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Oral Path 2, Exam 4 > Oral Cancer Screening Adjuncts > Flashcards

Oral Cancer Screening Adjuncts Flashcards

1
Q

Historically, what has oral cancer detection been based on?

A

Conventional oral examination

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2
Q

What do nearly all cases of OSCC arise from?

A

Precursor epithelial changes (oral epithelial dysplasia)

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3
Q

T/F: Conventional oral examination does not have good sensitivity or specificity

A

False - it has good sensitivity (85%) and specificity (97%)

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4
Q

T/F: Trained auxiliaries are not as accurate in detection as dental practitioners

A

False - they are nearly as accurate

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5
Q

3 limitations to conventional oral examination

A
  1. Common “mimics” of cancer and precancer lesions
  2. Cannot determine lesions that will progress to cancer
  3. Precancerous lesions have been IDed in clinically “normal” mucosa
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6
Q

5 Diagnostic Aids

A
  1. BrushTest-Oral CDx
  2. VixiLite Plus
  3. VELscope
  4. Identafi
  5. OralID
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7
Q

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

A

Screening test

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8
Q

Test used to analyze abnormal clinical finding or symptomatic patient in order to establish or suggest diagnosis

A

Case-finding test

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9
Q

Is the brush test a screening or case-finding test?

A

Case-finding

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10
Q

What was the brush test originally called?

A

Brush-biopsy

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11
Q

What is the Brush Test indicated?

A

To test the common, small, harmless-appearing white or red tissue spots that you see at least several times each week (FEATURES NOT SUSPICIOUS FOR DYSPLASIA OR CANCER)

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12
Q

What do you do if you have a suspicious lesion?

A

Immediate scalpel biopsy

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13
Q

What do the results of a Brush test mean if they are negative? Atypical? Positive? Incomplete specimen?

A

Negative - no precancerous cells
Atypical - abnormal cells
Positive - dysplastic cells
Incomplete specimen - insufficient cells

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14
Q

T/F: a brush test provides a diagnosis

A

False

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15
Q

What are 3 experimental design flaws of the brush-test? What do those flaws result in?

A
  1. Inclusion of suspicious lesions
  2. Inconsistent comparison to scalpel biopsy
  3. False-negatives reported

Result in inaccurate estimates of sensitivity/specificity

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16
Q

Is ViziLite Plus a screening or case-finding test?

A

Screening

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17
Q

Is VELscope a screening or case-finding test?

A

Screening

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18
Q

Is Identafi a screening or case-finding test?

A

Screening

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19
Q

Is OralID a screening or case-finding test?

A

Screening

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20
Q

What kind of system is ViziLite Plus?

A

An oral lesion identification and marking system

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21
Q

The emission of light as the result of a chemical reaction

A

Chemiluminescence

22
Q

What will normal cells look like in chemiluminescence? What will abnormal cells look like?

A 
Normal = dark
Abnormal = "acetowhite"
23
Q

3 Components of ViziLite Plus?

A
  1. 1% Acetic Acid
  2. Disposable light stick
  3. Toluidine blue (TBlue dye)
24
Q

What is the role of 1% acetic acid

A

Removes debris, dehydrates epithelial cells

25
Q

What is the role of TBlue dye?

A

Used to mark lesion location while using regular operatory light

26
Q

What are experimental design flaws with ViziLite Plus?

A

Infrequent correlation to scalpel biopsy - unable to discriminate benign from pre-malignant lesions

27
Q

T/F: ViziLite improves detection of oral lesions beyond conventional examination alone

A

False - there is no clear evidence

28
Q

What does VEL stand for in VELscope?

A

Visually Enhanced Lesion Scope

29
Q

VELscope is based on what concept?

A

Tissue fluorescence

30
Q

What color light does VELscope emit?

31
Q

Molecules that emit energy in the form of fluorescence when excited by light

A

Fluorophores (ex: collagen, elastin, NADH, FAD)

32
Q

What 2 things are the autofluorescent spectrum influenced by?

A
  1. Concentration of fluorophores

2. Absorption and scattering properties of the tissue

33
Q

In VELscope, what will normal cells look like? Abnormal?

A 
Normal = pale GREEN (negative finding)
Abnormal = DARK (positive finding)
34
Q

T/F: VELscope is considered a true screening tool

A

False - minimal evidence to support role as a true screening tool

35
Q

What is the main concern with VELscope?

A

False-positive (> 90%) and false-negative results

36
Q

What results in false-positives with VELscope?

A

Clinically relevant distracters are recognized (ex: inflammation, vascularity, melanin)

37
Q

What does the significance of a positive VELscope finding rely on for confirmation?

A

Conventional oral exam and knowledge/experience of clinician

38
Q

How can VELscope (a screening test) have a case-finding role?

A

ID of extent of lesional tissue for surgical margin delineation (extends detection beyond conventional exam alone)

39
Q

What is Identafi based on?

A

Multi-spectral fluorescence and reflectance spectroscopy

40
Q

3 color wavelengths in Identafi

A
  1. White
  2. Violet
  3. Amber
41
Q

What is the white light in Identafi used for?

A

For conventional oral exam

42
Q

What is the violet light in Identafi used for?

A

For observing tissue fluorescence (abnormal appears dark)

43
Q

What is the amber light in Identafi used for?

A

When suspected abnormalities are detected…For observing reflectance and vasculature

44
Q

What might the assessment of the confounder in the Identafi system reduce?

A

False-positive test results

45
Q

Oral ID incorporates ____ technology and _____-____ ____

A

Fluorescence

Liquid-based cytology

46
Q

OralID is anticipated to be comparable in performance to ____ and _____

A

VELscope and Brush Test

47
Q

What is the goal for techniques in the future?

A

Molecular analyses that look for specific biomarkers and genetic alterations

48
Q

What is the biggest problem in oral cancer survival rate?

A

MOST aren’t diagnosed until stage III-IV

49
Q

T/F: OralID can now be implemented into every dental office and everyone can be screened, thus saving more lives

50
Q

3 high risk sites for oral dysplasia and oral cancer

A
  1. Ventro-lateral tongue
  2. FOM
  3. Lateral soft palate/anterior tonsillar pilars
51
Q

3 suspicious physical features

A
  1. Leukoplakia/Erythroplakia/Erythroleukoplakis
  2. Persistent ulceration
  3. Induration
52
Q

2 best defenses

A
  1. Patient education

2. Careful examination

Oral Path 2, Exam 4 (6 decks)

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