Malignant Disorders Of Oral Cavity Research Articles

A prospective study to evaluate the efficacy of a fluorescence based hand-held device in the detection of malignant and potentially malignant disorders (PMD) of the oral cavity

ObjectiveOral cancers have varied clinical presentations, often leading to repeated and multiple biopsies to establish diagnosis and formulate treatment. Use of portable, office- based tools to help in diagnosis and biopsies can result in early diagnosis. We used a fluorescence-based device to study its efficacy in malignant and potentially malignant disorders of oral cavity. Method50 individuals including 41 patients and 9 controls were enrolled. Following a thorough clinical examination, the Oralscan® device (with combined autofluorescence and diffuse reflectance) was used for characterization of these lesion and to assist in biopsy taking. The zones (red/yellow/green) in which the lesion(s) fell were noted. Punch biopsies were performed and pathological reports were compared with the zonal category as given by the device. ResultsThe most common site of involvement was buccal mucosa (70.7 %). The total number of lesions studied was 59, with 143 images captured in toto. 75.6 % of cases were malignant. The overall sensitivity, accuracy and PPV of the device was 43.24 %, 34.04 % and 61.54 % respectively. ConclusionThe present study showed that the use of the autofluorescence and diffuse reflectance handheld device had poor sensitivity and specificity for diagnosing oral lesions both malignant and potentially malignant disorders of oral cavity.

Marking the Micro Details in Potentially Malignant Disorders of Oral Cavity

Marking the Micro Details in Potentially Malignant Disorders of Oral Cavity

EVALUATION OF CYTOGENIC DAMAGE IN ORAL EXFOLIATED BUCCAL CELLS OF TOBACCO USERS AND PATIENTS WITH POTENTIALLY MALIGNANT DISORDERS USING MICRONUCLEUS ASSAY - A PROSPECTIVE STUDY

Background: Cytogenic methods acts with complex type mutations, known as structural mutations (aberrations)and a special type of chromosomal damage, known as micronucleus. So, micronucleus (MN) assay has been used as a biomarker of genetic damage in buccal mucosa cells. Aim and Objectives: To evaluate micronucleus in the exfoliated cells of buccal mucosa of individuals with potentially malignant disorders and different tobacco related habits and in control group. To observe the incidence of micronucleus count based on duration, frequency and type of tobacco usage and also auto immune condition of Lichen planus. Materials and Method: The study population is divided into 3 groups. Group I : 15 healthy subjects (control), Group II : 15 smokers or chewers with habits andno evidence of lesion Group III : 30 Patients clinically diagnosed as having PMD of the oral cavity. Smears stained with DNA specific Feulgen stain. Association of micronucleus between all groups and its mean and standard deviation was assessed with ANOVA with p<0.05 was considered as significant level. Results: The mean MN revealed that individuals with potentially malignant disorders had 26.8±5.1, individuals with tobacco habit (smokers/chewers) had 11.0±5.5 and controls had 0.2±0.5. The ANOVA test for association and mean frequency of micronucleus between all groups revealed significant value of <0.001. Conclusion: Hence, MN assay in oral exfoliated buccal cells can be conveniently used as a biomarker for screening of potentially malignant disorders of oral cavity. And also provides an insight into the importance of early detection and prevention of OPMDs.

Isolation and Identification of Various Candida Species in Potentially Malignant Disorders of Oral Cavity: A Retrospective Study

