Fluorescence spectroscopy combined with 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in detecting oral premalignancy.
BACKGROUND
Early detection of premalignant/malignant lesions in the oral cavity can certainly improve the patient's prognosis. This study presents fluorescence imaging with the topical application of 5-aminolevulinic as a way to improve detection of various oral tissue pathologies. This procedure depends mainly on comparing the intensity of red and green fluorescence emitted from tissues during examination.


METHODS
Seventy-one patients who presented with clinically suspicious oral leukoplakia were recruited for this study. Each of the patients was required to have 5-aminolevulinic acid in the form of mouth rinse prior to fluorescence imaging. Following this a surgical biopsy was acquired from the exact examination site. The results of the fluorescence spectroscopy have been compared with histopathology.


RESULTS
A Student's t-test was applied to test the viability of the ratio between red and green fluorescence. The red-to-green ratio was found to increase significantly when the lesion was identified as dysplastic or carcinoma in situ. By applying a threshold line to discriminate between normal and dysplastic lesions; a sensitivity of 83-90% and specificity of 79-89% were obtained.


CONCLUSIONS
Fluorescence spectroscopy combined with 5-aminolevulinic acid-induced protoporphyrin IX was found as a valuable tool in the diagnosis of oral premalignancy. This technique offers the potential to be advantageous over other non-optical techniques in terms of providing real-time diagnosis, in situ monitoring, cost effectiveness and more tolerated by patient compared to surgical biopsy.
Sharwani
A
A
Department of Oral and Maxillofacial Surgery, Eastman Dental Institute for Oral Healthcare Sciences, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom.
Jerjes
W
W
Salih
V
V
MacRobert
A J
AJ
El-Maaytah
M
M
Khalil
H S M
HS
Hopper
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid; D001706:Biopsy; D006801:Humans; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018579:Patient Selection; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011524:Protoporphyrins / Q000032:analysis*; D012680:Sensitivity and Specificity; D013050:Spectrometry, Fluorescence / Q000379:methods
D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX