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| LETTER TO THE EDITOR |
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| Year : 2014 | Volume
: 51
| Issue : 4 | Page : 523 |
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Direct oral microscopy to enhance diagnostic accuracy
A Dave
Department of Oral and Maxillofacial Pathology, SGT Dental College and Hospital, Gurgaon, Haryana, India
| Date of Web Publication | 1-Feb-2016 |
Correspondence Address:
Dr. A Dave
Department of Oral and Maxillofacial Pathology, SGT Dental College and Hospital, Gurgaon, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-509X.175333
How to cite this article:
Dave A. Direct oral microscopy to enhance diagnostic accuracy. Indian J Cancer 2014;51:523 |
Sir,
Oral cancer, worlds sixth most common cancer, remains lethal and disfiguring. [1] Often, it goes undiagnosed in the initial stages. Invariably, the patient ignores the presence of lesion or at times visual examination may be deceptive that the underlying changes cannot be judged. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings.[2] Evaluating the malignant potential may not be easy. Apparently, normal looking mucosa actually may be undergoing an early malignant change. Biopsy has always remained the golden standard for a histopathological diagnosis. But, the selection of right biopsy site paves a right path toward right diagnosis. Here is the need of adjuvant diagnostic tools in selection of biopsy sites. Various techniques like cytology, brush biopsies, toluidine blue, and lugol's iodine have been helpful. Direct oral microscopy has been gaining popularity as better results are achieved. Hans Hinselmann in 1925 introduced colposcopy to visualize cervical epithelium and in screening of cervical neoplasia.[3] The advantages of visualization techniques over cytology has helped in applying it as an diagnostic aid in early detection of invasive carcinomas. Chemiluminescence examination of suspicious lesion appears to give reliable results [1] but cost involved needs to be evaluated. The visualization techniques are based on the fact that mucosal tissue undergoes metabolic and structural changes as it undergoes malignant transformation. There is close relationship between vascularity and tumor progression in oral mucosa.[4] These tumor blood vessels differ from normal vasculature by having altered morphology.[2] The pattern of tumor angiogenesis is different from neovascularization seen during repair and regeneration.[2] These vessels are often twisted and irregular. These altered patterns can be visualized. Application of this technique in selecting oral biopsy sites has not gained much popularity. Based on the principle of direct visualization, few studies have been done in selection of oral biopsy sites and have found to offer advantage in selecting a more representative site for biopsy than just by a routine clinical examination.[2],[4] Visualization of epithelium and subepithelial vascular pattern helps in better judgment of representative site and aids in better treatment planning. Few studies based on Raman spectroscopic methodology and laser-induced fluorescence has been gaining importance in biomedical application.[5]In vivo studies are being carried out. Based on the principle of autofluorescence, fluorescence spectroscopy is gaining a foothold as an effective diagnostic tool.[6] Change in fluorescence is based on structural and biochemical changes taking place with the transformation of the tissue. Careful interpretation is needed in benign reactive lesions which can show similar autofluorescence.[6] Better designing of optical probes will aid in an effective interpretation. Innovations in application of this technology for diagnosing oral lesions are an area for research. An early diagnosis will make oral cancer curable, less disfiguring for the patient, and inexpensive to treat.
| » References | |  |
| 1. | Ram S, Siar CH. Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions. Int J Oral Maxillofac Surg 2005;34:521-7.  |
| 2. | Shetty DC, Ahuja P, Taneja DK, Rathore A, Chinna S, Ahuja U, et al. Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer. Vasc Health Risk Manag 2011;7:41-7. |
| 3. | Olaniyan OB. Validity of colposcopy in the diagnosis of early cervical neoplasia: A review. Afr J Reprod Health 2002;6:59-69. |
| 4. | Gynther GW, Rozell B, Heimdahl A. Direct oral microscopy and its value in diagnosing mucosal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:164-70. |
| 5. | Chilakapati MK, Sockalingum GD, Vidyasagar MS, Manfait M, Fernanades DJ, Vadhiraja BM, et al. An overview on applications of optical spectroscopy in cervical cancers. J Can Res Ther 2008;4:26-36. [ PUBMED]  |
| 6. | Scheer M, Neugebauer J, Derman A, Fuss J, Drebber U, Zoeller JE. Autofluoresence imaging of potentially malignant mucosa lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:568-77. |
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