Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Center Rostock, Rostock, Germany.
Faculty of Medicine, Institute of Anatomy, University of Leipzig, Leipzig, Germany.
J Oral Pathol Med. 2017 Nov;46(10):911-920. doi: 10.1111/jop.12613. Epub 2017 Jul 28.
Uncertainties in detection of oral epithelial dysplasia (OED) frequently result from sampling error especially in inflammatory oral lesions. Endomicroscopy allows non-invasive, "en face" imaging of upper oral epithelium, but parameters of OED are unknown.
Mucosal nuclei were imaged in 34 toluidine blue-stained oral lesions with a commercial endomicroscopy. Histopathological diagnosis showed four biopsies in "dys-/neoplastic," 23 in "inflammatory," and seven in "others" disease groups. Strength of different assessment strategies of nuclear scoring, nuclear count, and automated nuclear analysis were measured by area under ROC curve (AUC) to identify histopathological "dys-/neoplastic" group. Nuclear objects from automated image analysis were visually corrected.
Best-performing parameters of nuclear-to-image ratios were the count of large nuclei (AUC=0.986) and 6-nearest neighborhood relation (AUC=0.896), and best parameters of nuclear polymorphism were the count of atypical nuclei (AUC=0.996) and compactness of nuclei (AUC=0.922). Excluding low-grade OED, nuclear scoring and count reached 100% sensitivity and 98% specificity for detection of dys-/neoplastic lesions. In automated analysis, combination of parameters enhanced diagnostic strength. Sensitivity of 100% and specificity of 87% were seen for distances of 6-nearest neighbors and aspect ratios even in uncorrected objects. Correction improved measures of nuclear polymorphism only. The hue of background color was stronger than nuclear density (AUC=0.779 vs 0.687) to detect dys-/neoplastic group indicating that macroscopic aspect is biased.
Nuclear-to-image ratios are applicable for automated optical in vivo diagnostics for oral potentially malignant disorders. Nuclear endomicroscopy may promote non-invasive, early detection of dys-/neoplastic lesions by reducing sampling error.
口腔上皮异型增生（OED）的检测存在不确定性，主要是由于采样误差，尤其是在炎症性口腔病变中。内窥式显微镜可实现对上口腔上皮的非侵入性、“直面”成像，但 OED 的参数尚不清楚。
采用商业内窥式显微镜对 34 例甲苯胺蓝染色的口腔病变进行黏膜核成像。组织病理学诊断显示，4 例活检为“异型/肿瘤性”，23 例为“炎症性”，7 例为“其他”疾病组。通过 ROC 曲线下面积（AUC）来衡量核评分、核计数和自动核分析的不同评估策略的强度，以识别组织病理学“异型/肿瘤性”组。从自动图像分析中提取的核对象经人工视觉校正。
核与图像比值的最佳参数是大核计数（AUC=0.986）和 6 个最近邻关系（AUC=0.896），核多形性的最佳参数是异型核计数（AUC=0.996）和核紧密度（AUC=0.922）。排除低级别 OED 后，核评分和计数对异型/肿瘤性病变的检出率达到 100%的灵敏度和 98%的特异性。在自动分析中，参数组合提高了诊断能力。即使在未经校正的对象中，6 个最近邻距离和纵横比的距离也可达到 100%的灵敏度和 87%的特异性。校正仅改善了核多形性的指标。背景颜色的色调强于核密度（AUC=0.779 比 0.687），可用于检测异型/肿瘤性组，表明宏观方面存在偏差。
核与图像比值适用于口腔潜在恶性疾病的自动光学体内诊断。核内窥式显微镜可以通过减少采样误差来促进异型/肿瘤性病变的非侵入性、早期检测。
