Yang Eric C, Tan Melody T, Schwarz Richard A, Richards-Kortum Rebecca R, Gillenwater Ann M, Vigneswaran Nadarajah
Department of Bioengineering, Rice University, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA.
Department of Bioengineering, Rice University, Houston, TX, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Jun;125(6):670-681. doi: 10.1016/j.oooo.2018.02.020. Epub 2018 Mar 9.
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.
潜在的口腔上皮癌前病变（PPOELs）是一组临床上可疑的病症，其中一小部分会发生恶变。在当前的护理标准下，PPOELs的诊断和管理并不理想。发育异常是区分高危PPOELs和低危PPOELs最成熟的标志物，通过活检确定发育异常是诊断的金标准。然而，活检受到发病率、资源需求以及漏诊可能性的限制。诊断辅助手段可能有助于临床医生在进行确定性活检之前更好地评估PPOELs，但现有的辅助手段，如甲苯胺蓝、醋酸白试验和自体荧光成像，准确性较差，一般不被推荐。最近，高分辨率显微内镜、光学相干断层扫描、反射共聚焦显微镜和多光子成像等体内显微镜技术已显示出改善PPOEL患者护理的前景。这些技术使临床医生能够在护理点可视化许多用于组织病理学评估的相同微观特征。
