Optical coherence tomography imaging of oral mucosa bullous diseases: a preliminary study

Abstract

Objectives: Optical coherence tomography (OCT) is a non-invasive technique based on optical imaging with a micrometre resolution. The purpose of this study is to investigate the potential role of OCT in evaluating oral mucosa bullous diseases. Methods: two patients with bullous pemphigoid (BP) and one patient with pemphigus vulgaris (PV) were examined and images of their oral lesions were performed using OCT. Results: In OCT images, the BP blister has a clearly different morphology from the PV one compared to the blistering level. Conclusion: This exploratory study suggests that the OCT is able to distinguish epithelial and subepithelial layer in vivo images of healthy oral mucosa from those with bullous diseases, assisting the clinicians in differential diagnosis.The presented data are in accordance with the scientific literature, although a wider pool of cases is needed to increase statistical power. Histological examination and immunofluorescence methods remain the gold standard for the diagnosis of oral bullous diseases. In this context, the OCT can provide the clinician with a valuable aid both as an additional diagnostic tool and in the follow up of the disease.

Diagnostic Concordance between Optical Coherence Tomography and Histological Investigations for Immune-Mediated Desquamative Gingivitis: Observational Study

“…To date, the different OCT diagnostic patterns reported in the literature for immunemediated DGs are based on information about the epithelium layers [12,15], basement membrane, lamina propria [13,15] and other intra/sub epithelial constituents (e.g., inflammatory, acantholytic cells) [23]. However, these patterns are not definitive and are not supported by studies with a confirmatory histological diagnosis.…”

Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases

“…The recently introduced LC-OCT combines the principles and advantages of both OCT and RCM in one device, that is: cellular resolution and vertical dephth of examination [16]. In addition, the new LC-OCT carries several technical advantages over conventional OCT [6,7,12,13,27], HD-OCT [14,15] and HURS [9,10] in the study of blistering conditions. First, all skin areas can be explored due to the reduced size of the tip of the handheld probe (ie, area of 0.94 cm 2 ), including: lips, ears, periocular area, conjunctiva, genitals, glans mucosa [18], interdigital spaces [21][22][23], etc.…”

“…Optical coherence tomography (OCT) recently emerged as a non-invasive imaging technique able to provide vertical images either on skin [1][2][3][4][5] and surface mucosa [6][7][8] in patients with autoimmune bullous diseases (AIBDs). In the oral mucosa, OCT was reported to identify the level of the split, to highlight clinically invisible initial splitting in the gingiva [7] and to help in localizing the ideal site to perform a biopsy in mucous membrane pemhigoid (MMP) and pemphigus vulgaris (PV). [8] At skin site, conventional OCT [3] and high resolution OCT (HD-OCT) devices [9,10] provided macroscopic images of the bullae as dark areas under a hyperreflective/backscattering epidermal layer.…”

“…[8] At skin site, conventional OCT [3] and high resolution OCT (HD-OCT) devices [9,10] provided macroscopic images of the bullae as dark areas under a hyperreflective/backscattering epidermal layer. However, due to their low resolution and high speckle, OCT devices and high-resolution ultrasound (HURS) were unable to identify cellular structures inside the bulla cavity or to provide morphological details of the bulla [1][2][3][4][5][6][7][8][9][10][11]. On the other hand, the reflectance confocal microscopy (RCM) techonology allowed to detect the bullae content reaching cellular resolution.…”

Optical coherence tomography for fast bedside imaging, assessment and monitoring of autoimmune inflammatory skin diseases?

“…In the past, it was suggested that subclinical blisters could be detected with US [17]. Recent studies have shown that OCT is able to distinguish epithelial and subepithelial blisters in patients with bullous pemphigoid and pemphigus vulgaris [18]. In OCT images, a bulla filled with fluid appears as a dark void.…”