Abstract
To assess noninvasive optical coherence tomography (OCT) and optical Doppler tomography (ODT) for early detection and evaluation of chemotherapy-induced oral mucositis. Cheek pouches of 10 Syrian golden hamsters were imaged using OCT/ODT during development of chemotherapy-induced mucositis. I.p. injections of 5-fluorouracil and mechanical irritation induced oral lesions. At 2, 4, 7, and 11 days, one hamster was sacrificed and processed for histopathology. OCT images were visually examined; ODT results were semiquantified. Imaging data were compared with histologic findings. During the development of mucositis, OCT/ODT identified the following events: (a) change in epithelial thickness (beginning on day 2), (b) loss of surface keratinized layer continuity (beginning on day 4), (c) loss of epithelial (day 4 onwards) and submucosal integrity (day 7 onwards), (d) changes in axial blood flow velocity (increased on days 2 and 4; decreased on day 7), and (e) changes in blood vessel size (diameter doubled on day 2; quadrupled on day 4; unchanged on day 7). The semiquantitative imaging-based scoring system identified the severity of mucositis as defined by histopathology. The combination of imaging criteria used allowed for the detection of early, intermediate, and late mucositic changes. Imaging data gave higher scores compared with clinical scores early on, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. OCT/ODT identified chemotherapy-induced oral changes before their clinical manifestation, and the proposed scoring system for oral mucositis was validated for the semiquantification of mucositic change.
Highlights
The occurrence of oropharyngeal mucositis can range from 30% to 75% in chemotherapy patients, up to 90% in patients receiving hemopoietic cell transplantation, and essentially in all patients receiving head and neck radiation in doses more than 5,000 cGy
Whereas advances in hemopoietic cell transplantation have led to a modest reduction in the frequency of severe oral ulcerative mucositis, changes in treatment of head and neck cancer, including combined chemotherapy and irradiation, and changes in radiation therapy dosing schedules have increased the severity and duration of mucositis in these
Total scoring range for Optical coherence tomography (OCT) plus Optical Doppler tomography (ODT) lies between 0 and 4. *ODT scale based on vascular effects previously described in mild and severe mucositis, not on progressive change in blood flow [5, 35, 36]
Summary
The occurrence of oropharyngeal mucositis can range from 30% to 75% in chemotherapy patients, up to 90% in patients receiving hemopoietic cell transplantation, and essentially in all patients receiving head and neck radiation in doses more than 5,000 cGy. Optical coherence tomography (OCT) is a high-resolution optical technique that permits minimally invasive imaging of near-surface abnormalities in complex tissues. It has been compared with ultrasound scanning [11]. Cross-sectional images of tissues are constructed in real time at near histologic resolution (f10 Am with current technology) This permits in vivo noninvasive imaging of the microscopic characteristics of epithelial and subepithelial structures, including (a) depth and thickness, (b) histopathologic appearance, and (c) peripheral margins. Because images of blood vessels, blood flow, and tissue structure are obtained simultaneously from a single scan, OCT/ODT has decided advantages over existing methodologies for investigating vascularization and altered tissue perfusion and epithelial and subepithelial change
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