Presence Of Epithelial Dysplasia Research Articles

Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis.

To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility. MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value. Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001). OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.

Surgical treatment compared with “wait and see” in patients affected by oral leukoplakia to prevent oral cancer: Preliminary data from a multicenter randomized controlled trial

AbstractObjectiveOral leukoplakia (OL) is one of the most common and investigated oral potentially malignant disorders (OPMD). Preventing OSCC occurrence should be the primary outcome in the clinical management of OL. Surgical removal of OL is performed by most clinicians, although its effectiveness in reducing OSCC onset has still not been established by randomized controlled trials (RCT). Wait and see approach is characterized by frequent clinical examinations and periodical biopsies of OL, avoiding unnecessary surgical procedures.This is the first multicenter RCT in literature aiming at comparing the effectiveness of surgical removal and the “wait and see” approach in preventing OSCC onset in patients affected by dysplastic and non‐dysplastic OL.MethodsTwo Italian referral care centres for oral diseases were involved in this multicenter two‐arm RCT comparing the surgical removal of OL (group A) and the “wait and see” approach (group B), with the aim of reducing oral cancer onset.ResultsThis report shows preliminary data on the first 161 patients, with a mean follow‐up of 19.14 ± 11.25 months. Eight cases of OSCC occurred (6 out 8 involving the tongue): one case in group A and seven cases in group B. Moreover, OL recurred in 13 (20%) cases after surgical excision.ConclusionsWithin the limitations of this preliminary report, these initial data underline the increased risk of OSCC onset in the case of OL of the tongue in the presence of epithelial dysplasia in group B (“wait and see”) compared to group A (surgery). This RCT is currently ongoing at the same clinical departments, with the aim of enrolling 310 patients and collecting data at 5‐year follow‐up, in order to achieve conclusive results, in an evidence‐based medicine approach.

OralImmunoAnalyser: a software tool for immunohistochemical assessment of oral leukoplakia using image segmentation and classification models.

Oral cancer ranks sixteenth amongst types of cancer by number of deaths. Many oral cancers are developed from potentially malignant disorders such as oral leukoplakia, whose most frequent predictor is the presence of epithelial dysplasia. Immunohistochemical staining using cell proliferation biomarkers such as ki67 is a complementary technique to improve the diagnosis and prognosis of oral leukoplakia. The cell counting of these images was traditionally done manually, which is time-consuming and not very reproducible due to intra- and inter-observer variability. The software presently available is not suitable for this task. This article presents the OralImmunoAnalyser software (registered by the University of Santiago de Compostela-USC), which combines automatic image processing with a friendly graphical user interface that allows investigators to oversee and easily correct the automatically recognized cells before quantification. OralImmunoAnalyser is able to count the number of cells in three staining levels and each epithelial layer. Operating in the daily work of the Odontology Faculty, it registered a sensitivity of 64.4% and specificity of 93% for automatic cell detection, with an accuracy of 79.8% for cell classification. Although expert supervision is needed before quantification, OIA reduces the expert analysis time by 56.5% compared to manual counting, avoiding mistakes because the user can check the cells counted. Hence, the SUS questionnaire reported a mean score of 80.9, which means that the system was perceived from good to excellent. OralImmunoAnalyser is accurate, trustworthy, and easy to use in daily practice in biomedical labs. The software, for Windows and Linux, with the images used in this study, can be downloaded from https://citius.usc.es/transferencia/software/oralimmunoanalyser for research purposes upon acceptance.

Leukoplakia and erythroplakia in youngers versus older individuals: a clinicopathological retrospective study.

The incidence of oral cancer has exhibited a rise within the young population. Considering that oral potentially malignant disorders (OPMDs) can precede the development of oral cancer, it is imperative to conduct studies in this particular younger population. This study aimed to evaluate the frequency and conduct a comparative analysis of the clinical-demographic characteristics of OPMDs in two distinct age groups. A retrospective analysis was conducted with patients diagnosed with leukoplakia, erythroplakia, and leukoerythroplakia between 1965 and 2020. The individuals were categorized into two groups: those aged up to 40 years (Group Younger) and those aged 41 years and above (Group Older). A total of 640 lesions were subjected to analysis. Among these, patients aged up to 40 years constituted 10.63% of the sample, however, this proportion decreased significantly to 6.9% between 2010 and 2020. A predominant male representation was observed in both groups, with white lesions being the most common in both as well. However, the frequency of red or mixed lesions was significantly higher (p=0.034) in the older group, along with a higher prevalence of dysplastic lesions (26.9% versus 11.8%, p=0.01). Moreover, the older group exhibited a relatively higher percentage of smokers/ex-smokers (78.6%), compared to the younger group (61.5%, p=0.085) and alcohol consumers/ex-consumers (54.9% versus 22.7%, p=0.028). Elderly individuals exhibited an unfavorable progression (p=0.028). However, a logistic regression analysis identified as significant variables associated with malignant transformation, the presence of epithelial dysplasia, and red lesions diagnosed as erythroplakia. A declining frequency of OPMDs in young adults was observed over the years, whereas in older adults, these disorders exhibited an unfavorable progression.

