Oral Cancer Screening Adjuncts Flashcards
historically, oral cancer has been detected based on what?
conventional oral examination (COE)
nearly all cases of OSCC arise from what?
precursor epithelial changes –> oral epithelial dysplasia
oral epithelial dysplasia
maturational disturbances of epithelial cells
oral epithelial dysplasia is a histo marker of what?
premalignancy
overall, conventional oral examination (COE) reportedly has good what?
sensitivity and specificity
who is nearly as accurate as dental practitioners when it comes to conventional oral examination (COE)?
trained auxiliaries
what are the limitations of conventional oral examination (COE)?
- many common MIMICS of cancerous and precancerous lesions
- among precancerous lesions, COE cannot determine those that will progress to cancer
- precancerous lesions have been identified in clinically “normal” mucosa
screening test
test used on people apparently free of disease in order to detect the disease in early stages
case-finding test
test used to analyze abnormal clinical finding or symptomatic patient in order to establish or suggest diagnosis
diagnostic aids
- BrushTest - Oral CDx
- ViziLite Plus
- VELscope
- Identafi
- OralID
when is BrushTest indicated?
common, small, harmless-appearing white or red tissue spots that you see at least several times each week
BrushTest is used for lesions NOT suspicious of what?
dysplasia or cancer
instead of performing a BrushTest, what should be done with a suspicious lesion?
immediate scalpel biopsy
negative BrushTest result
no precancerous cells
atypical BrushTest result
abnormal cells
positive BrushTest result
dysplastic cells
incomplete specimen BrushTest result
insufficient cells
T/F: BrushTest result provides a diagnosis
false, does NOT
ViziLite Plus
oral lesion identification and marking system
chemiluminescence
emission of light as result of chemical rxn
chemiluminescence serves a long-standing diagnostic adjunct in detection of what?
premalignant lesions of cervical mucosa
proposed mechanism of chemiluminescence detection
abnormal epithelial cells will have altered reflective properties
normal epithelial cells will appear what when using chemiluminescence?
dark
abnormal epithelial cells will appear what when using chemiluminescence?
acetowhite
ViziLite Plus components
- 1% acetic acid
- disposable light stick
- toluidine blue (TBlue) dye
what is the 1% acetic acid in ViziLite Plus used for?
- removed debris
2. dehydrates epithelial cells
what is toluidine blue (TBlue) dye in ViziLite Plus used for?
to mark lesion location while using regular operatory light
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
true
VELscope
Visually Enhanced Lesion scope
VELscope is based on what concept?
tissue fluorescence
VELscope emits blue light and allows for what?
direct visualization for oral cavity autofluorescence through a selective narrow-band filter
fluorophores
molecules that emit energy in the form of fluorescence when excited by light
examples of fluorophores
- collagen
- elastin
- NADH
- FAD
autofluorescent spectrum is influenced by what?
- concentration of fluorophores
2. absorption and scattering properties of the tissue
normal VELscope result
pale green autofluorescence –> negative VELscope finding
abnormal VELscope result
reduced autofluorescence (appears dark) –> positive VELscope finding
limitations of VELscope
- clinically-relevant distracters are recognized (i.e. inflammation, vascularity, melanin)
- resultant “false-positives” limit the usefulness as screening device
the significance of a given positive finding ultimately rests upon what?
COE and knowledge or experience of clinician
T/F: there is minimal data to support VELscope as a true screening tool
true, >90% false positives
VELscope can be used to identify what?
extent of lesional tissue for surgical margin delineation –> case-finding role
T/F: preliminary evidence indicates that VELscope extends detection of oral cancer and precancer margins beyond conventional exam alone
true
Identafi is based on what?
multi-spectral fluorescence and reflectance spectroscopy
what are the 3 color wavelengths used sequentially in Identafi?
- white
- violet
- amber
what is white light used for in Identafi?
for conventional oral exam
what is violet light used for in Identafi?
for observing tissue fluorescence
abnormal mucosa will appear what in Identafi?
appear dark (loses fluorescence)
what is amber light used for in Identafi?
for observing reflectance and vasculature
what light is used if suspected abnormalities are detected via Identafi?
amber light
Identafi allows clinician to directly observe the difference between what?
normal and abnormal tissue vasculature
OralID incorporates what?
fluorescence technology and liquid-based cytology
OralID is anticipated to have comparable performance to what?
VELscope and Brush Test
T/F: there are currently techniques being developed using molecular analysis to look for specific biomarkers or genetic alterations
true
high-risk sites for oral dysplasia and oral cancer
- ventro-lateral tongue
- floor of mouth
- lateral soft palate/anterior tonsillar pilars
what are some suspicious physical features?
- crisply defined red (erythroplakia), white
(leukoplakia) or mixed red and white
(erythroleukoplakia) lesions - persistent ulceration (despite conservative tx measures)
- induration
what is currently our best defense?
- patient education to raise awareness of oral cancer and the importance of oral examination
- careful visual and tactile examination with good clinical judgement
