Advances in Optical Adjunctive Aids for Visualisation and Detection of Oral Malignant and Potentially Malignant Lesions

Abstract

Traditional methods of screening for oral potentially malignant disorders and oral malignancies involve a conventional oral examination with digital palpation. Evidence indicates that conventional examination is a poor discriminator of oral mucosal lesions. A number of optical aids have been developed to assist the clinician to detect oral mucosal abnormalities and to differentiate benign lesions from sinister pathology. This paper discusses advances in optical technologies designed for the detection of oral mucosal abnormalities. The literature regarding such devices, VELscope and Identafi, is critically analysed, and the novel use of Narrow Band Imaging within the oral cavity is also discussed. Optical aids are effective in assisting with the detection of oral mucosal abnormalities; however, further research is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant and malignant lesions.

Improved surgical margin definition by narrow band imaging for resection of oral squamous cell carcinoma: A prospective gene expression profiling study

“…10 Diagnostic application of NBI to patients with head and neck cancer benefits their management through improved resection margin assessment, 10 and provides greater diagnostic sensitivity and specificity over other imaging techniques for detection of oral potentially malignant lesions. 8,11 The purpose of the present study was to provide evidence that NBI surgical margins possess fewer molecular abnormalities than the more conservative WL surgical margins. Accordingly, we performed a prospective bioinformatic evaluation of mRNA expression data for tissue biopsies of tumor core, WL determined margin, and NBI determined margin samples obtained from 18 patients during primary resection of intraoral SCC.…”

“…Narrow band imaging (NBI; Olympus Medical Systems Corporation, Tokyo, Japan), provides high‐resolution enhancement of tissue abnormality through selective wavelength reflectance magnifying endoscopy. Using blue (400–430 nm) and green (525–555 nm) light, NBI highlights both mucosal surface texture and underlying vasculature, facilitating identification of oral neoplasia where angiogenesis is an early feature that can be inconspicuous under conventional WL examination . Diagnostic application of NBI to patients with head and neck cancer benefits their management through improved resection margin assessment, and provides greater diagnostic sensitivity and specificity over other imaging techniques for detection of oral potentially malignant lesions …”

Non-Invasive Techniques for Detection and Diagnosis of Oral Potentially Malignant Disorders

“…8-94.3 70.7-99.6 (McIntosh et al 2009;Ibrahim et al 2014) Orascoptic DK n/a n/a (Patton et al 2008) VELscope 30-100 15-100 (Poh et al 2006;Balevi 2007;Patton et al 2008;Trullenque-Eriksson et al 2009;Mehrotra et al 2010;Moro et al 2010;Awan et al 2011a;Balevi 2011;Fricain 2011;Lopez-Jornet and De la Mano-Espinosa 2011;Scheer et al 2011;Farah et al 2012;Marzouki et al 2012;Bhatia et al 2013) Photodynamic diagnosis 79-100 50-99 (Leunig et al 2000;Betz et al 2002;Zheng et al 2002;Chang and Wilder-Smith 2005;Sharwani et al 2006a;Driemel et al 2007;Sieron et al 2008) Optical diagnostic technologies…”

“…Within the oral mucosa, the most relevant fluorophores are nicotinamide adenine dinucleotide and flavin adenine dinucleotide in the epithelium, and collagen cross-links in the stroma (Pavlova et al 2008). Mucosal abnormalities can alter the absorption and scattering properties of light as a result of changes in tissue architecture and concentrations of fluorophores (Bhatia et al 2013). At these excitation wavelengths, normal cells show a pale green fluorescence when viewed through a filter, while abnormal cells show a loss of autofluorescence and appear dark (Fig.…”

“…Nguyen et al (2013) conducted a prospective study involving 73 patients with head and neck cancer and found that the sensitivity for detecting moderate dysplasia or worse was 96% with NBI-better than white light, which achieved only 38%. However, chronic inflammation and postoperative radiotherapy may lead to false positivity, and this may be exacerbated if the operator lacks experience in recognizing the different IPCL changes associated with inflammatory and neoplastic lesions (Bhatia et al 2013). …”