RETROSPECTIVE AND OBSERVATIONAL STUDY OF POTENTIALLY MALIGNANT DISORDERS IN A PATHOLOGICAL ANATOMY SERVICE

Objective To evaluate a study population of a pathological anatomy service that was affected by potentially malignant disorders (PMDs), through a retrospective and observational study. Study Design Our study examined 144 cases of PMDs over a 20-year period, analyzing the frequency of such characteristics as age, gender, ethnicity, lesion location, histopathological diagnosis, associated risk factors, and presence of epithelial dysplasia. A follow-up clinical examination was also performed. Results Higher prevalence was observed in white females, in an age group of 61-70 years, and the buccal mucosa was the most affected site. Leukoplakia was the most frequent PMD; associated risk factors, alcohol, and tobacco in male patients were the most prevalent; and six cases of epithelial dysplasia were identified. Thirty-one patients attended the follow-up dental appointment, and 12 exhibited recurrences of oral lesions. Conclusion There is a lack of epidemiological surveys and follow-up clinical examinations for PMDs in Brazil and worldwide for the early detection of lesions. The difficulty in keeping the registration data of public healthcare services up-to-date, as well as low motivation and patient support for prolonged clinical follow-up, were also observed. To evaluate a study population of a pathological anatomy service that was affected by potentially malignant disorders (PMDs), through a retrospective and observational study. Our study examined 144 cases of PMDs over a 20-year period, analyzing the frequency of such characteristics as age, gender, ethnicity, lesion location, histopathological diagnosis, associated risk factors, and presence of epithelial dysplasia. A follow-up clinical examination was also performed. Higher prevalence was observed in white females, in an age group of 61-70 years, and the buccal mucosa was the most affected site. Leukoplakia was the most frequent PMD; associated risk factors, alcohol, and tobacco in male patients were the most prevalent; and six cases of epithelial dysplasia were identified. Thirty-one patients attended the follow-up dental appointment, and 12 exhibited recurrences of oral lesions. There is a lack of epidemiological surveys and follow-up clinical examinations for PMDs in Brazil and worldwide for the early detection of lesions. The difficulty in keeping the registration data of public healthcare services up-to-date, as well as low motivation and patient support for prolonged clinical follow-up, were also observed.

