Evaluation of Diagnostic Aids Flashcards

1
Q

Historically, oral cancer detection has been based on _______ _______ ______.

A

conventional oral examination (COE)

-visual and tactile

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2
Q

Nearly all cases of ______ arise from precursor epithelial changes.

A

OSCC

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3
Q

What do most cases of OSCC arise from?

A

precursor epithelial changes (oral epithelial dysplasia)

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4
Q

What is oral epithelial dysplasia?

A

maturational disturbances of epithelial cells

-histopathological marker of premalignancy

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5
Q

What proportion of the epithelium stains dark (dysplastic) in a sample of normal tissue? Mild Dysplasia? Severe dysplasia? Carcinoma in-situ?

A

Normal: 1/3
Mild: 1/2
Severe: 3/4
In-situ: entire thickness

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6
Q

True or False: Overall, COE has a good sensitivity and specificity.

A

True

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7
Q

What is the sensitivity percentage for COE? the specificity for COE?

A

sensitivity: 85%
specificity: 97%

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8
Q

True or False: Trained auxiliaries are as accurate as dental practitioners in detecting oral cancer.

A

True

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9
Q

What are three limitations of COE?

A
  1. Many common mimics of cancerous and precancerous lesions
  2. Cannot determine which lesions will progress to cancer
  3. Precancerous lesions have been found in normal mucosa
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10
Q

What is a “screening test?”

A

test used on people apparently free of disease in order to detect the disease in early stages

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11
Q

A ______ test is used to analyze abnormal clinical findings or symptomatic patient in order to establish or suggest dianosis.

A

case-finding test

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12
Q

Of the discussed diagnostic aids, which one is a case-finding test?

A

Brush Test Oral CDx (previously “brush biopsy”)

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13
Q

What is the indication for the Brush Test Oral CDx?

A

“to test the common, small, harmless-appearing white or red tissue spots” that are found on clinical examination.

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14
Q

True or False: The Brush Test provides a diagnosis based on cell culture.

A

False, does NOT provide a diagnosis. Only 1 of 4 “results”

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15
Q

What are the four results that are provided by Brush Test?

A

Incomplete Specimen (not enough cells)
Negative (no precancerous cells)
Atypical (abnormal cells)
Positive (dysplastic cells)

P.A.I.N…as in, this stuff is a pain to study

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16
Q

The Brush Test has recorded several false _____ results.

A

negative

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17
Q

Which of the Diagnostic Aids are “screening” tests?

A
  • ViziLite Plus
  • VELscope
  • Identafi
  • OralID
18
Q

What are the three components of ViziLite Plus?

A
  1. 1% acetic acid (dries tissue)
  2. Disposable light stick
  3. Toluidine Blue Dye

ViZi uses “T”

19
Q

True or False: TBlue Dye is very specific to dysplastic cells.

A

False, stains any surface abnormality (false positives)

**ViziLite is unable to discriminate normal tissue from premalignancy*

20
Q

ViziLite uses ______ which is the emission of light as the result of a chemical reaction.

A

Chemiluminescence

21
Q

What is the proposed mechanism of detection associated with chemiluminescence?

A

abnormal cells will have altered reflective properties. Normal cells will appear dark, Abnormal = acetowhite

22
Q

_______ is a diagnostic aid that is based on the concept of tissue fluorescence.

A

VELscope

23
Q

The VELscope emits _____light at 400-460nm and allows for direct visualization through a narrow-band filter. What color will “normal tissue” appear? What color will “abnormal tissue” appear?

A

blue
pale green = normal
dark = abnormal

24
Q

_____ are molecules that emit energy in the form of fluorescence when excited by light. What are some examples?

A

Fluorophores

ex: collagen, elastin, NADH, FAD

25
Q

Through the ViziLite, abnormal tissue appears ______. Through the VELscope, abnormal tissue appears ______.

A
ViziLite = white   (lite...white)
VELscope = dark
26
Q

Minimal data supports the role of ViziLite as a screening tool due to its false ____.

A

false + (90%)
and
false - (15 cases)

27
Q

In what other way might VELscope be beneficial?

A

allows for detection of cancer or precancer borders beyond conventional examination alone (visualizing the extend of margins for biopsy)

shows us the “scope” of the lesion

28
Q

Identafi is a diagnostic aid based on ____-_____ fluorescence and reflectance _________.

A

multi-spectral

spectroscopy

29
Q

True or False: Identafi is hand-held and cordless.

A

True

30
Q

How many “color wavelengths” does Identafi use?

A

Three: white, violet, amber

31
Q

Which color is used for the conventional oral exam (Identafi)?

A

white

32
Q

What is the violet color used for (Identafi)?

A

for observing tissue fluorescence (abnormal mucosa appears dark)

33
Q

When is the amber color used (Identafi)?

A

when suspected abnormalities are detected

-amber light shows reflectance and vasculature

34
Q

Why is the amber light detection of vascularity questionable?

A

there is no magnification included (how could details possibly be seen)

35
Q

True or False: The clinical application of Identifi has not been proven.

A

True

36
Q

______ incorporates fluorescence technology with liquid-based cytology.

A

Oral ID

37
Q

True or False: Oral ID has comparable performance to VELscope and BrushTest.

A

True

38
Q

____% of oral cancer is diagnosed in Stage III-IV

A

63

39
Q

What are the high risk sites for oral cancer and dysplasia?

A

ventro-lateral tongue
floor of mouth
lateral soft palate (anterior tonsillar pilars)

40
Q

The “High Risk Zone” for oral cancer accounts for ___% of total oral surface, but ____% of cancerous lesions occur in this area.

A

20% of area

80% of lesions

41
Q

What are the suspicious physical features that we must watch for?

A
  • crisply defined red, white, or mixed-red-white lesions
  • persistent ulceration (despite treatment)
  • induration
42
Q

What are the two best ways to defend against oral cancer?

A
  1. Patient education to raise awareness of oral cancer and the importance of oral examination
  2. careful visual and tactile examination with good judgement