Usefulness of optical coherence tomography as an adjunct diagnostic tool in the detection of oral squamous cell carcinoma: An in vitro study / Ali Yassen Obade
Objective: To correlate OCT imaging with histopathological diagnosis of biopsy specimen; To identify the structural change in oral cancers biopsy specimens by OCT; To evaluate OCT capability of defining the indication for surgical biopsy and measure the accuracy of the OCT findings with the final...
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| Format: | Thesis |
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2017
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| Online Access: | http://studentsrepo.um.edu.my/10335/ http://studentsrepo.um.edu.my/10335/4/ali.pdf |
| Summary: | Objective: To correlate OCT imaging with histopathological diagnosis of biopsy
specimen; To identify the structural change in oral cancers biopsy specimens by OCT;
To evaluate OCT capability of defining the indication for surgical biopsy and
measure the accuracy of the OCT findings with the final diagnosis.
Material and method: This prospective study included 52 oral lesions from 44 patients
(male = 21, female = 23). Surgical biopsies (excisional = 23, incisional = 29) were
obtained under local anesthesia. Two assessors (surgeon and pathologist) examined
OCT images of 52 samples in two separate sessions. In first session, they were asked to
evaluate the mucosal architectural status including keratin layer (KL), epithelial layer
(EP), lamina propria (LP), basement membrane (BM) and the reflection’s degree of
epithelial layer (EP Re.) and report biopsy need. In the second session, the same two
assessors reassessed the OCT images in the same manner of the first session. Firstly,
they were asked to give a differential diagnosis for that lesion based only on the brief
clinical history and secondly, they were required to score on the five OCT variables and
based on that they were asked to report the OCT agreement (agree, disagree) with their
clinical differential diagnosis that they had made earlier. The inter-observer agreement
(first and second session) and intra-observer agreement were calculated using Kappa
scores. The sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV), and the accuracy of COE, OCT and combined (COE + OCT) were also
calculated.
Results: The histopathological results showed there were SCC (14), verrucous
carcinoma (1), epithelial dysplasia (7), epithelial hyperkeratosis (1), epithelial
hyperplasia (1), and OLP (5). Other lesions included were mucoceles and pyogenic
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granuloma (4 each), traumatic eosinophilic ulcer, fibroepithelial polyps and traumatic
neuroma (3 each), irritation fibroma, squamous cell papilloma, oral melanotic macule,
lymphedema, hemangiolymphangioma and inflamed mucosa (1 each). Sn, Sp, NPV,
PPV and Ac for 1st assessor were 86%, 77%, 88%, 73% and 81% (COE), 95%, 80%,
96%, 78% and 87% (OCT), 95%, 77%, 96%, 75% and 85% (combined), while for the
2nd assessor 91%, 70%, 91%, 69% and 79% (COE), 95%, 71%, 96%, 69% and 81%
(OCT), 96%, 72%, 95%, 73% and 83% (combined). Kappa score of inter-observer
agreement was 0.92 for biopsy need.
Conclusion: Optical coherence tomography (OCT) is a non-invasive technique with a
high-resolution capability that is considered a useful tool for obtaining cross-sectional
real-time images for different parts of the human body. Basement membrane is
considered a key parameter in the detection of oral cancer and for differentiating it from
other oral pathological conditions. The EP thickness and its degree of reflection are
valuable parameters for recognizing healthy tissues from most pathological conditions,
but, they cannot be considered as accurate diagnostic criteria to discriminate between
the dysplastic epithelium and benign oral tissues. Overall OCT is a promising optical
technique that might be able to define the grades of oral dysplasia in the near future
with the continuous increase in its resolution capability.
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