ORAL LICHEN PLANUS AND ORAL LICHENOID LESION: A CLINICOPATHOLOGICAL STUDY

Objective To reassess the cases diagnosed as oral lichen planus (OLP) and oral lichenoid lesion (OLL) and compare their sociodemographic and clinicopathological characteristics. Study Design Records and slides of 72 cases with diagnosis of OLP and OLL were evaluated and submitted to bivariate analysis. Results OLP prevailed (52.8%). Middle-aged, non-smoking white women with white lesions at multiple oral sites without symptomatology, were, clinically, the most affected for both lesions. In LPO, bilateral lesions showing intense lymphocytic infiltrate (IL) in band, well-defined and in the superficial portion of the connective tissue, with a hydropic degeneration of the basal layer, colloid bodies, parakeratin, hyperplastic epithelial crest, and absence of epithelial dysplasia, predominated. In OLL, isolated lesions presenting moderate to intense focal IL, with basal degeneration colloid bodies, hyperplastic epithelial crest, and epithelial dysplasia, were observed. OLP was associated with lesions that appeared bilaterally (p=0.001), well-defined IL, in band, and in the superficial portion of the connective tissue (p≤0.0001). OLL was associated with the presence of epithelial dysplasia and mild dysplasia (p≤0.0001). Conclusion Histopathology of the lichenoid IL and the presence of dysplasia alone are not sufficient for the differential diagnosis LPO and LLO; the association of clinical and follow-up data is essential. To reassess the cases diagnosed as oral lichen planus (OLP) and oral lichenoid lesion (OLL) and compare their sociodemographic and clinicopathological characteristics. Records and slides of 72 cases with diagnosis of OLP and OLL were evaluated and submitted to bivariate analysis. OLP prevailed (52.8%). Middle-aged, non-smoking white women with white lesions at multiple oral sites without symptomatology, were, clinically, the most affected for both lesions. In LPO, bilateral lesions showing intense lymphocytic infiltrate (IL) in band, well-defined and in the superficial portion of the connective tissue, with a hydropic degeneration of the basal layer, colloid bodies, parakeratin, hyperplastic epithelial crest, and absence of epithelial dysplasia, predominated. In OLL, isolated lesions presenting moderate to intense focal IL, with basal degeneration colloid bodies, hyperplastic epithelial crest, and epithelial dysplasia, were observed. OLP was associated with lesions that appeared bilaterally (p=0.001), well-defined IL, in band, and in the superficial portion of the connective tissue (p≤0.0001). OLL was associated with the presence of epithelial dysplasia and mild dysplasia (p≤0.0001). Histopathology of the lichenoid IL and the presence of dysplasia alone are not sufficient for the differential diagnosis LPO and LLO; the association of clinical and follow-up data is essential.

Critical update, systematic review, and meta-analysis of oral erythroplakia as an oral potentially malignant disorder.

BackgroundOral erythroplakia has been classically considered as the potentially malignant disorder with the highest rate of malignant development into squamous cell carcinoma. This critical systematic review and meta‐analysis aim to estimate the malignant development rate of oral erythroplakia and identify the associated risk factors.MethodsWe performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and LILACS, with keywords “erythroplakia,” “erythroplasia,” “malignant transformation,” “malignant development,” “malignization,” “carcinogenesis,” “oral cancer,” “oral squamous cell carcinoma,” “mouth neoplasm,” and “prognosis.” Meta‐analysis was conducted using a random‐effects model.ResultsTen observational studies with 441 patients met the inclusion criteria, whose mean malignant development rate was 12.7% and with a mean follow‐up period of patients of 6.66 years. In the initial biopsy, 42.8% of oral erythroplakia were already squamous cell carcinoma. The buccal mucosa was the most frequent location of oral erythroplakia, but the floor of the mouth was the most common site of malignant development. All patients who underwent malignant development showed epithelial dysplasia on the initial diagnostic biopsy.ConclusionOverall malignant development rate of OE in the meta‐analysis was 19.9%. We could not associate any specific clinicopathological feature with the malignant development. The presence of epithelial dysplasia in the initial biopsy remains the worst prognostic factor. Further observational studies on OE are needed, with well‐established diagnostic criteria and good clinical follow‐up, in order to identify the true risk of malignant development of oral erythroplakia and the related risk factors.

Prognostic Significance of Histologic Phenotype in Periampullary Adenocarcinomas

Background: The precise origin of a periampullary adenocarcinoma is often difficult to determine due to tumor destruction of normal periampullary anatomy, and presence of epithelial dysplasia. The aim of this study is to evaluate prognostic significance of histologic type in periampullary carcinoma.

Malignant Transformation Rate of Non-reactive Oral Hyperkeratoses Suggests an Early Dysplastic Phenotype.

The presence of epithelial dysplasia (ED) in oral leukoplakia is the single most important predictor of malignant transformation (MT). The majority of leukoplakias, however, do not show evidence of ED and yet MT of these lesions is well-recognized. These lesions have been referred to as "hyperkeratosis/hyperplasia, no dysplasia," "keratosis of unknown significance" and "hyperkeratosis, not reactive (HkNR)." This study evaluates the MT rate of such leukoplakias. A literature review was performed to identify cohort studies on leukoplakias where (1) there was a recorded histopathologic diagnosis, (2) cases of "hyperkeratosis/hyperplasia, no dysplasia" comprised part of the cohort, and (3) follow-up information was available. There were 9,358 leukoplakias, of which 28.5% exhibited ED while 37.7% consisted of HkNR. Follow-up ranged from 15 to 73months. The incidence of MT in leukoplakia exhibiting HkNR was 4.9%, compared to 15.3% for ED. Among oral squamous cell carcinomas (SCC) with previously biopsied, site-specific precursor lesions, 55.7% arose from ED/carcinoma in situ and 28.0% arose from HkNR. Leukoplakia exhibiting HkNR has a substantial MT rate, similar to that of mild ED, and must be recognized and managed appropriately to reduce oral SCC incidence.

