Usefulness of optical fluorescence imaging in identification and triaging of oral potentially malignant disorders: A study of VELscope in the LESIONS programme.

Abstract

Optical fluorescence imaging (OFI) has been shown to enhance the detection of oral potentially malignant disorders (OPMD), by providing additional information about the nature of these lesions, with loss of autofluorescence (LAF) signifying potential underlying oral epithelial dysplasia (OED) or malignancy. This study aims to assess the usefulness of OFI in identification and triaging of OPMDs by primary oral health practitioners, in a community setting. Participants were recruited from the LESIONS programme in South-East Queensland, Australia. Participants underwent both conventional oral examination (COE) of mucosal tissues as well as screening with OFI by trained dentists and oral health therapists (OHTs). Lesions were classified as homogeneous, non-homogeneous, lichenoid or other. The study protocol included blanching of lesions detected with VELscope® (diascopy) and a two-week review and reassessment of all lesions to reduce false-positive findings. Analysis of decisions made by dentists and OHTs about lesion identification and triaging was undertaken. A total of 360 participants underwent both COE and OFI screening and presented with at least one lesion detected with either method. Lesion size increased and border distinctness and visibility improved with OFI. Of the 170 lesions that underwent two-week reassessment, 70% resolved or were confirmed as benign. OHTs were more likely to request review and referral for OPMDs compared to dentists. Optical fluorescence imaging is a useful tool to help dentists and OHTs identify and triage patients with possible OPMD in the primary care setting.