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Detection of Oral Pathologies Using Optical Coherence Tomography
but some studies suffered from poor-resolution images and poor OCT Microscope V1.0) (see Figure 1) to compare findings of OCT with
penetration depth.
14–16
histopathology of various oral lesions to see whether this technique
could be used as an adjunct to histopathology in assessing oral
Successful Optical Coherence Tomography Studies on leukoplakias and erythroplakias (see Figure 2).
Head and Neck Tissues
Ridgway et al. examined the mucosa of the oral cavity and the Twenty-four oral lesions from 19 patients with suspicious oral lesions
oropharynx using OCT in 41 patients during operative endoscopy. were excised and subjected to OCT. The acquired OCT images were
OCT imaging was combined with endoscopic photography for gross then compared with histopathology images. Epithelium, basement
and histological image correlation. They found that OCT images of membrane, lamina propria, microanatomical histological structures
and pathological processes were clearly identified. Normal
microanatomical structures identified in these tissues included the
Histopathology continues to be the overlying keratin layer, papillae, ducts, glands and blood vessels.
complementary objective ‘gold
Regions of pathological features studied included leukoplakias and
erythroplakias (see Figure 3). Areas of architectural changes were
standard’ to visual examination in the
clearly visible and correlated well with the histopathological slides to a
diagnosis of abnormal oral lesions.
depth of approximately 1.5mm (see Figure 4). It was concluded that
OCT can identify various histological structures as well as pathological
changes that occur in these tissues.
the oral cavity and oropharynx provided microanatomical information
on the epithelium, basement membrane, and supporting lamina The Future
propria of the mucosa. OCT imaging showed distinct zones of normal, OCT is a new optical modality that may be used alone or in
altered and ablated tissue microstructures for each pathological combination with other optical-based systems to aid diagnosis and
process studied.
14
monitor treatment. OCT imaging of suspicious oral lesions could
improve the diagnostic accuracy for oral dysplasia and the differential
Armstrong et al.
15
evaluated the ability of OCT to identify the
characteristics of laryngeal cancer and measurable changes in the
Optical coherence tomography
basement membrane, tissue microstructure, and the transition zone at
the edge of tumours in 26 OCT examinations. OCT clearly identified imaging of suspicious oral lesions could
basement membrane violation from laryngeal cancer and could identify
improve the diagnostic accuracy for
transition zones at the cancer margin. They suggested that OCT
showed potential for assisting in diagnostic assessment.
oral dysplasia and the differential
diagnosis between neoplastic and
Wong et al.
16
performed OCT imaging on 82 patients who underwent
surgical endoscopy for various head and neck pathologies. They
non-neoplastic lesions.
concluded that OCT has the unique ability to image laryngeal tissue
microstructure and can detail microanatomical changes in benign, pre- diagnosis between neoplastic and non-neoplastic lesions. Sampling for
malignant and malignant laryngeal pathologies. histological analysis could be better targeted.
A recent study carried out at the National Medical Laser Centre, If this technology were to be applied as screening or as part of
University College London and the Head and Neck Unit, University diagnostic programmes in clinical practice in the coming years, this
College Hospital used the swept-source frequency-domain optical might reduce morbidity and mortality in large populations of patients,
coherence tomography microscope (Michelson Diagnostics EX1301 especially those with treated oropharyngeal/laryngeal cancer. ■
1. Suhr MA, Hopper C, Jones L, et al., Optical biopsy systems 7. Jerjes W, Swinson B, Johnson KS, et al., Assessment of bony 335–7.
for the diagnosis and monitoring of superficial cancer and resection margins in oral cancer using elastic scattering 12. Bradley P, Pre-malignant lesions in the head and neck,
precancer, Int J Oral Maxillofac Surg, 2000;29(6):453–7. spectroscopy: a study on archival material, Arch Oral Biol, Oncology News, 2008;2(5):5–6.
2. Swinson B, Jerjes W, El-Maaytah M, et al., Optical techniques 2005;50(3):361–6. 13. Statistical Information Team, CR-UK 2004.
in diagnosis of head and neck malignancy, Oral Oncol, 8. Upile T, Fisher C, Jerjes W, et al., Recent technological 14. Ridgway JM, Armstrong WB, Guo S, et al., In vivo optical
2006;42(3):221–8. developments: in situ histopathological interrogation of coherence tomography of the human oral cavity and
3. Upile T, Jerjes W, Betz CS, et al., Optical diagnostic surgical tissues and resection margins, Head Face Med, oropharynx, Arch Otolaryngol Head Neck Surg, 2006;132(10):
techniques in the head and neck, Dent Update, 2007;3:13. 1074–81.
2007;34(7):410–12, 415–16, 419–20 passim. 9. Hopper C, Niziol C, Sidhu M, The cost-effectiveness of Foscan 15. Armstrong WB, Ridgway JM, Vokes DE, et al., Optical
4. Sharwani A, Jerjes W, Salih V, et al., Fluorescence mediated photodynamic therapy (Foscan-PDT) compared with coherence tomography of laryngeal cancer, Laryngoscope,
spectroscopy combined with 5-aminolevulinic acid-induced extensive palliative surgery and palliative chemotherapy for 2006;116(7):1107–13.
protoporphyrin IX fluorescence in detecting oral patients with advanced head and neck cancer in the UK, Oral 16. Wong BJ, Jackson RP, Guo S, et al., In vivo optical coherence
premalignancy, J Photochem Photobiol B, 2006;83(1):27–33. Oncol, 2004;40(4):372–82. tomography of the human larynx: normative and benign
5. Sharwani A, Jerjes W, Salih V, et al., Assessment of oral 10. Speight PM, Palmer S, Moles DR, et al., The cost- pathology in 82 patients, Laryngoscope, 2005;115(11):
premalignancy using elastic scattering spectroscopy, Oral effectiveness of screening for oral cancer in primary care, 1904–11.
Oncol, 2006;42(4):343–9. Health Technol Assess, 2006;10(14):1–144, iii–iv. 17. Jerjes W, Upile T, Conn B, et al., Oral leukoplakia and
6. Jerjes W, Swinson B, Pickard D, et al., Detection of cervical 11. Scully C, Newman L, Bagan JV, The role of the dental team in erythroplakia subjected to optical coherence tomography:
intranodal metastasis in oral cancer using elastic scattering preventing and diagnosing cancer: 3. oral cancer diagnosis preliminary results, BJOMS, accepted.
spectroscopy, Oral Oncol, 2004;40(7):673–8. and screening, Dent Update, 2005;32(6):326–8, 331–2,
EUROPEAN ONCOLOGY 59
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