Fluorescence spectroscopy for the detection of potentially malignant disorders of the oral cavity: analysis of 30 cases

Oral cancer is a major health problem worldwide and although early diagnosis of potentially malignant and malignant diseases is associated with better treatment results, a large number of cancers are initially misdiagnosed, with unfortunate consequences for long-term survival. Fluorescence spectroscopy is a noninvasive modality of diagnostic approach using induced fluorescence emission in tumors that can improve diagnostic accuracy. The objective of this study was to determine the ability to discriminate between normal oral mucosa and potentially malignant disorders by fluorescence spectroscopy. Fluorescence investigation under 408 and 532 nm excitation wavelengths was performed on 60 subjects, 30 with potentially malignant disorders and 30 volunteers with normal mucosa. Data was analyzed to correlate fluorescence patterns with clinical and histopathological diagnostics. Fluorescence spectroscopy used as a point measurement technique resulted in a great variety of spectral information. In a qualitative analysis of the fluorescence spectral characteristics of each type of injury evaluated, it was possible to discriminate between normal and abnormal oral mucosa. The results show the potential use of fluorescence spectroscopy for an improved discrimination of oral disorders.FAPESP/CePOF-CEPID (07/57126-5)CNPq (477439/2007-1)Instituto Nacional de Ciência e Tecnologia em Oncogenômica (INCITO

Healing process on rat skin and toungue submitted to CO2 and diode lasers, eletrosurgery and scalpel incisions. A morphometric analysis

O objetivo deste estudo foi avaliar e comparar a reparação tecidual após incisões com os lasers de CO2 e de diodo, bisturi elétrico e convencional em língua e pele de 30 ratos Wistar. Incisões de 5 mm de comprimento por 2 mm de profundidade na pele, e de 2,5 mm de comprimento por 1 mm de profundidade na língua, foram feitas nestes tecidos, e os animais sacrificados nos intervalos de zero, 24, 48, 72 horas, 7 e 14 dias após as intervenções. Cortes histológicos foram obtidos das incisões e submetidos a 3 tipos de análises: quantificação do dano tecidual, de mastócitos e da densidade de colágeno tipo I. Os dados foram submetidos à análise estatística pelo teste ANOVA de Kruskal-Wallis e pelo teste de comparações múltiplas de Turkey-Kramer, com nível de significância estabelecida para P < 0,05. Os resultados mostraram que o dano tecidual na pele das incisões realizadas com lasers e bisturi elétrico foi significativamente maior do que o do bisturi convencional (P < 0,05). Quanto às incisões na língua, houve diferença significante de menor dano tecidual resultante da incisão do bisturi convencional comparado com o das incisões realizadas com laser de CO2 2 W, laser de diodo 4 W e bisturi elétrico (P < 0,05). A quantificação de mastócitos mostrou diferenças estatísticas entre as incisões realizadas com bisturi convencional em relação às outras incisões (lasers e bisturi elétrico), principalmente nas 48 e 72h, tanto na pele quanto na língua. Quanto à quantificação de colágeno, apenas no 7º dia houve diferença estatisticamente significante, ocorrendo maior quantidade de colágeno tipo I somente na incisão com bisturi convencional comparada com a do bisturi elétrico (P < 0.05). No 14º dia, os dados morfométricos de colágeno foram semelhantes em todas as técnicas utilizadas. Concluímos que no período final analisado do processo reparacional, os dados morfométricos foram semelhantes em todas as técnicas utilizadas, apesar das diferenças ocorridas quanto ao dano tecidual, quantificação de mastócitos e colágeno tipo I no início do processo. Em princípio, dentro de um mesmo padrão de incisão, todos os instrumentos cirúrgicos geraram um processo reparacional semelhante, variações entre eles podem estar associadas às características do tecido, como foi observado entre a pele e mucosa.The aim of this study was to quantify and compare the healing process after incision with CO2 (2 W e 4 W) and diode lasers (2 W and 4 W), electrosurgery (2 W) and scalpel in the skin and tongue of Wistar rats (30 animals were used). One incision of each technique (6 in total) of 5 mm long and 2 mm deep was made in the dorsal skin and dorsal tongue. The animals were sacrificed at zero, 24, 48, 72 hours, 7 and 14 days after incisions. Histological sections were made from the wound areas and subjected to analyses of area of tissue damage, quantification of mast cells and density of collagen type I. The data were submitted to the ANOVA of Kruskal-Wallis and compared by Turkey-Kramer. The level of significance was set at 5% (P < 0.05). The results showed difference concerning area of tissue damage, occurring significant statistically difference between the incisions with scalpel compared with those of other techniques (lasers and electrosurgery) in skin (P < 0.05). On the tongue, there was statistical difference, with less tissue damage on scalpel incision compared with that of CO2 (2 W) and diode lasers (4 W) and electrosurgery incisions (P < 0.05). The quantification of mast in the incisions showed statistical differences between the incisions, especially in 48 and 72h, both on the skin and tongue. Concerning the collagen quantification, statistical difference was found only in 7 th day, the collagen types I was only more evident on scalpel incision than with the electrosurgery (P < 0.05). In 14 th day, the morphometric data were similar in all types of incisions. Based on these results, it is possible to conclude that at the end of the analyzed period, the morphometric data were similar in all techniques, even though there were differences concerning tissue damage, quantification of masts cell and collagen type I at the beginning of the process. Additionally, the healing process proceeds similarly in all this technique as long as the incisions are made in a similar pattern; variations may occur depending on the type of the tissue, as was shown here between the skin and tongue

