Collaboration Aims to Improve Oral Cancer Detection Without Biopsies

Dentistry Today
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The Melbourne University Dental School and OptiScan are collaborating to improve the screening and early diagnosis of oral cancer, which affects 750,000 people around the world and has a five-year mortality rate of about 50% when it is not detected and treated early, according to the school.

The project will use OptiScan’s InVivage handheld confocal laser endomicroscope (CLE), which uses a laser and confocal optics to painless perform “digital biopsies,” the researchers said. The technology could allow clinicians to microscopically see tumor cells in the dental office, helping them immediately assess whether or not a biopsy or surgery is required.

Although 95% of the lesions that clinicians see aren’t cancerous, the researchers said, it’s very difficult to determine which lesions are cancerous or not without a biopsy or surgery. The earlier the diagnosis can be made, and the less tissue that can be removed, the better it is for the patient, the researchers added.

Oral cancers often are preceded by changes in appearance such as the color and thickness of the skin of the mouth. These changes could have the potential to grow an oral cancer and affect as many as one in 20 people. But only around 3% to 5% of people with these changes will develop an oral cancer, the researchers said.

Sometimes there are changes in the way the skin is growing known as dysplasia that indicate a possible increased risk of cancer developing in the future. However, this assessment is limited and only applies to the small sample of skin, the researchers said.

The CLE, though, lets clinicians view tissue in 3-D with a thousand-times magnification. This could enable them to diagnose cancerous tissue in real time, reducing or eliminating the need to have one or more biopsies taken and sent to a laboratory for analysis, the researchers said.

In addition to testing the CLE, the collaboration between the school and OptiScan as well as with MoleMap aims to develop software to comprehensively record an annotated map of the patient’s mouth. Clinicians then could take a mouth map of each patient with each visit and compare it to the previous visit to assess any changes, the researchers said.

Also, the researchers said, clinicians could use special dyes that show them all the cells in the skin surface or other dyes that only bind to molecules that are found more commonly in cancer, identifying potential hotspots of skin growth.

The Mouthmap project will enable a detailed collection of a large amount of data to compare the CLE technology to diagnosis using standard light microscopy. According to the researchers, this has the potential to establish a new standard of diagnosis and allow advancement of both human and compute algorithm-based learning.

Participants in this clinical study will be recruited through invitations from the school’s main oral precancer referral center, networked with regional community centers where only individuals on healthcare card and pension card holders are eligible for treatment. The researchers said this is important because lower socioeconomic status and older age both are risk factors for oral cancer.

The researchers hope that this technology will help reduce the need for scalpel biopsies, allowing for more comprehensive assessment of skin changes in the mouth and earlier detection of oral cancer. This project also has received a grant of almost $1 million from the Australian government through the Medical Research Future Fund.

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