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AU'18 Oral Path II > Oral Cancer Screening Adjuncts > Flashcards

Oral Cancer Screening Adjuncts Flashcards

1
Q

historically, oral cancer has been detected based on what?

A

conventional oral examination (COE)

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2
Q

nearly all cases of OSCC arise from what?

A

precursor epithelial changes –> oral epithelial dysplasia

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3
Q

oral epithelial dysplasia

A

maturational disturbances of epithelial cells

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4
Q

oral epithelial dysplasia is a histo marker of what?

A

premalignancy

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5
Q

overall, conventional oral examination (COE) reportedly has good what?

A

sensitivity and specificity

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6
Q

who is nearly as accurate as dental practitioners when it comes to conventional oral examination (COE)?

A

trained auxiliaries

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7
Q

what are the limitations of conventional oral examination (COE)?

A
  1. many common MIMICS of cancerous and precancerous lesions
  2. among precancerous lesions, COE cannot determine those that will progress to cancer
  3. precancerous lesions have been identified in clinically “normal” mucosa
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8
Q

screening test

A

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

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9
Q

case-finding test

A

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

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10
Q

diagnostic aids

A
  1. BrushTest - Oral CDx
  2. ViziLite Plus
  3. VELscope
  4. Identafi
  5. OralID
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11
Q

when is BrushTest indicated?

A

common, small, harmless-appearing white or red tissue spots that you see at least several times each week

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12
Q

BrushTest is used for lesions NOT suspicious of what?

A

dysplasia or cancer

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13
Q

instead of performing a BrushTest, what should be done with a suspicious lesion?

A

immediate scalpel biopsy

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14
Q

negative BrushTest result

A

no precancerous cells

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15
Q

atypical BrushTest result

A

abnormal cells

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16
Q

positive BrushTest result

A

dysplastic cells

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17
Q

incomplete specimen BrushTest result

A

insufficient cells

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18
Q

T/F: BrushTest result provides a diagnosis

A

false, does NOT

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19
Q

ViziLite Plus

A

oral lesion identification and marking system

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20
Q

chemiluminescence

A

emission of light as result of chemical rxn

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21
Q

chemiluminescence serves a long-standing diagnostic adjunct in detection of what?

A

premalignant lesions of cervical mucosa

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22
Q

proposed mechanism of chemiluminescence detection

A

abnormal epithelial cells will have altered reflective properties

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23
Q

normal epithelial cells will appear what when using chemiluminescence?

A

dark

24
Q

abnormal epithelial cells will appear what when using chemiluminescence?

A

acetowhite

25
Q

ViziLite Plus components

A
  1. 1% acetic acid
  2. disposable light stick
  3. toluidine blue (TBlue) dye
26
Q

what is the 1% acetic acid in ViziLite Plus used for?

A
  1. removed debris

2. dehydrates epithelial cells

27
Q

what is toluidine blue (TBlue) dye in ViziLite Plus used for?

A

to mark lesion location while using regular operatory light

28
Q

T/F: there is no clear evidence that ViziLite improves detection of oral lesions beyond conventional examination alone thus it is unclear what added benefit ViziLite would provide the practicing clinician

A

true

29
Q

VELscope

A

Visually Enhanced Lesion scope

30
Q

VELscope is based on what concept?

A

tissue fluorescence

31
Q

VELscope emits blue light and allows for what?

A

direct visualization for oral cavity autofluorescence through a selective narrow-band filter

32
Q

fluorophores

A

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

33
Q

examples of fluorophores

A
  1. collagen
  2. elastin
  3. NADH
  4. FAD
34
Q

autofluorescent spectrum is influenced by what?

A
  1. concentration of fluorophores

2. absorption and scattering properties of the tissue

35
Q

normal VELscope result

A

pale green autofluorescence –> negative VELscope finding

36
Q

abnormal VELscope result

A

reduced autofluorescence (appears dark) –> positive VELscope finding

37
Q

limitations of VELscope

A
  1. clinically-relevant distracters are recognized (i.e. inflammation, vascularity, melanin)
  2. resultant “false-positives” limit the usefulness as screening device
38
Q

the significance of a given positive finding ultimately rests upon what?

A

COE and knowledge or experience of clinician

39
Q

T/F: there is minimal data to support VELscope as a true screening tool

A

true, >90% false positives

40
Q

VELscope can be used to identify what?

A

extent of lesional tissue for surgical margin delineation –> case-finding role

41
Q

T/F: preliminary evidence indicates that VELscope extends detection of oral cancer and precancer margins beyond conventional exam alone

A

true

42
Q

Identafi is based on what?

A

multi-spectral fluorescence and reflectance spectroscopy

43
Q

what are the 3 color wavelengths used sequentially in Identafi?

A
  1. white
  2. violet
  3. amber
44
Q

what is white light used for in Identafi?

A

for conventional oral exam

45
Q

what is violet light used for in Identafi?

A

for observing tissue fluorescence

46
Q

abnormal mucosa will appear what in Identafi?

A

appear dark (loses fluorescence)

47
Q

what is amber light used for in Identafi?

A

for observing reflectance and vasculature

48
Q

what light is used if suspected abnormalities are detected via Identafi?

A

amber light

49
Q

Identafi allows clinician to directly observe the difference between what?

A

normal and abnormal tissue vasculature

50
Q

OralID incorporates what?

A

fluorescence technology and liquid-based cytology

51
Q

OralID is anticipated to have comparable performance to what?

A

VELscope and Brush Test

52
Q

T/F: there are currently techniques being developed using molecular analysis to look for specific biomarkers or genetic alterations

A

true

53
Q

high-risk sites for oral dysplasia and oral cancer

A
  1. ventro-lateral tongue
  2. floor of mouth
  3. lateral soft palate/anterior tonsillar pilars
54
Q

what are some suspicious physical features?

A
  1. crisply defined red (erythroplakia), white
    (leukoplakia) or mixed red and white
    (erythroleukoplakia) lesions
  2. persistent ulceration (despite conservative tx measures)
  3. induration
55
Q

what is currently our best defense?

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

AU'18 Oral Path II (31 decks)

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