Reflectance confocal microscopy characteristics of oral lichen planus: An analysis of 47 cases in a Chinese cohort

Abstract

Reflectance confocal microscopy (RCM) is a non-invasive tool that provides real-time microscopic images and relatively high-resolution tissue images. This technique provides a link between clinical examination and histopathology. RCM has been used to detect skin diseases and has also recently been applied to diseases of the oral mucosa. The present study aimed to explore the features of oral lichen planus (OLP) using RCM. A total of 47 patients with OLP exhibiting a reticular pattern, were included in the present study. The lesion sites and healthy adjacent sites were examined using in vivo RCM, with the lesion being histopathologically confirmed after RCM examination. The confocal images were reviewed, and the features were described. Sensitivity and specificity analysis of the RCM features was also performed. RCM examination presented parakeratosis, acanthosis and connective tissue papillae disappearance, with the presence of large melanocytes and roundish inflammatory cell infiltration, as well as dilated vessels in the lesion tissue. The sensitivity and specificity of OLP for dorsal tongue lesions were not as satisfactory as those on other sites. The results implied that RCM may be a promising technique to detect OLP non-invasively in vivo.

Confocal microscopy in oral cancer and oral potentially malignant disorders: A systematic review

“…Seven studies in this review studied in vivo OPMD specimens with only one using a quantitative assessment method (Table 2). structures which corresponded to dilated vessels with inflammatory cell infiltration (Peng et al, 2020). The RCM features of OLP seen by these three studies were consistent with the ones reported in the review by Lucchese et al (2016) (Lucchese et al, 2016).…”

“…Inflammation and obscured connective tissue papillae were highlighted in the atrophic‐erosive lesions due to the lack of hyperkeratosis (Contaldo et al, 2019). Peng et al (2020) also noticed ring‐like bright structures at the epithelial‐connective tissue junction that were attributed to keratinocyte necrosis in their RCM OLP lesions. The authors noted dark lumen structures with bright round cells inside these structures which corresponded to dilated vessels with inflammatory cell infiltration (Peng et al, 2020).…”

“…Peng et al (2020) also noticed ring‐like bright structures at the epithelial‐connective tissue junction that were attributed to keratinocyte necrosis in their RCM OLP lesions. The authors noted dark lumen structures with bright round cells inside these structures which corresponded to dilated vessels with inflammatory cell infiltration (Peng et al, 2020). The RCM features of OLP seen by these three studies were consistent with the ones reported in the review by Lucchese et al (2016) (Lucchese et al, 2016).…”

Role of reflectance confocal microscopy for in vivo investigation of oral disorders: White, red and pigmented lesions

“…Biopsy for histopathological confirmation of the diagnosis has been performed for any suspected malignancy as well as not conclusive confocal examination. The RCM evaluation was based on diagnostic criteria previously described in oral pathology or, when not available in literature, in the skin 3–23 . The features were evaluated for presence/absence (non‐parametric binary data) by three dermatologists (C.F., V.D.M.…”

Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process

“…After pilot studies to validate the method [93,106,107], research has focused on highlighting the peculiarities of various pathologies affecting the oral mucosa, such as oral lichen planus and other inflammatory oral diseases [108][109][110][111][112], pigmented lesions of the lips [113][114][115][116], and actinic cheilitis [117,118], as well as to define some "confocal features" peculiar of preneoplastic and neoplastic oral lesions [119][120][121]. The RCM indicators of OSCC overlap the conventional histologic criteria, except the classical OIN grading [122,123], which, being performed on transversal sections of the tissue, is not allowed by the horizontal virtual slicing obtained by in vivo RCM.…”