Abstract
.We developed a multifiber optical probe for oblique polarized reflectance spectroscopy (OPRS) in vivo and evaluated its performance in detection of dysplasia in the oral cavity. The probe design allows the implementation of a number of methods to enable depth resolved spectroscopic measurements including polarization gating, source–detector separation, and differential spectroscopy; this combination was evaluated in carrying out binary classification tasks between four major diagnostic categories: normal, benign, mild dysplasia (MD), and severe dysplasia (SD). Multifiber OPRS showed excellent performance in the discrimination of normal from benign, MD, SD, and MD plus SD yielding sensitivity/specificity values of 100%/93%, 96%/95%, 100%/98%, and 100%/100%, respectively. The classification of benign versus dysplastic lesions was more challenging with sensitivity and specificity values of 80%/93%, 71%/93%, and 74%/80% in discriminating benign from SD, MD, and SD plus MD categories, respectively; this challenge is most likely associated with a strong and highly variable scattering from a keratin layer that was found in these sites. Classification based on multiple fibers was significantly better than that based on any single detection pair for tasks dealing with benign versus dysplastic sites. This result indicates that the multifiber probe can perform better in the detection of dysplasia in keratinized tissues.
Highlights
The early detection of oral cavity cancer can greatly reduce morbidity rates as the 5-year survival rate associated with localized stage increases to 83% from 36% for the disease that has a distant spread.[1,2] Even in highly developed nations where dental exams are prevalent, most cases of oral cancer are not detected until large, symptomatic lesions exist and the disease has advanced beyond the organ site when treatment options are limited and less effective.[1]
To further improve depth selectivity in reflectance spectroscopy, our group combined an oblique collection fiber geometry with polarization gating in a method termed oblique polarized reflectance spectroscopy (OPRS).[24,32]. Evaluation of this method in a pilot clinical trial in the oral cavity showed 90% sensitivity and 86% specificity in the separation of normal tissue from high-grade dysplasia and carcinoma. After these promising pilot clinical studies, we hypothesized that the performance of the probe can be significantly improved if a new probe design accounts for variations in thicknesses of the epithelium and the keratin layers that are very common in patients with malignancies in the oral cavity
Average benign spectra tended to have the highest intensity as compared to other diagnostic categories likely due to a high degree of keratinization associated with benign oral cavity lesions
Summary
The early detection of oral cavity cancer can greatly reduce morbidity rates as the 5-year survival rate associated with localized stage increases to 83% from 36% for the disease that has a distant spread.[1,2] Even in highly developed nations where dental exams are prevalent, most cases of oral cancer are not detected until large, symptomatic lesions exist and the disease has advanced beyond the organ site when treatment options are limited and less effective.[1] Suspicious lesions are typically biopsied following visual inspection and physical palpitation. One of the biggest risk factors in oral cancer is the synergistic effect of alcohol and tobacco, which exposes the entire lining of the oral cavity causing some of the lesions to span large regions of the cavity.[3] Since biopsies can be taken only from a few suspicious regions, there is a high probability of sampling errors in oral cancer detection and diagnosis. After treatment, oral cancer patients require monitoring for potential development of secondary tumors that
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