Development of an integrated multimodal optical imaging system with real-time image analysis for the evaluation of oral premalignant lesions.

Eric C Yang,Rebecca R Richards-Kortum,Nadarajah Vigneswaran,Jessica Rodriguez,Richard A Schwarz,Nancy Bass,Ann M Gillenwater,Michelle D Williams,Katelin D Cherry,Justin Jacob,Imran S Vohra,Alex Lang,Timothy Quang,Hawraa Badaoui

doi:10.1117/1.jbo.24.2.025003

Abstract

.Oral premalignant lesions (OPLs), such as leukoplakia, are at risk of malignant transformation to oral cancer. Clinicians can elect to biopsy OPLs and assess them for dysplasia, a marker of increased risk. However, it is challenging to decide which OPLs need a biopsy and to select a biopsy site. We developed a multimodal optical imaging system (MMIS) that fully integrates the acquisition, display, and analysis of macroscopic white-light (WL), autofluorescence (AF), and high-resolution microendoscopy (HRME) images to noninvasively evaluate OPLs. WL and AF images identify suspicious regions with high sensitivity, which are explored at higher resolution with the HRME to improve specificity. Key features include a heat map that delineates suspicious regions according to AF images, and real-time image analysis algorithms that predict pathologic diagnosis at imaged sites. Representative examples from ongoing studies of the MMIS demonstrate its ability to identify high-grade dysplasia in OPLs that are not clinically suspicious, and to avoid unnecessary biopsies of benign OPLs that are clinically suspicious. The MMIS successfully integrates optical imaging approaches (WL, AF, and HRME) at multiple scales for the noninvasive evaluation of OPLs.

Highlights

With over 300,000 new cases per year and a mortality rate of ∼50%, oral cancer is a major global health issue.[1]
We developed an multimodal optical imaging system (MMIS) to evaluate oral lesions
WL and AF images are used to macroscopically identify suspicious regions, which are explored at higher resolution with the high-resolution microendoscopy (HRME)

Summary

Introduction

With over 300,000 new cases per year and a mortality rate of ∼50%, oral cancer is a major global health issue.[1] The stage at diagnosis is the most important predictor of survival, and most patients are diagnosed at a late stage. Earlier diagnosis of oral cancer and its precursor lesions is critical to improved outcomes. OPLs affect millions worldwide and are challenging for clinicians to identify and manage, contributing to late-stage diagnosis. Some guidelines recommend that all suspicious lesions receive an initial biopsy[2] to assess the OPL for dysplasia, the most well-established risk marker of malignant transformation. Dysplasia can be graded as mild, moderate, or severe, and the risk of malignant transformation increases with grade.[3]

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Conclusion