Optical fluorescence imaging in oral cancer and potentially malignant disorders: A systematic review

Abstract

Objectives This study aimed to systematically review the efficacy of direct optical fluorescence imaging as an adjunct to comprehensive oral examination in the clinical evaluation, risk assessment and surgical management of oral cancer and potentially malignant disorders. Methods Studies adopting autofluorescence devices, evaluating the efficacy of comprehensive oral examination and optical fluorescence imaging in detection, visualisation or management of oral squamous cell carcinoma or oral potentially malignant disorders, as well as discriminating oral epithelial dysplasia from other mucosal lesions, were included in the literature search across bibliographic databases until October 2018. Results Twenty‐seven studies were found to be eligible for inclusion in qualitative analysis. Of these, only six studies demonstrated a low risk of bias across all domains of the methodological assessment tool (QUADAS‐2). Optical fluorescence imaging demonstrated positive results, with higher sensitivity scores, increased lesion detection and visualisation than comprehensive oral examination alone in the clinical evaluation of oral squamous cell carcinoma and oral potentially malignant disorders. Conclusions This review provides promising evidence for the utilisation of optical fluorescence imaging as an adjunct to comprehensive oral examination in varying clinical settings. It is important that devices utilising optical fluorescence imaging are viewed strictly as clinical adjuncts and not specifically as diagnostic devices.

Malignant transformation rate of oral leukoplakia in an Australian population

“…These include lesion size, site and homogeneity, as well as patient risk factors such as smoking, alcohol use and age . Adjunctive techniques such as tissue autofluorescence can also provide additional information about the malignant potential of specific lesions . Typically however, lesions must be biopsied and submitted for histopathological assessment and the presence and grade of oral epithelial dysplasia (OED) used to assess the risk of MT .…”

“…Typically however, lesions must be biopsied and submitted for histopathological assessment and the presence and grade of oral epithelial dysplasia (OED) used to assess the risk of MT . Higher risk OLK includes those that are larger, non‐homogeneous, exhibit a loss of autofluorescence on imaging and display features of OED, with the risk increasing with the grade . Proliferative verrucous leukoplakia (PVL) is a particularly aggressive variant of OLK characterised by multifocal lesions and a corrugated clinical appearance, and displays a particularly high MT rate of between 40% and 70% …”

“…7,8 Adjunctive techniques such as tissue autofluorescence can also provide additional information about the malignant potential of specific lesions. 9,10 Typically however, lesions must be biopsied and submitted for histopathological assessment and the presence and grade of oral epithelial dysplasia (OED) used to assess the risk of MT. 11 Higher risk OLK includes those that are larger, non-homogeneous, exhibit a loss of autofluorescence on imaging and display features of OED, with the risk increasing with the grade.…”

“…11 Higher risk OLK includes those that are larger, non-homogeneous, exhibit a loss of autofluorescence on imaging and display features of OED, with the risk increasing with the grade. 8,9 Proliferative verrucous leukoplakia (PVL) is a particularly aggressive variant of OLK characterised by multifocal lesions and a corrugated clinical appearance, and displays a particularly high MT rate of between 40% and 70%. 12 Leukoplakia can be managed by excision of lesions or by review, and there is variable evidence for the effectiveness of these two main approaches.…”

Atypical carcinoma detected after regression of a "benign" oral white lesion. A case report

“…As mentioned above, VELscope® is an instrument based on the difference between autofluorescence of the normal and dysplastic cells -while fluorochromes of healthy cells react to excitation by emitting light of a specific wavelength that can be visualized using a proper filtration, the distribution of the fluorochromes is disrupted in dysplastic cells resulting in their dark appearance during the investigation. Recent reviews by Nagi et al 8 and Tiwari et al 9 reveal the controversy in using VELscope®, with reported results varying from "not worth doing", through "a valuable adjunctive tool" to "an excellent screening tool". The latest study by Shi et al reported an excellent capability of VELscope® to identify high risk lesions (moderate/severe dysplasia/oral carcinoma) from low risk lesions on a cohort of 517 patients 10 .…”