Abstract
Simple SummaryEarly detection is crucial towards improving survival in patients diagnosed with oral cancer. Non-invasive strategies equivalent to histology diagnosis are extremely valuable in oral cancer screening and early detection in resource-constrained settings. Optical coherence tomography (OCT), an optical biopsy technique enables real-time imaging with periodic surveillance and capability to image architectural features of the tissues. We report that while OCT system delineates oral pre-cancer and cancer with more than 90% sensitivity, integration, with artificial neural network-based analysis efficiently identifies high-risk, oral pre-cancer (83%). This study provides evidence that the robust, low-cost system was effective as a point-of-care device in resource-constrained settings. The high accuracy and portability signify widespread clinical application in oral cancer screening and/or surveillance.Non-invasive strategies that can identify oral malignant and dysplastic oral potentially-malignant lesions (OPML) are necessary in cancer screening and long-term surveillance. Optical coherence tomography (OCT) can be a rapid, real time and non-invasive imaging method for frequent patient surveillance. Here, we report the validation of a portable, robust OCT device in 232 patients (lesions: 347) in different clinical settings. The device deployed with algorithm-based automated diagnosis, showed efficacy in delineation of oral benign and normal (n = 151), OPML (n = 121), and malignant lesions (n = 75) in community and tertiary care settings. This study showed that OCT images analyzed by automated image processing algorithm could distinguish the dysplastic-OPML and malignant lesions with a sensitivity of 95% and 93%, respectively. Furthermore, we explored the ability of multiple (n = 14) artificial neural network (ANN) based feature extraction techniques for delineation high grade-OPML (moderate/severe dysplasia). The support vector machine (SVM) model built over ANN, delineated high-grade dysplasia with sensitivity of 83%, which in turn, can be employed to triage patients for tertiary care. The study provides evidence towards the utility of the robust and low-cost OCT instrument as a point-of-care device in resource-constrained settings and the potential clinical application of device in screening and surveillance of oral cancer.
Highlights
Detection and subsequent intervention are the best approach for improving the outcome of oral cancer
Eighty percent of subjects had a habit history of tobacco chewing, smoking, or both (Figure S2F), with tobacco chewers being the majority of the population
Detection and regular surveillance of suspicious oral lesions are critical for decreasing mortality rate of oral squamous cell carcinoma (OSCC)
Summary
Detection and subsequent intervention are the best approach for improving the outcome of oral cancer. Cancers of the oral cavity and lips account for approximately. 377,713 new cancer cases with a mortality of approximately 177,757 cases worldwide [1]. More than 90% of the oral cavity cancers are oral squamous cell carcinoma (OSCC). The high morbidity and mortality in patients with OSCC are primarily attributed to late diagnosis, with more than two-thirds of OSCC cases diagnosed at an advanced stage. Prognosis of OSCC is stage-dependent, with an average five-year disease-free survival rate of 80–90% if diagnosed at early stages; and 20–30% if diagnosed at late stages [6,7]
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