Leucoplasia verrucosa proliferativa X leucoplasias oral: um estudo clínico comparativo e análise crítica dos critérios de diagnóstico

Abstract

The proliferative verrucous leukoplakia (PVL) is a rare entity and was classified as a subtype of oral leukoplakia (OL). It affects more commonly elderly females and tends to recur after any type of treatment. Initially, it presents inconspicuous white lesions that progress to non-homogenous areas and develop verrucous surface, aggressive behavior and multifocal involvement over time. The lesions show a high tendency to transform into squamous cell carcinomas, usually taking years or decades to develop malignancy. There are controversies in the literature regarding the diagnostic criteria for PVL. Some authors follow those proposed on the first PVL report in 1985 which claimed continued follow-up since initial stages until the development of verrucous areas. Others believe that waiting for later stages postpone the diagnosis, worsening the patient´s prognosis. The objective of this study was to evaluate clinical and demographic aspects of patients with PVL and to compare them to patients diagnosed with OL. The diagnostic criteria reported on the literature were also revised. A retrospective study was performed and we analyzed patient´s records of Stomatology Department at FOUSP. Nine files of patients with PVL, diagnosed between 2007 and 2011 and 29 files of individuals with OL between 1997 and 2011 were studied. PVL showed higher incidence among women with no smoking or drinking habits with an average age of 73 years old while OL affected smoking and drinking patients, with a median age of 57 years old, with no gender predilection. PLV lesions progressed over a 5.4-year period while OL lesions took 19.3 months. Clinically, none of the PVL patients presented unifocal homogenous white lesion at the time of diagnosis. All of them showed aggressive and multifocal lesions, varying from homogenous to non homogenous aspect with verrucous surface and erythematous areas. OL individuals showed uni or multifocal white lesions with more restricted behavior. PVL group presented higher recurrence rate when compared to OL group. It is believed that not taking into account patients with multifocal lesions on the first visit can misdiagnose real PVL cases and waiting for the development of verrucous areas postpones the diagnosis and worsens the prognosis. It is suggested that PVL diagnostic criteria should include the presence of multifocal white lesions with aggressive behavior, long-term evolution, recurrences after any type of treatment and excludes the obligation of verrucous aspect on the time of diagnosis.

Uso da inteligência artificial na caracterização nuclear e classificação entre leucoplasia bucal e leucoplasia verrucosa proliferativa

“…Com isso, nosso estudo propõe o uso da IA como uma ferramenta que eleve os critérios adotados atualmente na distinção entre essas duas lesões, diminuindo a margem de dúvidas e melhorando a precisão do diagnóstico com menos subjetividade. Novos estudos são necessários para verificar se esse método pode ser usado nos estágios iniciais das LVPs, quando normalmente são rotuladas como LBs sem qualquer indício de evolução para formas mais agressivas conforme descrito porLanel (2011), o que seria de grande importância na determinação de um diagnóstico precoce das LVPs, aumentando as chances de sucesso no tratamento.7. CONCLUSÃOA partir das investigações conduzidas neste trabalho, o presente estudo mostrou que apesar de histologicamente semelhante, as LBs e LVPs carregam propriedades nucleares distintas e que podem ser usadas para fins de diagnóstico diferencial entre elas e, dessa forma, auxiliando na resolução de um dos grandes desafios da patologia bucal na busca por maneiras mais efetivas e precisas de estabelecer o diagnóstico diferencial entre LB e LVP.…”