Malignant transformation of oral leukoplakia: Systematic review and meta-analysis of the last 5 years.

Oral leukoplakia (OL) is the most frequently encountered oral potentially malignant disorder. The aims of this systematic review are to estimate the overall malignant transformation of OL and to assess the risk factors associated with malignant transformation of OL published in the last 5years (2015-2020). We performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and Cochrane databases with keywords "oral leukoplakia", "oral cancer", "oral carcinoma" and "oral squamous cell carcinoma". Meta-analysis was conducted using a random-effects model. Twenty-four studies were selected, that reported a total of 16,604 patients. Malignant transformation proportion varied between 1.1% and 40.8%. Female gender, non-homogeneous clinical type, and presence of epithelial dysplasia were significantly related to MT. Other risk factors previously suggested did not show significant results. The pooled proportion of malignant transformation MT was 9.8% (95% CI: 7.9-11.7). It is necessary to continue to conduct well-designed prospective clinicopathological studies on OL, using a uniform definition for OL to reduce the risk of bias for evaluating various factors associated with the MT.

Oral cancer development in lichen planus and related conditions-3.0 evidence level: A systematic review of systematic reviews.

A systematic review of systematic reviews-aka overview of reviews, a novel type of study design providing a tertiary level of evidence-is presented on systematic reviews (SR) and meta-analyses (MTA) evaluating the cancer development in oral lichen planus (OLP), oral lichenoid lesions (OLL), and oral lichenoid reactions (OLR). We searched for SR-MTA published before January 2021. We evaluated the methodological quality of SR-MTA using AMSTAR2 and checked the quality of evidence. Inclusion criteria were met by seven SR-MTA. Oral cancer ratios ranged between 0.44% and 2.28% for OLP, between 1.88% and 3.80% for OLL, and 1.71% for OLR. Significant factors on cancer development reported in SR-MTA were the presence of epithelial dysplasia, the consumption of tobacco and alcohol, the infection by the hepatitis C virus, the presence of atrophic and erosive lesions, and the location on the tongue. Only, one of the SRs assessed the quality of evidence, and most of them were judged to be of critically low methodological quality. In conclusion, based on the reported evidence on cancer incidence in OLP, our results reaffirm classifying OLP as an oral potentially malignant disorder. In relation to OLLs and OLRs, larger studies are necessary to provide further scientific evidence in this regard. Future follow-up studies on OLP and related lesions should be carried out under stricter criteria that improve their quality of evidence and methodological quality.

Dysplasia in oral lichen planus: relevance, controversies and challenges. A position paper.

Background Patients with oral lichen planus (OLP) have an increased risk of oral cancer. For this reason, OLP is classified as an oral potentially malignant disorder. However, the precise personal (or individual) risk is unknown. Recent meta-analytical studies have reported that dysplastic OLP may transform to cancer in around 6% of cases, while the rate of transformation is lower (<1.5%) in non-dysplastic cases. The presence of epithelial dysplasia has emerged as the most powerful indicator for assessing cancer risk in oral potentially malignant disorders in routine practice. However, the general acceptance of epithelial dysplasia as an accompanying histologic feature in OLP is subject to great controversy. Many pathologists consider the presence of dysplasia as a criterion to exclude OLP when routinely reporting on this disease. This practice, widespread among oral pathology professionals, has resulted in the underestimation of the potential for malignancy of OLP.Material and Methods A review of the literature was carried out in order to critically analyze the relevance, controversies and challenges encountered across the diagnosis of epithelial dysplasia in OLP.Results 12 studies have been published examining dysplastic changes in OLP, reporting Figures ranging from 0.54% to 25% of cases with dysplasia in the first diagnostic biopsy. The diagnosis of dysplasia in the OLP poses an additional difficulty due to the fact that the affected oral epithelium per se develops changes related to autoimmune aggression. Among the most frequent histological features of OLP that develops dysplasia are basal cell hyperplasia with basaloid appearance, loss of basal cells polarity, cellular and nuclear pleomorphism and irregular stratification.Conclusions Epithelial dysplasia should not be considered an exclusion criterion for OLP; its evaluation requires experienced pathologists in this field. Key words:Oral lichen planus, epithelial dysplasia, oral cancer.