Aim: The aim of this study was to find and compare various Candida species in the normal and ‘potentially malignant disorders’ of oral cavity.
 Study Design: Retrospective cross-sectional study.
 Materials and Methods: 110 subjects were selected for the study comprising of 55 normal healthy individuals (control group) and 55 patients with ‘‘potentially malignant disorders’’ (test group). A saliva swab was taken from the normal healthy individuals and patients with ‘potentially malignant disorders’ to check the presence of Candida on Sabouraud’s Dextrose Agar (SDA) media. A wedge shaped tissue sample from the representative site was surgically excised and sent for routine tissue processing for histopathological diagnosis. All the fungal colonies from SDA were subjected to further microbiological tests to check for the presence of various species of Candida.
 Results: No fungus growth was found in the saliva of healthy patients. Out of 55 patients with ‘potentially malignant disorders’, Candida growth was isolated by using the culture method, 30 patients (54.5%) showed positive growth on Sabouraud’s Dextrose Agar (SDA) media, of which 23 were diagnosed cases of leukoplakia and 7 oral submucous fibrosis. No fungus growth was seen in patients with oral lichen planus. There is positive association between the potentially malignant lesions and Candida and the p-value (.006) is statistically significant.
 Conclusion: The results of the study showed that a positive association exists between the ‘potentially malignant disorders’ and various Candida species and the p-value (.006) is statistically significant. The most prevalent Candida species was Candida albicans followed by Candida tropicalis, Candida glabrata, Candida Krusei.

Diagnostic efficacy of neutrophil to lymphocyte ratio (NLR) in oral potentially malignant disorders and oral cancer.

Inflammation is considered to be the seventh hallmark of cancer and plays a pivotal role in all stages of tumor development. Systemic inflammatory responses in particular neutrophil to lymphocyte ratio (NLR) have garnered immense attention of current researchers and its role is well proven in various solid malignancies. Its prognostic role in oral cancer have been extensively studied. However, its diagnostic role is yet to be explored. The current study aims to investigate diagnostic utility of NLR in oral potentially malignant disorders and oral cancer, when compared to normal subjects. A total of 150 subjects were involved in the study, a total of 2.5 ml of blood was drawn from the median cubital vein of the patient in an EDTA vial and hematological parameters were assessed using Erba-Transasia B7256 Autoanalyzer and reassessed manually by two experts. The NLR values were recorded and tabulated as Mean ± S.D. and comparisons were analyzed using Kruskal Wallis and Mann Whitney post hoc U test. ROC curve analysis was performed to estimate cut-off values. The NLR values when compared between the 3 groups were statistically significant (P < 0.001). The cut off value between disease and normal subject was 2.33, while the cut-off value between potentially malignant and malignant condition is 3.20. NLR can be a valuable diagnostic adjunct in oral cancer and potentially malignant disorders of oral cavity.

Evaluation of serum immunoglobulin (IgG, IgM, IgA) in potentially malignant disorders of oral cavity – A case control study

BackgroundOnly few studies have been done to evaluate level of serum immunoglobulins (IgG,IgM,IgA) in patients with Potentially Malignant Disorders (PMD) like Leukoplakia, Oral Submucous Fibrosis (OSMF) and Oral Lichen Planus (OLP) as tumour markers. Aims and objectivesTo estimate the serum immunoglobulins level (IgG, IgM, IgA) in leukoplakia, OSMF and oral lichen planus (OLP) patients and its comparison with levels among control groups and Weather these values can be used to predict severity of disease or not. Materials and methods30 patients with different potentially malignant disorders like leukoplakia, OSMF and oral lichen planus and 30 healthy controls were selected at random and subjected for analysis of serum IgG, IgA, IgM. Statistical methods employed were mean, standard deviation and ANOVA test. ResultsWe observed significant elevated levels of all the immunoglobulins in leukoplakia, OSMF and oral lichen planus when compared with the control group and levels were increasing with clinical stages of OSMF (p < 0.05). ConclusionsAll these immunoglobulins are indicative of tumour burden or transformation of malignancy in higher stage and might be employed as prognostic indicators in these disorders.