Rhabdomyomatous (Mesenchymal) Hamartoma Presenting as Haemangioma on the Upper Lip: A Case Report with Immunohistochemical Analysis and Treatment with High-Power Lasers

Rhabdomyomatous hamartoma is a rare disease that occurs predominantly in the skin. This paper describes a congenital lesion in a 17-year-old male, who came to our clinic presenting a circumscribed swelling involving the oral mucosa and vermillion border of the upper lip, purplish in color, and blanching under pressure. The patient reported that he had had lesion since his birth. A clinical diagnosis was of congenital haemangioma, and the patient was treated by photocoagulation using diode laser. When the lesion became smaller, by having its blood content reduced, the upper portion of the lesion was sliced off with CO2 laser and the tissue was sent for microscopic analysis. Histopathological examination showed an oral mucosa fragment with proliferation of striated muscle bundles admixed with small blood vessels, collagen, and nerve fibres. A supplementary analysis with immunohistochemistry demonstrated positivity for desmin, HHF35, smooth muscle actin, S-100, and CD34. Based on these findings, the lesion was diagnosed as rhabdomyomatous hamartoma. The aesthetic result has been very satisfactory after a 14-month followup

Fluorescence spectroscopy for the detection of potentially malignant disorders and squamous cell carcinoma of the oral cavity

Oral cancer is a public health problem with relevant incidence in the world population. The affected patient usually presents advanced stage disease and the consequence of this delay is a reduction in survival rates. Given this, it is essential to detect oral cancer at early stages. Fluorescence spectroscopy is a non-invasive diagnostic tool that can improve cancer detection in real time. It is a fast and accurate technique, relatively simple, which evaluates the biochemical composition and structure using the tissue fluorescence spectrum as interrogation data. Several studies have positive data regarding the tools for differentiating between normal mucosa and cancer, but the difference between cancer and potentially malignant disorders is not clear. The aim of this study was to evaluate the efficacy of fluorescence spectroscopy in the discrimination of normal oral mucosa, oral cancer, and potentially malignant disorders. The fluorescence spectroscopy was evaluated in 115 individuals, of whom 55 patients presented oral squamous cell carcinoma, 30 volunteers showing normal oral mucosa, and 30 patients having potentially malignant disorders. The spectra were classified and compared to histopathology to evaluate the efficiency in diagnostic discrimination employing fluorescence. In order to classify the spectra, a decision tree algorithm (C4.5) was applied. Despite of the high variance observed in spectral data, the specificity and sensitivity obtained were 93.8% and 88.5%, respectively at 406 nm excitation. These results point to the potential use of fluorescence spectroscopy as an important tool for oral cancer diagnosis and potentially malignant disorders1128290CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP477439/2007-198/14270-8; 07/57126-5; 09/12938-8; 2008/57887-