Abstract
BackgroundDiffusely reflected light is influenced by cytologic and morphologic changes that take place during tissue transformation, such as, nuclear changes, extracellular matrix structure and composition as well as blood flow. Albeit with varying degree of sensitivity and specificity, the properties of diffusely reflected light in discriminating a variety of oral lesions have been demonstrated by our group in multiple studies using point monitoring systems. However, the point monitoring system could not identify the region with the most malignant potential in a single sitting.MethodsIn order to scan the entire lesion, we developed a multi-spectral imaging camera system that records diffuse reflectance (DR) images of the oral lesion at 545 and 575 nm with white light illumination. The diagnostic accuracy of the system for 2-dimensional DR imaging of pre-malignant and malignant changes in the oral cavity was evaluated through a clinical study in 55 patients and 23 healthy volunteers. The DR imaging data were compared with gold standard tissue biopsy and histopathology results.ResultsIn total 106- normal/clinically healthy sites, 20- pre-malignant and 29- malignant (SCC) sites were compared. While the median pixel value of the R545/R575 image ratio for normal/clinically healthy tissue was 0.87 (IQR = 0.82-0.94), they were 1.35 (IQR = 1.13-1.67) and 2.44 (IQR = 1.78-3.80) for pre-malignant and malignant lesions, respectively. Area under the ROC curve to differentiate malignant from normal/clinically healthy [AUC = 0.99 (95% CI: 0.99-1.00)], pre-malignant from normal/clinically healthy [AUC = 0.94 (95% CI: 0.86-1.00)], malignant from pre-malignant [AUC = 0.84 (95% CI: 0.73-0.95)] and pre-malignant and malignant from normal/clinically healthy [AUC = 0.97 (95% CI: 0.94-1.00)] lesions were desirable.ConclusionWe find DR imaging to be very effective as a screening tool in locating the potentially malignant areas of oral lesions with relatively good diagnostic accuracy while comparing it to the gold standard histopathology.
Highlights
Reflected light is influenced by cytologic and morphologic changes that take place during tissue transformation, such as, nuclear changes, extracellular matrix structure and composition as well as blood flow
Diffuse reflectance imaging system The diffuse reflectance imaging system (DRIS) [18] developed (Figure 1) for recording the monochrome images of the oral cavity lesion at 545 and 575 nm in the present study consisted of an electron multiplying charge coupled device (EMCCD) camera with 1024 × 1024 pixels of 8 micron size, coupled to a Nikkon AF 35–70 zoom lens for focusing and a liquid crystal tunable filter (LCTF) of 7 nm bandwidth (CRI Inc., USA) for wavelength selection
The spatial distribution of the image ratio R545/R575 of the lesion was displayed as a Pseudo Color Map (PCM) according to the ratio value of each pixel in the image and based on cut-off values derived from our previous studies [11,12,13,14] with a point monitoring system
Summary
Reflected light is influenced by cytologic and morphologic changes that take place during tissue transformation, such as, nuclear changes, extracellular matrix structure and composition as well as blood flow. Albeit with varying degree of sensitivity and specificity, the properties of diffusely reflected light in discriminating a variety of oral lesions have been demonstrated by our group in multiple studies using point monitoring systems. Several multi-centric clinical studies established the effectiveness of optical spectroscopy techniques for non-invasive detection of oral malignancies with good diagnostic accuracies [10,11,12,13,14]. They are point monitoring systems that analyse the tissue characteristics at a particular point in the entire area of an oral lesion
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