Evaluation of Histomorphological Parameters to Predict Occult Nodal Metastasis in Early-Stage Oral Squamous Cell Carcinoma

A Literature Review on Oral Lumenoscopy: A Non-invasive Method for Diagnosing Oral Potentially Malignant Disorders

Dentistry still faces difficulties in diagnosing oral precancer and cancer, especially when it comes to early phase changes or disease detection, evaluation, and treatment. In essence, oral lumenography is the process of identifying oral lesions using a chemiluminescent light source and a toluidine blue labeling system. Since neoplastic epithelial cells have a changed nuclear-cytoplasmic ratio, acetic acid dehydration brings out this nuclear density and gives the tissue an "acetowhite" look. This phenomenon is further intensified when diffuse blue-white chemiluminescent illumination is created by using toluidine blue, which preferentially stains premalignant lesions, in place of ordinary lighting. In developing countries like India, oral cancer and other precancerous and malignant lesions of the oral cavity are very common. The most common diagnostic methods for oral mucosal lesions suggestive of malignancy or premalignancy are tissue samples and histological examination. There is a waiting period following this invasive operation before learning the diagnostic findings. Thus, the creation of a non-invasive screening instrument is required to detect oral cancer. Thus, the main goal of our work is to create a real-time, non-invasive diagnostic tool for oral cancer screening that is based on optical imaging methods like fluorescence emission imaging and diffuse reflectance imaging. To enhance clinical assessment and facilitate the diagnosis of premalignant and early-stage malignant lesions, numerous novel approaches have been developed. In this article, the purpose of a tissue reflectance-based analysis has been discussed. It is currently offered for sale under the ViziLite brand (Zila Pharmaceuticals, Phoenix, AZ, US) after being altered for usage in the oral cavity.

Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?

The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan–Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07–6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08–1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17–4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging.