SCREEN,SAVE,SURVIVE - NATIONAL OMR DAY 2025.pptx

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1. DR INDHUMATHI S SENIOR LECTURER DEPARTMENT OF ORAL MEDICINE & RADIOLOGY SCREEN, SAVE, SURVIVE: APPROACHES TO ORAL CANCER PREVENTION AND EARLY DIAGNOSIS NATIONAL ORAL MEDICINE AND RADIOLOGY DAY – 2025

2. INTRODUCTION Oral cancer is defined as malignant neoplasia of oral cavity and includes buccal mucosa, floor of mouth, anterior tongue, alveolar ridges, retromolar trigone , hard palate and inner parts of lips. (ICD-10-CM; C00 to C10 ). According to 2020 statistics, cancers including oral cavity and lip accounted for incidence of 377,713 cases and mortality of 177,757 cases worldwide . Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2021;71(3):209–49.

3. RISK FACTORS A risk prediction model for OSCC / oropharyngeal carcinoma by Tota et al., including risk factors such as age, sex, race, smoking, alcohol and HPV infection predicted the 1 year risks as following: 21.1 per 100,000 for individuals of age 65-69 years, 13.9 per 100,000 for men, and 18.0 per 100,000 for smokers > 20 packs/year 30 (Tota et al., 2019). 2 Tota JE, Gillison ML, Katki HA, Kahle L, Pickard RK, Xiao W, et al. Development and validation of an individualized risk prediction model for oropharynx cancer in the US population. Cancer [Internet]. 2019;125(24):4407–16.

4. SIGNIFICANCE OF ORAL CANCER SCREENING Oral cancer is a two step process. Two principal benefits of cancer screening are down-staging the disease and reducing the mortality . 1 The most relevant and the only randomized control study (RCT) in the literature for oral cancer screening was conducted in rural areas of Trivandrum, Kerala, India. This study infers that oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37,000 oral cancer deaths worldwide. 2 Warnakulasuriya S, Kerr AR. Oral cancer screening: Past, present, and future. J Dent Res [Internet]. 2021;100(12):1313–20. Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: a clusterrandomised controlled trial. Lancet [Internet]. 2005;365(9475):1927–33.

5. An evidence map to outline the volume and type of evidence related to screening for oral cancer for the UK National Screening Committee October - 2020

6. Solutions for public health. Screening for oral cancer in adults; An evidence map to outline the volume and type of evidence related to screening for oral cancer for the UK National Screening Committee [Internet]. UK National Screening Committee; 2020 Oct [cited Dec 16]. Available from: https://view-health-screening-recommondations.service.gov.uk/oral-cancer/

7. How to estimate the risk of a particular case transforming into oral squamous cell carcinoma; that is, to assess the likelihood of malignant transformation and how soon it may happen?

8. How to estimate the risk of a particular case transforming into oral squamous cell carcinoma; that is, to assess the likelihood of malignant transformation and how soon it may happen?

9. LIMITATION OF CONVENTIONAL METHODS Difficulty to distinguish benign from malignant lesions Tissue biopsies can be invasive and painful for the patients Difficulty in determining extent of lesions Can be subjective, especially during histopathological analyses

10. BRUSH CYTOLOGY (BRUSH BIOPSY; ORALCDX) It was introduced in 1999 as an alternative to conventional exfoliative cytology painless procedure captures the deeper epithelial cells on the bristles and the entire brush is sent to a lab, where the cells are removed and plated on a microscopic slide . A computer-associated optical scanner compares the size of each individual cell with the size of its nucleus .

11. Carcinogenesis in the oral cavity : Act as molecular signatures These changes acts as molecular signatures which can be detected in early oral cancers, using optical principles like endogenous (autofluorescence) and exogenous fluorescence.

12. It is crucial to have new diagnostic methods that are quick and accurate and can assist us in reducing the burden of oral cancer by its early detection and appropriate management. OPTICAL TECHNIQUES: ROBUST ACCURATE LOW COST PORTABLE

13. Molecular imaging probes such as gold nanoparticles, iron oxide nano-rings and other biomarker targeted conjugates play an important role in optical imaging. In addition to this, novel endoscopic optical imaging modalities such as laser confocal endomicroscopy and optical coherence tomography (OCT), can be employed to acquire in vivo high resolution imaging of oral epithelial tissues for diagnostic purposes.

14. PROBES FOR MOLECULAR IMAGING Molecular imaging is a promising non-invasive modality that can image and quantify molecular changes associated with diseases. Three important elements Gold nanoparticles have been extensively utilized in cellular imaging because of their favorable physical and chemical properties. They can provide an optical contrast to discriminate between cancerous and normal cells and their conjugation with antibodies allows them to map the expression of relevant biomarkers for molecular imaging.

