Occurrence of Oral Premalignant Lesions Among Tobacco Users in a Tribal Population: A Systematic Review and Meta-Analysis

This review aimed to comprehensively assess the association between tobacco use and oral health outcomes, specifically the presence of premalignant lesions (PMLs), through a synthesis of multiple assessments conducted in diverse populations. A systematic search of relevant literature was performed, and studies meeting the inclusion criteria were selected using appropriate Medical Subject Headings (MeSH) words and Boolean operators. Data from these studies was pooled and analysed using Review Manager 5.4 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen). The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. The pooled analysis of the five selected papers revealed a significant correlation between tobacco use and an increased prevalence of PMLs among tobacco users. Tobacco users had an odds ratio of 15.22 (95% CI: 10.01-23.15) as compared to non-user cohorts, significant at p 0.0001. This comprehensive synthesis of assessments underscores the detrimental impact of tobacco use on oral health, particularly in terms of potentially malignant lesions. The findings emphasise the urgency of targeted public health interventions to address tobacco consumption and promote oral health awareness, especially in populations with high tobacco consumption rates. Standardisation of methodologies and representation of diverse populations in future research would strengthen the evidence base and facilitate more effective strategies to improve oral health outcomes globally.

The Potential of Raman Spectroscopy in the Diagnosis of Dysplastic and Malignant Oral Lesions

Simple Summary

Raman spectroscopy, a light scattering technique that provides the biochemical fingerprint of a sample, was used on samples taken from patients with cancer and precancerous lesions. This information was then used to build a classifier to identify cancer and the precancerous phases. The ability to distinguish cancerous tissue from normal and precancerous tissue is diagnostically crucial as it can alter the patients’ prognosis and management. Moreover, as cellular changes are often present at the tumour margin, the ability to distinguish these changes from cancer can help in preserving more of the tissue and maintaining aesthetics and functionality for the patient.

Abstract

Early diagnosis, treatment and/or surveillance of oral premalignant lesions are important in preventing progression to oral squamous cell carcinoma (OSCC). The current gold standard is through histopathological diagnosis, which is limited by inter- and intra-observer errors and sampling errors. The objective of this work was to use Raman spectroscopy to discriminate between benign, mild, moderate and severe dysplasia and OSCC in formalin fixed paraffin preserved (FFPP) tissues. The study included 72 different pathologies from which 17 were benign lesions, 20 mildly dysplastic, 20 moderately dysplastic, 10 severely dysplastic and 5 invasive OSCC. The glass substrate and paraffin wax background were digitally removed and PLSDA with LOPO cross-validation was used to differentiate the pathologies. OSCC could be differentiated from the other pathologies with an accuracy of 70%, while the accuracy of the classifier for benign, moderate and severe dysplasia was ~60%. The accuracy of the classifier was lowest for mild dysplasia (~46%). The main discriminating features were increased nucleic acid contributions and decreased protein and lipid contributions in the epithelium and decreased collagen contributions in the connective tissue. Smoking and the presence of inflammation were found to significantly influence the Raman classification with respective accuracies of 76% and 94%.

Looking beyond the smokescreen: can the oral microbiome be a tool or target in the management of tobacco-associated oral cancer?

A wide range of microbes inhabit the oral cavity, and bacterial and fungal communities most often exist as structured communities or biofilms. The use of tobacco alters the structure of the oral microbiome, including that of potentially malignant lesions, and the altered oral microbiome influences key microenvironmental changes such as chronic inflammation, secretion of carcinogenic toxins, cellular and tissue remodelling and suppression of apoptosis. Given this, it is clear that the bacterial and fungal biofilms in potentially malignant states are likely not passive entities, but could play a critical role in shaping potential malignant and carcinogenic conditions. This holds potential towards leveraging the oral microbiome for the management of tobacco-associated potentially malignant lesions and oral cancer. Here, we explore this line of investigation by reviewing the effects of tobacco in shaping the oral microbiome, and analyse the available evidence in the light of the microbiome of oral potentially malignant and cancerous lesions, and the role of dysbiosis in carcinogenesis. Finally, we discuss possible interventions and approaches using which the oral microbiome could be leveraged towards precision-based oral cancer therapeutics.

Workplace based Potentially Malignant Oral Lesions Screening among Tobacco Consuming Migrant Construction Site Workers in Chennai, South India: A Pilot Study

Context:

Vulnerable population groups such as migrant workers are identified as emerging high-risk groups for oral cancer owing to the high prevalence of smokeless tobacco consumption. Premature deaths due to oral cancer can be prevented by screening the population with high tobacco consumption practices and detecting early reversible stages of oral mucosal cavity lesions and facilitating linkages for further care.

Aim:

To assess prevalence of potentially malignant oral mucosal cavity lesions among tobacco consuming migrant construction workers in sub-urban Chennai, India.

Settings and Designs:

A workplace based cross-sectional study design.

Materials and Methods:

A cross-sectional study was conducted at workplaces i.e., construction sites for screening potentially malignant oral mucosal cavity lesions among migrant workers across 23 construction sites of Chennai during September 2019 - February 2020. An onsite, group health education session was provided about the harms of tobacco use to the migrants.

Statistical Analysis Used:

Data entered in MS Excel was analysed using SPSS and multivariate analysis was performed.

