Early Detection of Premalignant Lesions and Oral Cancer

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The early detection of oral cancer

With the development and success of screening programs for breast, cervical, and colon cancer, the potential to reduce the morbidity and mortality of oral cancer through early detection modalities is of critical importance. Data indicates that the diagnosis of oral squamous cell carcinoma at an early stage of disease allows for less aggressive treatment, improves quality of life, and improves the overall 5-year survival rate when compared with SCCs diagnosed at late stages.3 The major

Oral cavity examination

The examination of the oral cavity has traditionally been the preferred approach for the detection of oral mucosal abnormalities. As a noninvasive technique, the oral cavity examination can be performed quickly, is without additional diagnostic expense to patients, and may be performed by health care professionals across a multitude of disciplines. The evidence regarding oral examination as an effective screening technique, however, remains controversial. In a recently published randomized

Supravital staining

Toluidine blue (TB) is an acidophilic dye designed to stain acidic cellular components, such as DNA and RNA. Its use in the detection of precancerous/cancerous tissue is based on the fact that dysplastic tissue contains quantitatively more DNA and RNA than nondysplastic tissue. To perform the staining, a 1% solution is placed on the oral mucosa and removed after 1 to 2 minutes with 2% acetic acid. The clinician then examines the oral mucosa for areas of increased cellular staining.13 In the

Oral cytology

Oral cytology describes a diagnostic technique employed to sample oral tissue for histomorphologic analysis. To obtain a tissue sample, the clinician applies a stiff brush to the oral mucosa with enough pressure to induce pinpoint bleeding which ensures a full-thickness or trans-epithelial tissue sample. These cellular samples can then be analyzed by a variety of unique diagnostic measures, including cytomorphometry, DNA cytometry, and immunocytochemical analysis.13, 17

Computerized image

The optical detection of oral cancer

The field of optical diagnostics comprises a variety of techniques designed to characterize the relationship between the optical and biologic properties of tissue. Through the detection of changes in light after interaction with tissue, optical technologies provide information on the physiologic condition of the tissue at a molecular level. Early research in optical diagnostics suggested that alterations in light-tissue interactions can be used to differentiate normal from malignant tissue.18

Spectroscopy

The use of spectroscopic techniques for the detection of cancerous and precancerous lesions is based on the analysis of specific light-tissue interactions to assess the state of biologic tissue. As tissue undergoes the carcinogenic sequence from normal to neoplasia, complex morphologic and molecular transformations occur that modify the manner in which light is absorbed and reflected in the tissue. With the delivery of specific wavelengths of light to tissue through an optical probe, a spectral

The application of optical diagnostic technology in the oral cavity

As the most thoroughly investigated optical techniques for the detection and characterization of oral lesions, autofluorescence spectroscopy and imaging systems are capable of distinguishing normal oral mucosa from cancerous lesions. In addition, research suggests that autofluorescence techniques are capable of discriminating between lesion types, although sensitivities and specificities reported by researchers have varied. Research suggests that autofluorescence spectroscopy is exceedingly

Summary

Even with remarkable technological advancements and extraordinary efforts from cancer advocates, scientists, and clinicians, the diagnosis of oral cancer often occurs at a late stage conferring a dismal prognosis. Importantly, the improvement of patient outcomes is related to the detection and surveillance of cancerous or precancerous lesions at early stages of disease. Although many of these techniques have only recently been implemented in medical settings, they offer scientists a highly

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  • Cited by (29)

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      Each year, more than 100,000 patients die of OSCC, and its incidence has increased up to about 500,000 worldwide (Warnakulasuriya, 2009). Despite all established diagnostic and treatment modalities (surgery and radiotherapy), more than 50% of the patients with OSCC have a relapse and increased mortality rate (Steele and Meyers, 2011). Unfortunately, the histopathological findings still remain the main parameters for confirming the diagnosis, and this disturbing fact imposes the necessity of finding a new approach/advances in molecular biology strategies.

    • Oral cancer preventive campaigns: Are we reaching the real target?

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      The most commonly employed method in screening for early lesions is visual inspection of the oral cavity (oral exam), which has a specificity of about 98%.8 This is a non-invasive, fast, and inexpensive technique that can be performed by medical professionals from different fields.1 Aiming at reducing the mortality and morbidity of this disease, several oral cancer prevention campaigns have been launched, whose goal is to educate the population at greatest risk of developing the disease (mainly alcohol and tobacco consumers) and secondarily, to diagnose lesions at an early stage.

    • How should we manage oral leukoplakia?

      2013, British Journal of Oral and Maxillofacial Surgery
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      They also provide real-time assessment of tissue structure and metabolism through a minimally invasive approach. The benefits of optical technologies are limited in current daily clinical use, but with developing technological advances they have the potential to revolutionise the diagnosis and surveillance of precancerous and cancerous lesions at the early stage of development.29 Autofluorescence spectroscopy and imaging systems can differentiate normal oral mucosa from abnormal tissue (82–100% sensitivity, 63–100% specificity) but there is a lack of evidence to support their ability to distinguish different types of lesions.30

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