Shah Sonal, Waknis Pushkar, Saha Aditi, Setiya Sneha, Ratra Tusha, Vaswani Vibha
Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Vidyapeeth, Pune, India.
J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):99-103. doi: 10.1016/j.jobcr.2020.03.004. Epub 2020 Mar 14.
To improve visualization of suspicious lesions of the oral mucosa and to assess the accuracy of Velscope in assessing cellular changes occurring in oral premalignancy for early diagnosis.
In this prospective, randomized in-vivo clinical study a total of 250 patients who gave history of chewing tobacco were screened. The selection of the site of biopsy was taken based on the area of loss of fluorescence identified by the Velscope within the lesion. Routine blood investigations were done. A biopsy was performed to confirm the findings of clinical examination. The data was collected and analysed.
Among 200 patients only 110 underwent incisional biopsy. Of these only 89 patients showed neoplastic changes. Of the control biopsies, none of them showed any dysplastic changes. Out of 106 who exhibited speckling under autofluorescence, only 89 showed dysplastic changes whereas only 17 showed no dysplastic changes. Out of these 17 specimens, the histopathological diagnosis of 5 was coated tongue, 3 were pigmented lesions, 3 were geographic tongue and 2 were mucositis. Of the remaining 4, the histopathological diagnosis of 1 was oral submucous fibrosis, 1 was lichen planus and 2 were frictional keratosis.
False positive findings are possible in presence of highly inflamed tissues, and it is possible that use of Velscope alone may result in failure to detect regions of dysplasia, but it has its use definitely to improve clinical decision making about the nature of oral lesions and aids in decisions to biopsy regions of concern. Use of the scope has allowed practitioners to identify the best region for biopsy. It is much better to occasionally sample tissue that turns out to be benign than to fail to diagnose dysplastic or malignant lesions. However, poor specificity is a major limitation for using it as a screening tool.
改善口腔黏膜可疑病变的可视化效果，并评估Velsocpe在评估口腔癌前病变中发生的细胞变化以进行早期诊断方面的准确性。
在这项前瞻性、随机体内临床研究中，共筛查了250名有咀嚼烟草史的患者。活检部位的选择基于Velsocpe在病变内识别出的荧光缺失区域。进行了常规血液检查。进行活检以确认临床检查结果。收集并分析数据。
在200名患者中，只有110名接受了切开活检。其中只有89名患者显示出肿瘤性变化。在对照活检中，没有一例显示出任何发育异常变化。在106例在自发荧光下出现斑点的患者中，只有89例显示出发育异常变化，而只有17例未显示出发育异常变化。在这17个标本中，组织病理学诊断为5例为舌苔，3例为色素沉着病变，3例为地图舌，2例为黏膜炎。在其余4例中，组织病理学诊断为1例为口腔黏膜下纤维化，1例为扁平苔藓，2例为摩擦性角化病。
在组织高度炎症的情况下可能出现假阳性结果，仅使用Velsocpe可能无法检测到发育异常区域，但它在改善关于口腔病变性质的临床决策以及辅助决定对可疑区域进行活检方面肯定有其用途。使用该仪器使从业者能够确定最佳活检区域。偶尔对结果为良性的组织进行采样比未能诊断出发育异常或恶性病变要好得多。然而，特异性差是将其用作筛查工具的一个主要限制。