Results:

Among 640 migrants included in the study, 411 (64.2%) were less than 30 years of age, 623 (97.4%) were from north-eastern states of India such as West Bengal, Bihar, Rajasthan, Uttar Pradesh, Jharkhand. A considerable size (272, 42.5%) could not read or write and 355 (55.4%) earn a monthly income of less than ten thousand rupees. Current tobacco users were 619 (96.7%), smokeless tobacco users (463, 72.34%), smokers (206, 32.2%) and dual users (52,8.12%). Inflammatory mucosal lesions in the oral cavity were 70.97% and more among smokeless tobacco users comparable to 22.58% among tobacco smokers and was significantly associated with up to 20 years of tobacco consumption.

Conclusions:

Prevalence of Potentially malignant oral lesions among smokeless tobacco using interstate migrant construction site workers is very high and need urgent interventions.

Evaluation and Expression of Survivin in Potentially Malignant Lesions and Squamous Cell Carcinoma: A Comparative Study

Introduction Overexpression of survivin, an anti-apoptotic protein, has been associated with the progression of cancer, resistance to drugs, and a poor prognosis. The expression level of survivin indicates the progression of the disease, early recurrence, and a failure to respond to therapy. Our study was a retrospective analysis performed on archival specimens. Materials and methods The study included a total of 50 histopathologically proven cases of potentially malignant lesions and squamous cell carcinoma. Immunohistochemical staining was carried out using primary rabbit monoclonal antibodies to survivin (PathnSitu, Telangana, India) along with a horseradish peroxidase detection kit (Leica Biosystems, Maharashtra, India). The intensity of staining of survivin in the epithelium was determined, and the data obtained from potentially malignant lesions, oral squamous cell carcinoma, fetal tissue, and normal oral mucosa were compared. Results The expression of survivin was positive in 70% of the samples of oral squamous cell carcinoma followed by 50% from cases of leukoplakia, 20% of oral submucous fibrosis samples, and 10% of lichen planus samples (P < 0.05). Conclusion Malignant transformation of these potentially malignant lesions increases with increased expression of survivin. This expression of the anti-apoptotic protein might be an early phenomenon in the initiation and advancement of oral squamous cell carcinoma. The prognosis of oral squamous cell carcinomas becomes poorer with increased expression of survivin. Therefore, survivin might be helpful as an important therapeutic target because it is expressed more in tumor cells and absent in most adult tissues.

Importance of Early Detection of Potentially Malignant Lesions in the Prevention of Oral Cancer

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.

Toluidine Blue Staining in Identification of a Biopsy Site in Potentially Malignant Lesions: A Case-control Study

Objective:

Oral cancer is a significant threat to public health all over the world, especially in Southeast Asia. At the present time, screening of oral cancer, its premalignant stages as well as its early detection, is still largely based on visual examination of the mouth. Visual examination is highly subjective and hence lacks the specificity and sensitivity. The objective of this study was to determine the usefulness of toluidine blue in marking a biopsy site in potentially malignant disorders.

Methods:

In this study, a total of 500 patients were screened. The study was a case–control study which included 17 lesion cases and 23 normal controls. Toluidine blue staining was taken into consideration to identify clinically doubtful oral potentially malignant lesions and to compare the clinical evaluation with toluidine blue stain followed by a punch biopsy and histological evaluation. SPSS Statistics version 16.0 and Chi-square test were used for statistical analyses.

Results:

The most common site for potentially malignant lesions was found to be the buccal mucosa. The sensitivity of toluidine blue was found to be 88.89%, while specificity was found to be 74.19%. The positive predictive and negative predictive values were 50% and 97.83%, respectively. P = 0.000672 was considered statistically significant.

Conclusions:

The results seem to be promising, but many such studies have to be done at larger scales to exactly help us in identifying the capability of toluidine blue in the long run.

Challenges in predicting which oral mucosal potentially malignant disease will progress to neoplasia

Probably the greatest challenge to those managing patients with oral diseases is the dilemma of attempting to predict which oral erythroplakias, leukoplakias, lichenoid and other potentially malignant mucosal disease (PMD) such as oral submucous fibrosis will progress to neoplasia--notably oral squamous cell carcinoma (OSCC). The paper reviews progress over the past decade and the application to the clinical situation.

Use of electrical impedance spectroscopy to detect malignant and potentially malignant oral lesions

The electrical properties of tissues depend on their architecture and cellular composition. We have previously shown that changes in electrical impedance can be used to differentiate between different degrees of cervical dysplasia and cancer of the cervix. In this proof-of-concept study, we aimed to determine whether electrical impedance spectroscopy (EIS) could distinguish between normal oral mucosa; benign, potentially malignant lesions (PML); and oral cancer. EIS data were collected from oral cancer (n=10), PML (n=27), and benign (n=10) lesions. EIS from lesions was compared with the EIS reading from the normal mucosa on the contralateral side of the mouth or with reference spectra from mucosal sites of control subjects (n=51). Healthy controls displayed significant differences in the EIS obtained from different oral sites. In addition, there were significant differences in the EIS of cancer and high-risk PML versus low-risk PML and controls. There was no significant difference between benign lesions and normal controls. Study subjects also deemed the EIS procedure considerably less painful and more convenient than the scalpel biopsy procedure. EIS shows promise at distinguishing among malignant, PML, and normal oral mucosa and has the potential to be developed into a clinical diagnostic tool.