Article

Adjunctive Techniques for Oral Cancer Examination and Lesion Diagnosis: A Systematic Review of the Literature

Department of Dental Ecology, General Practice Residency Program, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599-7450, USA.
Journal of the American Dental Association (1939) (Impact Factor: 2.24). 08/2008; 139(7):896-905; quiz 993-4. DOI: 10.14219/jada.archive.2008.0276
Source: PubMed

ABSTRACT Adjunctive techniques that may facilitate the early detection of oral premalignant and malignant lesions (OPML) have emerged in the past decades.
The authors undertook a systematic review of the English-language literature to evaluate the effectiveness of toluidine blue (TB), ViziLite Plus with TBlue (Zila Pharmaceuticals, Phoenix), ViziLite (Zila Pharmaceuticals), Microlux DL (AdDent, Danbury, Conn.), Orascoptic DK (Orascoptic, a Kerr Company, Middleton, Wis.), VELscope (LED Dental, White Rock, British Columbia, Canada) and OralCDx (Oral CDx Laboratories, Suffern, N.Y.) brush biopsy. They abstracted data relating to study design, sampling and characteristics of the study group, interventions, reported outcomes and diagnostic accuracy of adjunctive aids from 23 articles meeting inclusion and exclusion criteria, including availability of histologic outcomes.
The largest evidence base was for TB. A limited number of studies was available for ViziLite, ViziLite Plus with TBlue and OralCDx. Studies of VELscope have been conducted primarily to assess the margins of lesions in known OPML. The authors identified no studies of Microlux DL or Orascoptic DK. Study designs had various limitations in applicability to the general practice setting, including use of higher-risk populations and expert examiners.
There is evidence that TB is effective as a diagnostic adjunct for use in high-risk populations and suspicious mucosal lesions. OralCDx is useful in assessment of dysplastic changes in clinically suspicious lesions; however, there are insufficient data meeting the inclusion criteria to assess usefulness in innocuous mucosal lesions. Overall, there is insufficient evidence to support or refute the use of visually based examination adjuncts. Practical Implications. Given the lack of data on the effectiveness of adjunctive cancer detection techniques in general dental practice settings, clinicians must rely on a thorough oral mucosal examination supported by specialty referral and/or tissue biopsy for OPML diagnosis.

Download full-text

Full-text

Available from: Joel B Epstein, Aug 31, 2015
1 Follower
 · 
133 Views
 · 
0 Downloads
  • Source
    • "Fluorescent imaging is based on fluorophore concentrations , fluorescent collagen cross-links, tissue scattering characteristics , hemoglobin absorption properties, and tissue thickness [42] [43] [44] [45] [46]. Thus, when exposed to various forms of light or energy, mucosal tissues reveal different absorbance, reflectance and fluorescent profiles that may assist in detection of dysplastic/neoplastic tissue [47] [48]. Various devices that utilize chemiluminescence [49] [50] [51] [52], autofluorescence [42,46,48,51,53–58] and multi-spectral imaging [59] [60] have been introduced in order to assist detection and determination to biopsy to facilitate diagnosis of PMD and OSCC with variable results. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Stage of disease at the diagnosis of oral cancer is thought to be a significant factor in prognosis and outcome (International Agency for Research on Cancer/World Health Organization, 2014). Unfortunately, we continue to diagnose almost 2/3 of these cancers at advanced stages of disease despite the ongoing research for devices/methods to aid the clinicians in detection and accurate oral mucosal lesion diagnosis. This paper explores both the nature of oral cancer and the adjuncts available for detection, and presents the current issues in diagnostic delays of oral cancer detection.
    Oral Oncology 09/2014; 50(12). DOI:10.1016/j.oraloncology.2014.09.005 · 3.03 Impact Factor
  • Source
    • "Few studies evaluated the efficacy of Microlux/DL (McIntosh et al., 2009). To our knowledge, the current study is the first to evaluate Microlux/DL both as a screening device and as a case finding (diagnostic) device (Lingen et al., 2008; Patton et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effectiveness of Microlux/DL with and without toluidine blue in screening of potentially malignant and malignant oral lesions.
    Asian Pacific journal of cancer prevention: APJCP 08/2014; 15(15):6081-6. DOI:10.7314/APJCP.2014.15.15.6081 · 2.51 Impact Factor
  • Source
    • "Autofluorescence originates from a variety of fluorophores in the oral cavity and is sensitive to alterations in both tissue morphology and biochemistry associated with neoplasia.10,11,12 Oral cancer and precancer display a loss of autofluorescence across a broad range of ultraviolet and visible excitation wavelengths; as described later, this loss of fluorescence is largely attributed to a decrease in fluorescent crosslinks associated with stromal collagen that underlies the neoplastic lesions.13,14,15 Oral cancer is also associated with increased angiogenesis, which can affect both autofluorescence and reflectance spectra. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Optical spectroscopy devices are being developed and tested for the screening and diagnosis of oral precancer and cancer lesions. This study reports a device that uses white light for detection of suspicious lesions and green-amber light at 545 nm that detect tissue vascularity on patients with several suspicious oral lesions. The clinical grading of vascularity was compared to the histological grading of the biopsied lesions using specific biomarkers. Such a device, in the hands of dentists and other health professionals, could greatly increase the number of oral cancerous lesions detected in early phase. The purpose of this study is to correlate the clinical grading of tissue vascularity in several oral suspicious lesions using the Identafi(®) system with the histological grading of the biopsied lesions using specific vascular markers. Twenty-one patients with various oral lesions were enrolled in the study. The lesions were visualized using Identafi(®) device with white light illumination, followed by visualization of tissue autofluorescence and tissue reflectance. Tissue biopsied was obtained from the all lesions and both histopathological and immunohistochemical studies using a vascular endothelial biomarker (CD34) were performed on these tissue samples. The clinical vascular grading using the green-amber light at 545 nm and the expression pattern and intensity of staining for CD34 in the different biopsies varied depending on lesions, grading ranged from 1 to 3. The increase in vascularity was observed in abnormal tissues when compared to normal mucosa, but this increase was not limited to carcinoma only as hyperkeratosis and other oral diseases, such as lichen planus, also showed increase in vascularity. Optical spectroscopy is a promising technology for the detection of oral mucosal abnormalities; however, further investigations with a larger population group is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant lesions.International Journal of Oral Science advance online publication, 25 July 2014; doi:10.1038/ijos.2014.39.
    International Journal of Oral Science 07/2014; 6(3). DOI:10.1038/ijos.2014.39 · 2.03 Impact Factor
Show more