15. AUTOFLUORESCENCE When oral cavity tissue is illuminated - fluorophores gets excited - emit lower energy photons - detected as fluorescence from the mucosal surface. Subepithelial stromal collagen fibers are the predominant source of autofluorescence in oral mucosa. Decreased green fluorescence- attributed to collagen degradation, and increased red fluorescence, attributed to release of porphyrin.

16. FLUORESCENCE DIAGNOSIS FD using fluorescence endoscopy system is a technique to visualize the neoplastic lesions in a tumorous organ after topical or systemic application of a tumor-selective photosensitizer. Most promising photosensitizers for oral cancer diagnosis is 5- Amino Levulinic Acid. ALA-derived PPIX fluorescence spectroscopy : detection of epithelial hyperkeratosis (EH) or epithelial dysplasia (ED) and lesions in oral submucous fibrosis (OSF) patients that could not be detected by autofluorescence spectroscopy. Bio-optical imaging: A Paradigm Shift in Early Detection of Oral Cancer Esha Mukherjee , Aumiyo Das

17. LASER CONFOCAL ENDOMICROSCOPY New optical technique that offers in vivo confocal imaging of tissue structures from surface to subsurface layers down to a few hundred micrometers. Recently, Haxel et al. extended the use of confocal endomicroscopic imaging to five regions of the human oropharynx, namely the buccal area, the tongue, the base of the tongue, the tonsils, and the floor of the mouth. The disadvantages: examiner-dependent technology, long duration of time.

18. Confocal laser endomicroscopic findings of cancerous tissue and normal mucosa after acriflavine application. (A) lingual squamous cell carcinoma (upper) and corresponding normal mucosa (lower), (B) oropharyngeal carcinoma in situ (upper) and corresponding normal mucosa (lower). Real-time imaging of head and neck squamous cell carcinomas using confocal micro-endoscopy and applicable dye: A preliminary study ; Auris Nasus Larynx 47(4)

19. OPTICAL COHERENCE TOMOGRAPHY A non-invasive optical imaging technique -Produces cross-sectional images of tissue with a high spatial resolution of 10 to 20 µm. It uses broadband-limited coherence range laser light in near-infrared (NIR) region (770 to 1300 nm) to scan the topology of the tissue subsurface. Studies difference in epithelial thickness Intergrity of basement membrane Cell migration and mitotic cycle

20. OCT and histopathology images of a case of OSCC on the dorsal surface of the tongue compared with the same healthy site: ( a , b ): Clinical and OCT images of healthy mucosa of dorsal surface of tongue; ( c – e ): Clinical, OCT and histopathological images (H-E stain; original magnification ×25) of OSCC on dorsal surface of tongue, superficial ulcerations are indicated by yellow arrows, An asterisk (*) indicates the thin transparent plastic wrapping around the scanning probe F—Lingual papillae; #—Subpapillary spaces; SEL—Stratified Epithelial Layer; BM—Basement Membrane; LP—Lamina Propria. Site-Coded Oral Squamous Cell Carcinoma Evaluation by Optical Coherence Tomography (OCT): A Descriptive Pilot Study

21. CONFOCAL REFLECTANCE MICROSCOPY Optical tool to non-invasively image tissue with near histological resolution. CRM provided details of cells and organelles including nuclei, circulating blood cells and extracellular matrix without the artifacts of histological processing. Apart from oral mucosa, CRM has been used to image human dermis. White, W.M.; Rajadhyaksha , M.; Gonzalez, S.; Fabian, R.L.; Anderson, R.R. Noninvasive imaging of human oral mucosa in vivo by confocal reflectance microscopy. Laryngoscope 1999, 109, 1709-1717.

22. In vivo confocal endomicroscope images of clinically normal buccal mucosa at approximately (a) 10 μ m, (b) 70 μ m, and (c) 120 μ m, and of buccal mucosa clinically diagnosed as leukoplakia at (d) 10 μ m, (e) 70 μ m, and (f) 120 μ m. (g) Clinical photograph of the leukoplakia with the imaged lesion circled. (h) H&E stained histology section of lesion diagnosed as mild to focally moderate epithelial dysplasia. Yellow arrow: increased nuclear to cytoplasmic ratio. Green arrow: loss of polarity of basal cells. White arrow: hyperkeratosis. Handheld tunable focus confocal microscope utilizing a double-clad fiber coupler for in vivo imaging of oral epithelium : Cory Olsovsky , Taylor Hinsdale, Rodrigo Cuenca, Yi-Shing Lisa Cheng, John M. Wright, Terry D. Rees, Javier A. Jo, Kristen C. Maitland

23. CONCLUSION Early detection of oral premalignant lesions and early neoplastic changes may be the most effective means to improve survival and quality of life for oral cancer patients. As the technology and techniques evolve, imaging modality may progressively reduce the need for biopsy, define surgical margins, and provide a direct evaluation of the effectiveness of oral cancer.