Abstract
The autofluorescence visualization method (AVM) uses blue excitation light to assist in the diagnosis of epithelial dysplasia. It detects epithelial dysplasia as a black area, which is known as fluorescence visualization loss (FVL). In this study, we evaluated the detection accuracy for epithelial dysplasia of the tongue using the objective AVM and assessed its possible clinical utility. Seventy-nine tongue specimens clinically suspected to have leukoplakia or squamous cell carcinoma (SCC) were analyzed. First, the AVM was subjectively performed using the Visually Enhanced Lesion scope (VELscope), and the iodine-staining method was then performed. After biopsy, the histopathological results and the luminance ratio between the lesion and healthy tissue were compared, and a receiver operating characteristic curve was created. The cutoff value for the objective AVM was determined; the lesion was considered FVL-positive or -negative when the luminance ratio was higher or lower than the cutoff value, respectively. The histopathological diagnoses among the 79 specimens were SCC (n=30), leukoplakia with dysplasia (n=34), and leukoplakia without dysplasia (n=15). The cutoff value of the luminance ratio was 1.62, resulting in 66 FVL-positive and 13 FVL-negative specimens. The luminance ratio was significantly higher in the epithelial dysplasia-positive than -negative group (P<0.000 1). The objective AVM showed much higher consistency between histopathological results than did the two methods (kappa statistic=0.656). In conclusion, objective autofluorescence visualization has a potential as an auxiliary method for diagnosis of epithelial dysplasia.
Highlights
Epithelial dysplasia is often observed in the tissue surrounding oral squamous cell carcinoma (SCC),1 and it is reportedly associated with a malignant transformation rate of 2.2%–38.1%.2–3 residual epithelial dysplasia after surgical treatment of oral SCC is an important risk factor for a poor prognosis,4–5 and precise detection of affected areas with epithelial dysplasia prior to surgical resection of oral SCC is important to prevent local recurrence
The subjective autofluorescence visualization method (AVM) was carried out for the area visually suspected to be affected by epithelial dysplasia and the presence of fluorescence visualization loss (FVL) was illuminally detected subjectively
These procedures were performed by two specialists in oral and maxillofacial surgery who had 19 and 27 years of clinical experience in oral cancer treatment
Summary
Epithelial dysplasia is often observed in the tissue surrounding oral squamous cell carcinoma (SCC), and it is reportedly associated with a malignant transformation rate of 2.2%–38.1%.2–3 residual epithelial dysplasia after surgical treatment of oral SCC is an important risk factor for a poor prognosis, and precise detection of affected areas with epithelial dysplasia prior to surgical resection of oral SCC is important to prevent local recurrence. The iodine-staining method (IOM) has been used to detect oral SCC and epithelial dysplasia.. In the IOM, healthy oral mucosa turns to a yellowish brown color secondary to the iodine-glycogen reaction; epithelial dysplasia of the oral mucosa, which has less glycogen, is visually detected as an iodine-unstained area because of the absence of this reaction. The IOM is a useful modality with which to detect epithelial dysplasia, it has several weak points: iodine is irritative to the mucosa, it is contraindicated in patients with allergy to iodine, and it cannot be used in keratinized mucosa, such as the gingiva and hard palate, because of the mechanism of iodine staining.. The autofluorescence visualization method (AVM) is another modality that has a potential for detecting epithelial dysplasia without the above-mentioned weak points of the IOM.. No drugs or other agents are required. Recently, several optical imaging system have been produced such as Visually Enhanced Lesion scope
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