EVALUATION OF INFLAMMATORY MARKERS IN POTENTIALLY MALIGNANT DISORDERS OF THE ORAL CAVITY

Objective: The aim this study was to evaluate the expression of inflammatory markers in potentially malignant disorders of oral cavity (leukoplakia) and its relationship with the degree of epithelial dysplasia. Study design: Immunohistochemistry was used to identify the number (cells/mm2) of interleukin 17 (IL-17+), neutrophil (CD66 b+), matrix metalloproteinase‐9 (MMP-9+) cells, and neoformed microvessels (CD105+) in the subepithelial region of leukoplakia samples from 31 patients. Evaluation of IL‐17 expression in keratinocytes cells was semiquantitative and performed by assigning scores. Samples of healthy oral mucosa (n = 10) were used as controls. Results: The classification of epithelial dysplasia by the binary grading system totaled 17 samples with high risk and 14 samples with low risk of malignant transformation. Irrespective of the severity of epithelial dysplasia, the counts of inflammatory markers (CD66 b, IL-17, MMP-9, and CD105) were higher in the leukoplakia group compared to controls (P< .05 for all comparisons). In addition, the intraepithelial expression of IL-17 was high in leukoplakia samples (44%) and absent/low in the control group (100%; P< .05). Conclusions: This study showed that potentially malignant disorders of oral cavity are characterized by a high count of inflammatory markers. Objective: The aim this study was to evaluate the expression of inflammatory markers in potentially malignant disorders of oral cavity (leukoplakia) and its relationship with the degree of epithelial dysplasia. Study design: Immunohistochemistry was used to identify the number (cells/mm2) of interleukin 17 (IL-17+), neutrophil (CD66 b+), matrix metalloproteinase‐9 (MMP-9+) cells, and neoformed microvessels (CD105+) in the subepithelial region of leukoplakia samples from 31 patients. Evaluation of IL‐17 expression in keratinocytes cells was semiquantitative and performed by assigning scores. Samples of healthy oral mucosa (n = 10) were used as controls. Results: The classification of epithelial dysplasia by the binary grading system totaled 17 samples with high risk and 14 samples with low risk of malignant transformation. Irrespective of the severity of epithelial dysplasia, the counts of inflammatory markers (CD66 b, IL-17, MMP-9, and CD105) were higher in the leukoplakia group compared to controls (P< .05 for all comparisons). In addition, the intraepithelial expression of IL-17 was high in leukoplakia samples (44%) and absent/low in the control group (100%; P< .05). Conclusions: This study showed that potentially malignant disorders of oral cavity are characterized by a high count of inflammatory markers.

Evaluation of hematological parameters in oral cancer and oral pre-cancer

Background: Oral squamous cell carcinoma (OSCC) is the most common public health issue in Indian population. Quite a large number of OSCC cases are preceded by potentially malignant disorders of oral cavity. The need for simple diagnostic marker for early diagnosis and thus better therapeutic outcome is imperative. The current study aims to evaluate hematological parameters such as hemoglobin, bleeding time, clotting time, total leucocyte count (TLC) and differential leucocyte count (DLC) in OSCC and oral potentially malignant disorder cases along with normal healthy controls.Methods: A total of 150 subjects; 50 in each group were taken and 2.5 ml of blood were withdrawn from each subject and TLC, DLC and hemoglobin assessment was done using autoanalyzer while bleeding time and clotting time was recorded through Duke’s method and modified Dale’s method respectively.Results: All the data were tabulated and recorded as mean±standard deviation and comparison was done using one-way ANOVA test (p&lt;0.05). TLC count, neutrophil count and lymphocyte count showed statistically significant difference amongst three groups while other parameters such as hemoglobin percentage, bleeding time, clotting time, eosinophil count, monocyte count and basophil count were statistically non-significant.Conclusions: This study showed TLC count, neutrophil count and lymphocyte count might prove as useful determinant factor in oral squamous cell carcinoma and oral potentially malignant disorders. However, further study with larger sample size is required to establish their role as diagnostic, prognostic marker or predictor of malignant transformation.

Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis.

Oral squamous cell carcinoma (OSCC) is a commonly occurring head and neck cancer. It has a high prevalence in certain parts of the world, and is associated with a high mortality rate. In this review, we describe metastasis related to OSCC, and disorders that could lead to OSCC with common etiological factors. In addition, a brief account of the diagnosis of OSCC and role of salivary biomarkers in its early detection has also been highlighted. Google Scholar and PubMed search engines were searched with keywords including "oral squamous cell carcinoma", "OSCC", "oral cancer", "potentially malignant disorders in oral cavity", "etiological factors of OSCC", "diagnosis of OSCC", and "salivary biomarkers and OSCC" to gather the literature for this review. The review concludes that OSCC has the potential for regional as well as distant metastasis, and many potentially malignant diseases can transform into OSCC with the help of various etiological factors. Diagnosis of OSCC involves traditional biopsy, but salivary biomarkers could also be utilized for early recognition.

