A prospective study to assess in vivo optical coherence tomography imaging for early detection of chemotherapy‐induced oral mucositis

Abstract

Background and Objective Oral mucositis (OM) is a common and severe complication of many cancer therapies. Currently, prediction and early detection are not possible and objective monitoring remains problematic. Goal of this prospective study is to assess non-invasive imaging using optical coherence tomography (OCT) for early detection and evaluation of chemotherapy-induced OM in 48 patients, 12 of whom developed clinical mucositis. Study Design/Materials and Methods In 48 patients receiving neoadjuvant chemotherapy for primary breast cancer, oral mucosal health was assessed clinically, and imaged using non-invasive OCT. Images were evaluated for mucositis using an imaging-based scoring system ranging from 0 to 6. Conventional clinical assessment using the OM assessment scale (OMAS) was used as the gold standard. Patients were evaluated on Days 0–11 after commencement of chemotherapy. OCT images were visually scored by three blinded investigators. Results The following events were identified from OCT images (1) change in epithelial thickness and subepithelial tissue integrity (beginning on Day 2), (2) loss of surface keratinized layer continuity (beginning on Day 4), (3) loss of epithelial integrity (beginning on Day 4). Imaging data gave higher scores compared to clinical scores early in treatment, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. Conclusion Using OCT imaging and a novel scoring system, earlier, more sensitive detection of mucositis was possible than using OMAS. Specific imaging-based changes were a consistent predictor of clinical mucositis.

The potential role of in vivo optical coherence tomography for evaluating oral soft tissue: A systematic review

“…Seven of the 27 articles examined the oral cavity, connecting it to a wider systemic framework. In particular, three articles aimed to seek in‐the‐mouth damages caused by chronic degenerative diseases: di Stasio et al scanned the marginal gingiva of a patient with oral pemphigus vulgaris, capturing an image of an intraepithelial blister; Grulkowski et al evaluated the progressive condition of volumetric and quantitative reduction in LMSG in Sjögren's syndrome; Robakidze et al used the accessibility of the oral cavity to develop an integrative diagnostic method of intestinal biopsy for the differential diagnosis of the inflammatory bowel diseases, Crohn's disease, and ulcerative colitis, arriving at statistically significant results that agreed with the histological examination.…”

“…Kawakami‐Wong et al and Calantog et al employed OCT to study the oral mucosa of patients undergoing chemotherapy, considering various conditions associated with mucositis: the absence of clinical signs, mucosal erythema, microulceration, frank open ulceration, surface necrosis and sloughing, and mucosal breakdown and healing. The two research groups used different OCT devices.…”

“…Kawakami‐Wong et al exploited the potential of phase‐resolved OCT (PR‐OCT), which takes into account both the amplitude and the phase of the light reflected from the sample, proving particularly useful in evaluating the velocity of biological fluid flow . Calantog et al instead used a conventional OCT device. The authors concluded that chemotherapy‐induced oral changes can be identified using OCT prior to their clinical manifestation.…”

“…However, based on the same basic principles, different devices allow inspection of the tissues with different parameters and different techniques, making comparisons among results obtained by the various research groups difficult. In 13 of the 27 studies, the oral mucosa was examined with a commercial OCT apparatus (seven different types of equipment); the remaining 14 used an OCT system developed by the authors.…”

Differences in the whole saliva baseline proteome profile associated with development of oral mucositis in head and neck cancer patients undergoing radiotherapy

“…However, currently prediction of onset and severity of OM is not possible and thus early detection is not feasible, but limited to diagnosis and classification by its clinical manifestations [11]. Understanding the molecular details of the pathogenesis of OM will eventually allow the early identification of patients prone to develop early OM, but also facilitate close monitoring and characterization of this side effect [5].…”