OP117: Autofluorescence visualization for detecting potentially malignant white oral mucosal lesions

Abstract

Introduction White or white-red oral mucosal lesions (WOL) are considered to be potentially malignant disorders. While heterogeneous appearance and presence of dysplastic changes portend a higher risk of progression, homogeneous WOLs can also sometimes progress to invasive cancer (CA). We evaluated the utility of autofluorescence visualization (AFV) in the detection of ‘high-risk’ WOLs. Methods A total of 146 patients with WOLs were evaluated at the Oral Cancer Screening Clinic at Roswell Park Cancer Institute, Buffalo, NY, USA. The patients underwent conventional white-light evaluation (WLE), AFV, and lesion risk stratification as ‘suspicious’ or ‘non-suspicious’ on either light evaluation. All lesions were biopsied for histopathology diagnosis. Results A total of 255 WOL were detected, including 75 homogeneous leukoplakia/white lesions, 40 verrucous leukoplakia, 19 leuko-erythroplakia, 86 leukoplakia with ulcer/focal erythema, 28 lichenoid lesions and 7 treatment-related white scars. Histopathology diagnoses showed, 71 normal/benign lesions, 100 mild dysplasia (MiD), 19 moderate dysplasia (MoD), 20 severe dysplasia (SD), 13 carcinoma in situ (CIS) and 32 CA. Of the 255 WOLs, 138 and 223 were suspicious on WLE and AFV, respectively. The sensitivity and specificity of WLE in detecting WOLs with dysplasia/CA were 54% and 46%, respectively. On AFV, the sensitivity was 89% and the specificity was 17%. When the 75 homogenous WOLs were evaluated separately, 46 had dysplasia/CA (34 MiD, 6 MoD, 3 SD, 2 CIS and 1 CA). Of these 46 lesions, only 9 (8 MiD and 1 CIS) were missed (non-suspicious) on AFV. The sensitivity and specificity of AFV in detecting homogenous WOLs with dysplasia/CA were 80% and 37%, respectively. Conclusion While AFV is useful in detecting ‘high-risk’ potentially malignant oral lesions, it is not as efficient in discriminating between high-risk and low-risk lesions. AFV, in its current stage of development, may only be effective when used in a selective high-risk patient population.