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Autofluorescence-Guided Surveillance for Oral Cancer

Authors' Affiliations: ¹ Division of Cancer Prevention and Population Sciences and Departments of ² Dentistry and Maxillofacial Prosthetics, ³ Pathology, ⁴ Head and Neck Surgery, ⁵ Cancer Genetics, and ⁶ Biostatistics, Roswell Park Cancer Institute; Departments of ⁷ Oral and Maxillofacial Surgery and ⁸ Oral Biology, State University of New York at Buffalo, Buffalo, New York; and ⁹ Division of Biophysics and Imaging, Ontario Cancer Institute, Ontario, Canada

Requests for reprints: Mary Reid, Division of Cancer Prevention and Population Sciences, Carlton Building, Room 308, Roswell Park Cancer Institute, Buffalo, NY 14263. Phone: 716-845-1209; Fax: 716-845-8487; E-mail: mary.reid{at}roswellpark.org.

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.

Key Words: Autofluorescence visualization • Oral cancers • Surveillance and detection