The use of Velscope to assess cellular changes occuring in oral premalignancy

Abstract

To improve visualization of suspicious lesions of the oral mucosa and to assess the accuracy of Velscope in assessing cellular changes occurring in oral premalignancy for early diagnosis. Materials and methods: In this prospective, randomized in-vivo clinical study a total of 250 patients who gave history of chewing tobacco were screened. The selection of the site of biopsy was taken based on the area of loss of fluorescence identified by the Velscope within the lesion. Routine blood investigations were done. A biopsy was performed to confirm the findings of clinical examination. The data was collected and analysed. Results: Among 200 patients only 110 underwent incisional biopsy. Of these only 89 patients showed neoplastic changes. Of the control biopsies, none of them showed any dysplastic changes. Out of 106 who exhibited speckling under autofluorescence, only 89 showed dysplastic changes whereas only 17 showed no dysplastic changes. Out of these 17 specimens, the histopathological diagnosis of 5 was coated tongue, 3 were pigmented lesions, 3 were geographic tongue and 2 were mucositis. Of the remaining 4, the histopathological diagnosis of 1 was oral submucous fibrosis, 1 was lichen planus and 2 were frictional keratosis. Conclusion: False positive findings are possible in presence of highly inflamed tissues, and it is possible that use of Velscope alone may result in failure to detect regions of dysplasia, but it has its use definitely to improve clinical decision making about the nature of oral lesions and aids in decisions to biopsy regions of concern. Use of the scope has allowed practitioners to identify the best region for biopsy. It is much better to occasionally sample tissue that turns out to be benign than to fail to diagnose dysplastic or malignant lesions. However, poor specificity is a major limitation for using it as a screening tool.

To Evaluate the Efficacy of Tissue Autofluorescence (Velscope) in the Visualization of Oral Premalignant and Malignant Lesions among High-Risk Population Aged 18 Years and Above in Haroli Block of Una, Himachal Pradesh

“…Thus, false-negative results were given by these lesions which affected the sensitivity of the device. These results of the study suggest that the Velscope cannot accurately differentiate between dysplastic and non-dysplastic lesions and are in agreement with various studies[ 23 24 ] who stated that autofluorescence has low specificity for dysplasia and malignant lesions. 45 cases of oral submucous fibrosis (OSF) were included in the present study demonstrating both autofluorescence patterns with focal areas of FVL interspersed between areas of FVR [ Table 2 ].…”

“…Lesions showing FVR and both autofluorescence characteristics could be due to overlap in the wavelengths of healthy oral mucosa (between 375 and 440 nm) and fibrosis (between 380 and 460 nm)[ 25 ] Physical and chemical irritation is caused by Areca nut and its metabolites which results in microtrauma and inflammation of the underlying mucosa. [ 24 26 ] The focal areas of FVL seen in OSF could be due to changes in metabolic activity of the inflamed mucosa. These lesions have a malignant transformation rate of 7–13%.…”

May VelScope Be Deemed an Opportunistic Oral Cancer Screening by General Dentists? A Pilot Study

“…Another critical aspect of the auto-fluorescence observed in literature is the presence of false positives. The percentage of false positives is much higher in groups of patients with reactive or not dysplastic alterations because many inflammatory lesions may show LAF due to the presence of vascular inflammatory modifications (hyperemia and vasodilatation) [25]. In our study, we observed only two cases of false positives (5.71%) in s-GD and 6 (17.14%) in u-GD.…”

Evaluation of Oral Mucosal Lesions Using the IllumiScan® Fluorescence Visualisation Device: Distinguishing Squamous Cell Carcinoma

“…However, the use of the device by unskilled users can lead to high false-positive results because of misinterpretation. Furthermore, it has been reported that the device should not be used at the screening stage as false positives may lead to unnecessary referrals and biopsies [ 27 , 28 ]. However, there have been reports of an increase in specificity from 8% to 10% when the FV device was used in addition to conventional oral cavity examination for the detection of epithelial dysplasia and OPMDs, even if the clinician was not specifically trained in the use of the FV device [ 29 ].…”