Comparison of different stains in exfoliated oral mucosal cell micronucleus of potentially malignant disorders of oral cavity

Micronucleus (MN) has been proved to be an important biomarker of genomic damage. Leishman Giemsa (LG) cocktail, being a relatively new staining technique, has not been used in exfoliative cytology. The aim of this study is to observe and compare the micronuclei (MN) frequency in potentially malignant disorders (PMDs) and also to compare the staining efficacy of May-Grünwald Giemsa (MGG), LG cocktail, and Papanicolaou (PAP) for micronuclei in exfoliated oral mucosal cells. Three smears were prepared from each 30 controls (buccal mucosa) and 120 patients (40 oral submucous fibrosis, 40 lichen planus, and 40 leukoplakia) clinically diagnosed with having one of the PMDs of the oral cavity stained with PAP, MGG, and LG cocktail stains. MN frequency (No. of MN/1000 cells) was evaluated and compared between the cases and the controls. Comparison between the three different stained smears was also made to determine the clarity and efficacy of the stains. LG cocktail gave comparatively better results followed by PAP and MGG. Statistically significant results (P < 0.05) were obtained, using Mann-Whitney test for comparison of MN frequency between cases and controls. LG cocktail is an easy, cost- effective, and one step technique comparable to PAP staining; however, it warrants further study in its potential application in screening of oral cancer.

Effect of curcumin in reducing burning sensation in potentially malignant disorders of oral cavity

Introduction: Curcumin, chemically named as diferuloylmethane is a yellow coloured pigment which shows anti inflammatory, antioxidant, pro apoptotic, antibacterial, antiviral and antifungal activities. It suppresses cyclooxygenase, lipooxygenase and other inflammatory mediators and destroys free radicals. Aim: To evaluate the efficacy of curcumin in reducing the burning sensation in potentially malignant disorders of oral cavity. Materials and Methods: 100 subjects diagnosed clinically with potentially malignant disorders of oral cavity were included in this study. The patients were administered commercially available turmeric systemically and topical application of turmeric and honey was advised. Their burning sensation on VAS scale was evaluated after 15 days, and the data was then statistically analysed by Wilcoxon sign rank test. Results: After the treatment there was a significant decrease in VAS scale. The median showed decrease from 7 to 4. The mean value also showed decrease from 6.91 to 3.98. Conclusion: Hence, it is concluded that turmeric and honey showed positive results in reducing burning sensation in potentially malignant disorders of oral cavity.

Molecular Insight Into Pathogenesis of Potentially Malignant Disorders of Oral Cavity

Molecular Insight Into Pathogenesis of Potentially Malignant Disorders of Oral Cavity

An inter-correlative study on clinico-pathological profile and different predisposing factors of oral leukoplakia among the ethnics of Darjeeling, India

Context: Idiopathic leukoplakia is the most common potentially malignant disorder of oral cavity. Owing to the year-wide cold environment in Darjeeling, here the indigenous ethnic people practice a distinct addiction pattern that strongly predisposes them to oral leukoplakia. Aims: The purpose of the present study was to assess the clinico-pathological profile and various predisposing factors involved in oral leukoplakia, and to correlate its exfoliative cytological appearances with the histopathological diagnoses. Materials and Methods: A total of 53 patients were clinically diagnosed with oral leukoplakia during the study period. All information − clinical data pertaining to the patient and the patch, their personal history including addiction and diet, and the cyto-histopathological features of the lesion − was evaluated and methodically compared with each other using the statistical software, Statistical Package for the Social Sciences version 16.0. Results: The female-dominated cohort was chiefly affected with thin leukoplakia (67.9%) involving their buccal mucosa (66.1%). Smokeless tobacco (49.1%) was the most popular addiction. Alcoholism and smoking, increasing daily frequency of tobacco misuse, and verrucous and granular leukoplakias were significantly associated with dysplastic transformation (P

Proposed new grading of oral submucous fibrosis based on cheek flexibility.