Retraction: Oral leukoplakia, a clinical-histopathological study in 412 patients.

The authors detected some minor errors in the published manuscript (Rubert A, Bagán L, Bagán JV. Oral leukoplakia, a clinical-histopathological study in 412 patients. J Clin Exp Dent. 2020 Jun 1;12(6):e540-e546. doi: 10.4317/jced.57091. PMID: 32665812; PMCID: PMC7335600.) and have requested that the entire article be republished with these errors already rectified. BackgroundA retrospective clinical-histopathological study was made of the evolution of oral leukoplakia over time, staging the disease according to the classification of van der Waal. Material and MethodsA study was made of 412 patients with oral leukoplakia, analyzing the corresponding clinical factors and histopathological findings; assessing associations between the different clinical presentations and epithelial dysplasia; and evaluating the factors influencing malignant transformation of the lesions. ResultsClinically, homogeneous presentations were seen to predominate (n = 336, 81.6%), while histologically most of the lesions exhibited no dysplastic changes (n = 271; 65.7%). Stage 1 of the van der Waal classification was the most common presentation (n = 214; 51.9%). The lesion malignization rate was 8.5%, and the factors associated to a significantly increased malignization risk were non-homogeneous OL lesions (p=0.00), lesion location in the tongue (p=0.00), and the presence of epithelial dysplasia (p=0.00). ConclusionsIn our series of patients with oral leukoplakia, malignization was associated to the less common clinical presentations of the disease, i.e., non-homogeneous lesions, and the latter tended to exhibit high grade epithelial dysplasia. Key words:Oral leukoplakia, potentially malignant disorders, malignant transformation.

Oral leukoplakia, a clinical-histopathological study in 412 patients.

BackgroundA retrospective clinical-histopathological study was made of the evolution of oral leukoplakia over time, staging the disease according to the classification of van der Waal. Material and MethodsA study was made of 412 patients with oral leukoplakia, analyzing the corresponding clinical factors and histopathological findings; assessing associations between the different clinical presentations and epithelial dysplasia; and evaluating the factors influencing malignant transformation of the lesions. ResultsClinically, homogeneous presentations were seen to predominate (n = 336, 81.6%), while histologically most of the lesions exhibited no dysplastic changes (n = 271; 65.7%). Stage 1 of the van der Waal classification was the most common presentation (n = 214; 51.9%). The lesion malignization rate was 8.3%, and the factors associated to a significantly increased malignization risk were non-homogeneous OL lesions (p=0.00), lesion location in the tongue (p=0.00), and the presence of epithelial dysplasia (p=0.00). ConclusionsIn our series of patients with oral leukoplakia, malignization was associated to the less common clinical presentations of the disease, i.e., non-homogeneous lesions, and the latter tended to exhibit high grade epithelial dysplasia. Key words:Oral leukoplakia, potentially malignant disorders, malignant transformation.

Clinical and histopathologic prognostic implications of the expression of cytokeratins 8, 10, 13, 14, 16, 18 and 19 in oral and oropharyngeal squamous cell carcinoma

ObjectivesTo identify cytokeratins (CK) of significant correlations with clinical and histopathologic prognostic parameters in oral and oropharyngeal squamous cell carcinoma (SCC). DesignThe sample consisted of 100 cases retrieved from the archives of the Pathology Department/ King Hussein Cancer Center/Amman/ Jordan. Recorded data included: age, gender, location, grade, depth of invasion, the presence of epithelial dysplasia, tumor size, lymph node metastasis, number of positive lymph nodes, distant metastases, clinical stage, local recurrence, treatment modalities and 5-year survival rate. Immunohistochemical staining of 7 cytokeratins: 8, 10, 13, 14, 16, 18, and 19 was performed using standard protocols. Stained sections were digitized and analyzed using ImageJ-color deconvolution to identify the percentage of cytokeratin-positive area (score). Statistical tests used were: student t-test, analysis of variance, bivariate analysis and logistic regression. ResultsLower CK8,18, 19 scores correlated with lower 5-year survival rate. Higher CK19 and lower CK 10, 14, 16 scores were associated with distant metastasis. Increased CK8, 18, 19 scores correlated with higher stage and with higher depth of invasion. Increased CK18 scores correlated with increased local recurrence. Higher CK10, 13, 16 scores correlated with well-differentiated grade. Higher CK19 and lower CK16 scores were associated with adjacent epithelial dysplasia. Regression analysis showed that better 5-year survival rate was significantly correlated with increased CK16, decreased CK18 and 19 scores. ConclusionExpression scores of a panel of cytokeratin are potential prognostic indicators for 5-year survival and correlates with other prognostic parameters.

