Gopinath Divya, Thannikunnath Beena Valappil, Neermunda Salmanul Faris
Senior Lecturer, Department of Oral Pathology and Microbiology, Malabar Dental College and Research Centre Edappal , Malappuram, Kerala, India .
Professor and Head, Department of Oral and Maxillofacial Pathology, Government Dental College , Kottayam, Kerala, India .
J Clin Diagn Res. 2016 Aug;10(8):ZC78-83. doi: 10.7860/JCDR/2016/16815.8305. Epub 2016 Aug 1.
Oral Leukoplakia (OL), the most common potentially malignant disorder, is diagnosed clinically on the basis of exclusion of other lesions. In a country like India, where prevalence of oral cancer is very high, the issue of carcinomatous foci within OL at the time of initial diagnosis of leukoplakia has never been addressed before.
To estimate the prevalence and risk factors for epithelial dysplasia as well as carcinoma within OL lesions at the time of initial clinical presentation in an Indian population with high prevalence of tobacco use.
Clinical and pathologic data (age, sex, lesion location and histopathologic grading) of 546 cases of leukoplakia were analyzed. The prevalence rate of dysplasia and carcinoma in 546 oral leukoplakia cases was calculated. Univariate analysis was performed to examine risk factors associated with the presence of carcinoma and dysplasia within the lesions.
The male to female ratio in this study was 2:1. Majority of the patients irrespective of sex had a history of tobacco use. Of the total 85% of non-homogeneous lesions and 70% for the homogeneous lesions were illustrating, features of epithelial dysplasia. The prevalence rate of carcinoma was 11.9%. In univariate analysis it was found that lesion site, clinical appearance, tobacco use were strongly correlated with the presence of carcinoma within OL.
Our results demonstrate that majority of leukoplakia irrespective of its clinical appearance contain a dysplastic component and significant proportion contains carcinomatous foci. Lesions with certain features are more prone to have carcinomatous foci. However there is always a chance of finding foci of carcinoma in OL anywhere in the oral cavity. Therefore, excision biopsy is always mandatory before long term follow-up and treatment is planned.
口腔白斑（OL）是最常见的潜在恶性疾病，临床上通过排除其他病变来诊断。在印度这样一个口腔癌患病率很高的国家，白斑初诊时OL内癌灶的问题此前从未得到解决。
评估在烟草使用率高的印度人群中，OL病变初诊时上皮发育异常及癌的患病率和危险因素。
分析546例白斑患者的临床和病理数据（年龄、性别、病变部位和组织病理学分级）。计算546例口腔白斑病例中发育异常和癌的患病率。进行单因素分析以检查与病变内癌和发育异常存在相关的危险因素。
本研究中男女比例为2:1。大多数患者无论性别都有烟草使用史。在所有病例中，85%的非均质型病变和70%的均质型病变显示有上皮发育异常特征。癌的患病率为11.9%。单因素分析发现病变部位、临床表现、烟草使用与OL内癌的存在密切相关。
我们的结果表明，大多数白斑无论其临床表现如何都含有发育异常成分，且相当比例含有癌灶。具有某些特征的病变更容易有癌灶。然而，在口腔任何部位的OL中都始终有可能发现癌灶。因此，在计划进行长期随访和治疗之前，切除活检总是必不可少的。
