Clinical evaluation of an autofluorescence diagnostic device for oral cancer detection

Abstract

The prognosis for patients with oral squamous cell carcinoma remains poor despite advances in multimodal treatment concepts. Early diagnosis and treatment is the key to improved patient survival. A device (VELscope) that uses autofluorescence technology, allowing direct fluorescence visualization of the oral cavity, might be a useful tool for oral cancer detection or as an adjunct to standard clinical examination. A total of 289 patients with oral premalignant lesions were randomly divided into two groups for clinical examination of precancerous oral lesions. In group 1, 166 patients were examined conventionally with white light, and in group 2, 123 patients were examined with the autofluorescence visualization device (VELscope) in addition to the white light examination. Biopsies were obtained from all suspicious areas identified in both examination groups (n=52). In the first step, baseline characteristics of the two groups (only white light vs. white light and VELscope) were compared to exclude selection bias. In the second step, for the group examined with white light and VELscope (123 patients), the diagnostic strategies were compared with regard to sensitivity and specificity using biopsy as the gold standard. The results showed that using the VELscope leads to higher sensitivity (100% instead of 17%), but to lower specificity (74% instead of 97%). Thus, we can conclude that the VELscope is a useful new diagnostic device for detection of oral cancer diseases.

Molecular Imaging of Oral Premalignant and Malignant Lesions Using Fluorescently Labeled Lectins

“…have been developed to analyze tissue autofluorescence for cancerous tissue. However, these devices were identified as ineffective adjuncts to current white light head and neck exams as well as histological methods as they lack adequate specificity and sensitivity to accurately diagnose oral cancer [34], [35]. Similar conclusions were seen in our data which showed suggestive differences in autofluorescence between normal and cancerous tissue at 365nm ( P = .098).…”

Open questions and novel concepts in oral cancer surgery

“…Autofluorescence detects the loss of autofluorescence of tissues due to alterations of fluorophore distribution, such as collagen breakdown and flavin adenine dinucleotide concentration decrease, associated with malignant transformation. Both these approaches have already achieved successful clinical experimentation and are currently used by several head and neck surgeons to obtain early diagnosis and to perform a more targeted surgery, in particular concerning the wideness of superficial resection [114,115,[127][128][129][130][131]. An additional imaging technology, potentially useful for a better assessment of tumor thickness, depth of invasion and resection margins of OSCC, is intraoral ultrasound (US) [40,41,132].…”

A novel multimodal optical imaging system for early detection of oral cancer

“…For instance, restructuring of extracellular matrix in subepithelial stroma during oral carcinogenesis results in collagen degradation accompanied by loss of fluorescence and decrease in scattering, and therefore can serve as a relevant biomarker [12]. Nevertheless, while devices based on autofluorescence imaging have shown relatively high sensitivity in early detection of oral malignant lesions, the poor specificity of these devices does not support their routine use [14-17]. …”