Can MMP-9 be a Prognosticator Marker for Oral Squamous Cell Carcinoma?

Invasion and metastasis of malignant tumours severely endanger the life of cancer patients. Squamous cell carcinoma is one of the commonly found malignancies in the oral cavity and its survival rate has not improved from past few decades. Since an important risk factor for oral squamous cell carcinoma is the presence of epithelial dysplasia, it is necessary to check the presence of a prognosticator marker in both of them. As matrix metalloproteinase's (MMP's) are involved in degradation of type IV collagen, which are one of the important components of extracellular matrix components which play a relevant role in several steps of tumour progression such as invasion and metastasis. We have studied MMP-9 expression to evaluate its prognostic potential in oral cancers as well as oral epithelial dysplasia along with tissues of normal oral epithelium. The expression was examined using immunohistochemistry procedure with MMP-9 in 100 samples including cases of epithelium from normal oral mucosa, oral dysplastic lesions and oral squamous cell carcinoma. One set of formalin fixed, paraffin embedded sections of the three categories were stained by haematoxylin and eosin. The sections were then evaluated under microscope. Data was examined for statistical significance using SPSS 13.0 by Mann-Whitney Test and Kruskal-Wallis Test. With MMP-9 gain of expression was noted from Control group to oral squamous cell carcinoma. Cytoplasmic staining was seen with MMP-9. Statistically highly significant differences were seen between oral epithelial dysplasia and oral squamous cell carcinoma and statistically significant differences were found between the control group and the oral squamous cell carcinoma group. This study suggested that oral squamous cell carcinoma shows higher MMP-9 expression as compared to oral epithelial dysplasia followed by epithelium from normal oral mucosa. However, no correlation was found among the histological grades of oral squamous cell carcinoma.

Clinical and histological evaluation of toluidine blue positive and negative stained oral mucosal lesions

Introduction: Screening of suspicious oral precancerous lesions can aid in early detection of oral cancer thus reducing the mortality and morbidity associated with this condition. Incisional biopsy remains a gold standard for diagnosis of oral potentially malignant disorders. Toluidine blue is a basic metachromatic stain that demonstrates affinity for DNA and RNA. It offers a potentially simple, inexpensive, and sensitive chair-side solution for screening of early oral squamous cell carcinoma and high-grade dysplasias. The aim of this study was to assess the reliability of toluidine blue stain as clinical screening test, for presence of epithelial dysplasia in oral mucosal lesions. In this study, biopsy was done in patients with oral pre-malignant lesions to relate their toluidine blue status to outcome as well as to conventional histopathologic features. Method: Study Group consisted of 51 patients with potentially malignant oral mucosal lesions like homogenous leukoplakia (20), non-homogenous leukoplakia (16), erythroplakia (6), oral submucous fibrosis (5) and tobacco pouch keratosis (4). Patients were subjected to toluidine blue vital stain and were observed for positive and negative staining. Biopsy was taken from both toludine blue positive as well as negative lesions and graded for epithelial dysplasia to analyze the role of toludine blue staining in selecting lesions requiring biopsy. Results: Out of 51 lesions 46 cases stained positive with toluidine blue vital stain. The overall sensitivity and specificity of toluidine blue staining in identifying dysplastic lesions was found to be 97.6% and 50% respectively. Conclusion: Staining with toluidine blue was demonstrated to be highly reliable in the detection of dysplasia since false-negative results for the lesions did not occur. Toluidine blue staining can be an adjunct to clinical judgment and not a substitute for either judgment or biopsy. Keywords: Epithelial dysplasia, potentially malignant disorders