Objectives: Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral cavity, pharynx and upper digestive tract, characterized by progressive inability to open the mouth. Based on clinical and/or histopathological features, various classifications and grading systems have been put forth till date. The aim of the present study was to study the variance in cheek flexibility in OSMF patients, the observance of which led to the introduction of a new grading for the condition. Material and Methods: The study included 412 patients with OSMF attending to the Department of Oral Medicine and Radiology during the period from December 2008 to June 2013. A detailed history and examination of the patients was performed with special emphasis on measuring cheek flexibility. Statistical analysis was done using Chi-square test and p<0.05 was considered to be statistically significant. Results: The most common etiological factor was tobacco (73.3%). All the patients reported with burning sensation of the mouth and blanching of the mucosa. Malignancy was reported in only 4.6% patients. 60.4% patients showed cheek flexibility of 30mm and above, while 29.6% patients showed cheek flexibility between 20-30mm and 10% patients showed less than 30mm of cheek flexibility. Conclusion: The observations of the present study have led to the proposal of a new grading of OSMF based on cheek flexibility which could assist in the categorization of the condition by the clinicians. Key words:Cheek flexibility, oral submucous fibrosis, grading, areca nut.

Evaluation of diagnostic reliability of micronuclei in potentially malignant disorders of oral cavity

Context: Micronucleus (MN) has been proved to be an important biomarker of genomic damage. MN scoring in oral exfoliated epithelial cells has been used in the past as a biomarker to identify different preneoplastic conditions much earlier than the manifestations of clinical features. However, no attention has been, until now, given to determine the overall accuracy of MN assay in diagnosing potentially malignant disorders (PMDs). Aim: The present study was being conducted to evaluate the diagnostic accuracy of MN assay in PMDs of oral cavity. Materials and Methods: Cytosmears from 30 controls with healthy mucosa and 45 cases as patients with suspicious lesions, clinically diagnosed as PMDs of the oral cavity were taken and separately stained with Papanicolaou (Pap) stain and haematoxylin and eosin (H and E) stain. MN frequency was evaluated and based on the 50 th percentile of all the MN (%) frequency values obtained for both the groups combined; a cut off value was calculated independently for each stain. Results: The sensitivity and specificity with Pap stain was found to be 84% and 93%, respectively, with diagnostic accuracy of 88%, whereas with H and E stain, sensitivity of 89% and specificity of 100% with diagnostic accuracy of 93% was observed. Conclusion: MN assay in oral exfoliated epithelial cells can be conveniently used as a biomarker for the screening of PMDs of oral cavity.

Role of exfoliative cytology in the detection of potentially malignant lesions of oral cavity in high risk population

Background&Objectives : Squamous cell carcinoma of oral cavity is one of the leading causes of cancer related deaths in Indian subcontinent. The morbidity and mortality associated with the disease has not improved drastically due to lack of early diagnosis. Surgical biopsy, although regarded as a gold standard has limitations to be adopted as a screening tool for suspicious lesions. Recently citemorphological evaluation of scrape material collected from clinically suspicious lesions has emerged as a potential tool for detection of precancerous lesions at their incipient stage. The present study has attempted to evaluate the utility of brush cytology in detecting potentially malignant lesions of oral cavity in high risk population with histopathological correlation. Method : Scrape smears were collected from clinically suspicious lesions using commercially available cytobrush. Cytomorphological features were assessed and graded according to the system of Papanicolaou et al. Histopathological examination of biopsy specimen was done and correlate with cytological diagnosis. Appropriate statistical analysis was done for evaluation. Results : A total of fifty cases were studied. Majority of the patients were in 30-50 years age group with buccal mucosa being the most common site of involvement. Cytologically most of the smears belonged to class 3 and on histopathological examination moderate dysplasia was the most common diagnosis. The sensitivity, specificity and positive predictive value of brush cytology were 93%, 100% and 100% respectively. Conclusion : The results obtained in our study were comparable with those of similar studies making brush cytology an ideal screening tool for potentially malignant disorders of oral cavity.