controlled trial (RCT). Of the 251 who replied, 178 (71%) were oral and maxillofacial surgeons, and 99 (39%) expressed an interest in participating in a future RCT. Most respondents (n=164 or 99%) would always treat severely dysplastic lesions by excision or laser ablation, whereas only 8% (n=13) would always excise mild dysplasia. The greatest equipoise among those interested in taking part in a RCT was found in the case of moderate dysplasia for which 27% (n=27) favoured observation compared with surgical excision or laser ablation. This study shows that there is support for a multicentre, prospective RCT that compares observation with resection and laser ablation in patients with moderate dysplasia.
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Affiliation(s)
- P J Thomson
- Oral and Maxillofacial Surgery, School of Dental Sciences, Framlington Place, Newcastle upon Tyne NE2 4BW, UK.
| | - J A McCaul
- Maxillofacial Surgery, Bradford Teaching Hospitals NHS Foundation Trust
| | - F Ridout
- The Facial Surgery Research Foundation - Saving Faces
| | - I L Hutchison
- The Facial Surgery Research Foundation - Saving Faces
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Abstract
The concept of an oral disease process that presents as a ‘potentially malignant state’ that is neither entirely benign nor frankly malignant is a difficult concept both for clinicians and their affected patients. While it is recognised that a range of oral mucosal conditions, now collectively termed ‘potentially malignant disorders’, harbour an increased risk of squamous carcinoma, we remain frustratingly unable in contemporary clinical practice to predict individual lesion behaviour, quantify the risk of malignant transformation or objectively plan interventions.
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Affiliation(s)
- Peter Thomson
- School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW
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