舌扁平上皮癌に対するヨード2回染色法の有用性の検討

We examined the usefulness of a double-staining method using iodine solutions of different concentrations for the excision of T1, T2 squamous cell carcinomas （SCCs） of the tongue. We studied 127 patients who were given a diagnosis of T1, T2 SCCs of the tongue at Maxillofacial Surgery, Tokyo Medical and Dental University from 2000 through 2010. The patients were classified into 2 groups. One group, consisting of 89 cases, underwent staining once with 3% iodine solution （single-staining group: Group I）. The other group, consisting of 38 cases, underwent staining with 3% iodine solution and then with 5% iodine solution （double-staining group: Group II）. The excision margin of the lesion was designed to be about 10 mm outside of the border of the unstained areas （USAs） and stained areas （SAs）. Then the lesion was excised. In addition, the borders of the SAs and USAs were examined, and any recurrence after excision was noted. The type of lesion, type of epithelial dysplasia at the surgical margin, and recurrence rate were compared between the two groups. Local recurrence and the presence of epithelial dysplasia at the surgical margin in SCCs cases were seen in 12/127 cases （9.4%） and 58/127 cases （45.7%）, respectively. The numbers of the surgical marginpositive cases were 47/89 cases （52.8%） in Group I and 11/38 （28.9%） in Group II. The rate of SCC recurrence was significantly lower in Group II than in Group I （p=0.01）. The number of cases with local recurrence was 12/89 （13.5%） in Group I, but 0/38 （0%） in Group II. These results suggest that the double-iodine-staining method indicated the border of epithelial dysplasia more clearly than the single-staining method. Therefore,the double-iodine-staining method is useful for determining the excision margin of SCCs of the tongue.

Malignant transformation in 5071 southern Taiwanese patients with potentially malignant oral mucosal disorders.

BackgroundOral cancers can be preceded by clinically evident oral potentially malignant disorders (OPMDs). The current study evaluated the rate and the time of malignant transformation in the various OPMDs in a cohort of patients from southern Taiwan. Parameters possibly indicative for malignant transformation of OPMDs, such as epidemiological and etiological factors, and clinical and histopathological features were also described.MethodsWe followed-up 5071 patients with OPMDs—epithelial dysplasia with oral submucous fibrosis, epithelial dysplasia with hyperkeratosis/epithelial hyperplasia, hyperkeratosis/epithelial hyperplasia, oral submucous fibrosis, lichen planus, and verrucous hyperplasia—between 2001 and 2010 for malignant transformation.ResultsTwo hundred nineteen of these 5071 OPMD patients (202 men, 17 women; mean age: 51.25 years; range: 30–81 years) developed oral cancers (179 squamous cell carcinomas; 40 verrucous carcinomas) in the same sites as the initial lesions at least 6 months after their initial biopsies. The overall transformation rate was 4.32% (mean duration of transformation: 33.56 months; range: 6–67 months). Additionally, the mean time of malignant transformation was significantly shorter for lesions with than without epithelial dysplasia. The risk of malignant transformation was 1.89 times higher for epithelially dysplastic than non-dysplastic lesions. The anatomical site of OPMD and the presence of epithelial dysplasia were significantly associated with malignant transformation. The hazard rate ratio was 1.87 times larger for tongue lesions than for buccal lesions.ConclusionPatients with OPMDs require long-term follow up.

Clinicopathologic assessment of Candida colonization of oral leukoplakia.

Leukoplakia is the most common premalignant lesion of the oral mucosa. We studied the colonization of Candida in oral leukoplakia using direct microscopy, culture and histopathology to determine if there is a statistical correlation between Candida invasion and the clinical appearance and presence of epithelial dysplasia in leukoplakia. Samples were collected from 40 patients with oral leukoplakia and 21 controls. The swabs collected were used to inoculate Sabouraud's dextrose agar slant and for direct microscopy with Gram's stain. Culture growths were subjected to germ tube and corn meal agar tests to differentiate between Candida albicans and non-albicans groups. Biopsies were also done in all patients for histopathological confirmation; Gomori's methanamine silver stain was used to identify fungal invasion of lesional epithelium. Nineteen cases of leukoplakia showed Candida on direct smears, compared to 3 controls. Eighteen cases and one control showed growth of Candida on culture. Non-homogenous leukoplakia showed a higher positivity rate on microscopy and culture than homogenous lesions. All these correlations were statistically significant. Forty percent of leukoplakia cases were simultaneously positive for Candida on direct microscopy, culture and histopathologic evaluation. No significant difference was found between non-dysplastic and distinctly dysplastic lesions with respect to Candida detection on microscopy or culture.