title: Autofluorescence-guided surveillance for oral cancer.
abstract: Early detection of oral premalignant lesions (OPL) and oral cancers (OC) is critical for improved survival. We evaluated if the addition of autofluorescence visualization (AFV) to conventional white-light examination (WLE) improved the ability to detect OPLs/OCs. Sixty high-risk patients, with suspicious oral lesions or recently diagnosed untreated OPLs/OCs, underwent sequential surveillance with WLE and AFV. Biopsies were obtained from all suspicious areas identified on both examinations (n = 189) and one normal-looking control area per person (n = 60). Sensitivity, specificity, and predictive values were calculated for WLE, AFV, and WLE + AFV. Estimates were calculated separately for lesions classified by histopathologic grades as low-grade lesions, high-grade lesions (HGL), and OCs. Sequential surveillance with WLE + AFV provided a greater sensitivity than WLE in detecting low-grade lesions (75% versus 44%), HGLs (100% versus 71%), and OCs (100% versus 80%). The specificity in detecting OPLs/OCs decreased from 70% with WLE to 38% with WLE + AFV. Thirteen of the 76 additional biopsies (17%) obtained based on AFV findings were HGLs/OCs. Five patients (8%) were diagnosed with a HGL/OC only because of the addition of AFV to WLE. In seven patients, additional HGL/OC foci or wider OC margins were detected on AFV. Additionally, AFV aided in the detection of metachronous HGL/OC in 6 of 26 patients (23%) with a history of previously treated head and neck cancer. Overall, the addition of AFV to WLE improved the ability to detect HGLs/OCs. In spite of the lower specificity, AFV + WLE can be a highly sensitive first-line surveillance tool for detecting OPLs/OCs in high-risk patients.
authors.affiliation: Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
authors.forename: Vijayvel
authors.initials: V
authors.lastname: Jayaprakash
authors.forename: Maureen
authors.initials: M
authors.lastname: Sullivan
authors.forename: Mihai
authors.initials: M
authors.lastname: Merzianu
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Rigual
authors.forename: Thom R
authors.initials: TR
authors.lastname: Loree
authors.forename: Saurin R
authors.initials: SR
authors.lastname: Popat
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Moysich
authors.forename: Soumya
authors.initials: S
authors.lastname: Ramananda
authors.forename: Timothy
authors.initials: T
authors.lastname: Johnson
authors.forename: James R
authors.initials: JR
authors.lastname: Marshall
authors.forename: Alan D
authors.initials: AD
authors.lastname: Hutson
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Mang
authors.forename: Brian C
authors.initials: BC
authors.lastname: Wilson
authors.forename: Steven R
authors.initials: SR
authors.lastname: Gill
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frustino
authors.forename: Arjen
authors.initials: A
authors.lastname: Bogaards
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult