Thomson P J, Hamadah O
Oral & MaxilloFacial Surgery, School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place NE2 4BW, UK.
Oral Oncol. 2007 Jan;43(1):20-6. doi: 10.1016/j.oraloncology.2005.12.019. Epub 2006 Jun 6.
Field cancerisation within the oral cavity risks multiple primary tumour development. Whilst multi-focal disease may ultimately affect up to 24% of oral cancer patients, a particular management problem is encountered with those patients presenting with pan-oral dysplasia. In an attempt to characterise the extent of dysplasia and to quantify the risk of malignant change, examination under anaesthesia (EUA) and multiple, 'field mapping biopsies' were carried out for 16 consecutive patients presenting with pan-oral disease. Seventy lesions, predominantly homogenous leukoplakias, were biopsied primarily showing hyperkeratosis or mild dysplasia histologically. More significant dysplasia was seen to affect the faucial pillars, floor of mouth and ventral tongue. Interventional CO(2) laser surgery was used to excise 11 severely dysplastic lesions in six patients. Field mapping appears effective in the initial identification and treatment of the most significant areas of dysplasia in patients with multi-focal precancer. Longitudinal, multi-centre trials are now required.
口腔内的场癌化存在多个原发性肿瘤发生的风险。虽然多灶性疾病最终可能影响多达24%的口腔癌患者，但对于那些表现为全口发育异常的患者，会遇到一个特殊的管理问题。为了确定发育异常的程度并量化恶变风险，对16例连续出现全口疾病的患者进行了麻醉下检查（EUA）和多次“场域映射活检”。对70个病变进行了活检，主要是均质型白斑，组织学上主要表现为角化过度或轻度发育异常。更显著的发育异常见于咽柱、口底和舌腹。对6例患者的11个重度发育异常病变采用介入性二氧化碳激光手术进行切除。场域映射似乎在多灶性癌前病变患者最显著的发育异常区域的初步识别和治疗中有效。现在需要进行纵向、多中心试验。
