University of Massachusetts at Boston, Department of Physics, Boston, Massachusetts, United States.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
J Biomed Opt. 2023 Aug;28(8):082809. doi: 10.1117/1.JBO.28.8.082809. Epub 2023 Jul 21.
India has one of the highest rates of oral squamous cell carcinoma (OSCC) in the world, with an incidence of 15 per 100,000 and more than 70,000 deaths per year. The problem is exacerbated by a lack of medical infrastructure and routine screening, especially in rural areas. New technologies for oral cancer detection and timely treatment at the point of care are urgently needed.
Our study aimed to use a hand-held smartphone-coupled intraoral imaging device, previously investigated for autofluorescence (auto-FL) diagnostics adapted here for treatment guidance and monitoring photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence (FL).
A total of 12 patients with 14 buccal mucosal lesions having moderately/well-differentiated micro-invasive OSCC lesions ( diameter and depth) were systemically (in oral solution) administered three doses of ALA (total ). Lesion site PpIX and auto-FL were imaged using the multichannel FL and polarized white-light oral cancer imaging probe before/after ALA administration and after light delivery (fractionated, total of 635 nm red LED light).
The handheld device was conducive for access to lesion site images in the oral cavity. Segmentation of ratiometric images in which PpIX FL is mapped relative to auto-FL enabled improved demarcation of lesion boundaries relative to PpIX alone. A relative FL (-value) threshold of 1.4 was found to segment lesion site PpIX production among the patients with mild to severe dysplasia malignancy. The segmented lesion size is well correlated with ultrasound findings. Lesions for which -value was at the time of treatment were associated with successful outcomes.
These results indicate the utility of a low-cost, handheld intraoral imaging probe for image-guided PDT and treatment monitoring while also laying the groundwork for an integrated approach, combining cancer screening and treatment with the same hardware.
印度是世界上口腔鳞状细胞癌（OSCC）发病率最高的国家之一，发病率为每 10 万人中有 15 人，每年有超过 7 万人死亡。由于医疗基础设施和常规筛查的缺乏，尤其是在农村地区，这一问题更加严重。迫切需要用于口腔癌检测的新技术和在护理点进行及时治疗。
我们的研究旨在使用手持式智能手机耦合口腔内成像设备，该设备先前已针对自发荧光（auto-FL）诊断进行了研究，这里适用于使用 5-氨基酮戊酸（ALA）诱导的原卟啉 IX（PpIX）荧光（FL）进行治疗指导和监测光动力疗法（PDT）。
共有 12 名患者的 14 个颊黏膜病变具有中度/高分化微侵袭性 OSCC 病变（直径和深度），系统地（口服溶液）给予 3 剂 ALA（共）。在 ALA 给药前后和光输送后（分次，共 635nm 红色 LED 光）使用多通道 FL 和偏振白光口腔癌成像探头对病变部位的 PpIX 和 auto-FL 进行成像。
手持式设备有利于获取口腔内病变部位的图像。将 PpIX FL 相对于 auto-FL 进行映射的比率图像进行分割，使得相对于 PpIX 单独对病变边界的划分得到改善。在轻度至重度发育不良恶性肿瘤的患者中，发现相对 FL（-值）阈值为 1.4 以分割病变部位 PpIX 产生。在治疗时 -值为的病变与成功的结果相关。
这些结果表明，低成本的手持式口腔内成像探头可用于图像引导的 PDT 和治疗监测，同时为结合癌症筛查和治疗的综合方法奠定基础，使用相同的硬件。
