Unraveling the Keratin Expression in Oral Leukoplakia: A Scoping Review.

Intermediate filaments are one of three polymeric structures that form the cytoskeleton of epithelial cells. In the epithelium, these filaments are made up of a variety of keratin proteins. Intermediate filaments complete a wide range of functions in keratinocytes, including maintaining cell structure, cell growth, cell proliferation, cell migration, and more. Given that these functions are intimately associated with the carcinogenic process, and that hyperkeratinization is a quintessential feature of oral leukoplakias, the utility of keratins in oral leukoplakia is yet to be fully explored. This scoping review aims to outline the current knowledge founded on original studies on human tissues regarding the expression and utility of keratins as diagnostic, prognostic, and predictive biomarkers in oral leukoplakias. After using a search strategy developed for several scientific databases, namely, PubMed, Scopus, Web of Science, and OVID, 42 papers met the inclusion and exclusion criteria. One more article was added when it was identified through manually searching the list of references. The included papers were published between 1989 and 2024. Keratins 1-20 were investigated in the 43 included studies, and their expression was assessed in oral leukoplakia and dysplasia cases. Only five studies investigated the prognostic role of keratins in relation to malignant transformation. No studies evaluated keratins as a diagnostic adjunct or predictive tool. Evidence supports the idea that dysplasia disrupts the terminal differentiation pathway of primary keratins. Gain of keratin 17 expression and loss of keratin 13 were significantly observed in differentiated epithelial dysplasia. Also, the keratin 19 extension into suprabasal cells has been associated with the evolving features of dysplasia. The loss of keratin1/keratin 10 has been significantly associated with high-grade dysplasia. The prognostic value of cytokeratins has shown conflicting results, and further studies are required to ascertain their role in predicting the malignant transformation of oral leukoplakia.

Retrospective study of qualitative assessment in detecting synchronous and metachronous malignancies in adult cancer patients by 18 F-FDG PET/CT.

OBJECTIVES: The study aimed to evaluate the frequency of incidental suspicious lesions detected by flourine-18 fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) scans done for staging or restaging in adult cancer patients. We further determined the detection rate of synchronous and metachronous malignancies in these suspicious lesions after further investigations. MATERIALS AND METHODS: This retrospective analysis evaluated the consecutive patients with 18 F-FDG PET/CT scans done in Queen Elizabeth Hospital (QEH), Hong Kong between July 2021 and June 2022. The adult cancer patients who underwent staging or restaging 8 F-FDG PET/CT were included while the remaining were excluded. Patients' demographics, primary cancer type, tumor markers, and pathological analyses for the incidental suspicious lesions were reviewed to establish the detection rate of synchronous and metachronous malignancies. RESULTS: A total of 2054 patients fulfilled inclusion criteria with age ranging from 18 to 93 years old. Out of the 2054 patients, 304 (14.8%) were found to have incidental suspicious lesions. Of these, 206 patients (67.8%) underwent further investigations including pathological analyses. Subsequently, 84 of these 206 patients (40.8%) had pathologically proven synchronous or metachronous malignancies. CONCLUSION: The detection rate of incidental suspicious lesions in adult cancer patients who underwent 18 F-FDG PET/CT scans for staging or restaging was 14.8% and the rate of synchronous and metachronous malignancies in these suspicious lesions was 40.8%. The treatment plan of these patients may potentially be altered, which should be included in the cost-benefit analysis of using this imaging modality.

Giant parathyroid adenoma and hungry bone syndrome in MEN1 syndrome: A case report.

An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of bone pain afterwards, multiple imaging modalities revealed features of osteitis fibrosa cystica and biochemical profile showed features of hungry bone syndrome. Incidental suspicious pancreatic lesion was initially revealed by 18F-FDG PET/CT scan while MRI further characterized the possibility of insulinoma. Ultimately, the patient was diagnosed of MEN1 syndrome by genetic test. This case report demonstrates the utilization of various imaging modalities such as ultrasound, Tc99m-sestamibi parathyroid scintigraphy, bone scintigraphy, CT, PET/CT and MRI, which leads to ultimately the diagnosis of MEN1 syndrome.

Adjunctive aids for the detection of oral squamous cell carcinoma and oral potentially malignant disorders: A systematic review of systematic reviews.

This study presents the results of systematic reviews on adjunctive tools in screening and diagnosis of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) and to determine if the current literature supports their use as either an adjunctive tool or replacement of gold standard techniques. Systemic reviews and meta-analysis that evaluated adjunctive tools including chemiluminescence, tissue autofluorescence, tissue fluorescence spectroscopy, vital staining and cytology techniques were systematically examined using AMSTAR II. Twenty-seven systematic reviews were included. Five studies had a low quality of evidence, and nine studies had a critically low quality of evidence. This review found limited evidence to recommend chemiluminescence, tissue autofluorescence tools and vital staining as diagnostic tools, but only serve as clinical adjuncts to conventional oral examination. Cytology techniques and narrow-band imaging may be utilised as a non-invasive diagnostic adjunctive tool for the detection of OSCC and the malignant transformation of OPMD. In conclusion, this paper provides evidence on several types of adjunctive tools and provides recommendations on their use in clinical practice. These tools are considered useful as clinical adjuncts but there is insufficient evidence for their use as a diagnostic tool to replace gold standard conventional oral examination and surgical biopsy.

The diagnostic performance of 18 fluorine-fluorodeoxyglucose PET for brain metastases: a systematic review and meta-analysis.

INTRODUCTION: Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18 fluorine-fluorodeoxyglucose PET ( 18 F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers. METHODS: PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found. RESULTS: A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295-0.597) and 0.997 (95% CI, 0.977-1.000). In view of significant between-study heterogeneity ( I2  = 74.0% for sensitivity and I2  = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601-0.836) vs 0.304 (95% CI, 0.223-0.400), P value = 0.000]. CONCLUSION: Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients.

Paediatric Dentists Treating Children on Bisphosphonates: A Cross-Sectional Questionnaire-Based Study.

Purpose: The purposes of this study were to: (1) investigate the knowledge and management strategies of pediatric dentists in Australia and New Zealand who are treating children on bisphosphonates; and (2) determine if there is consistency in management. Methods: A 19-item questionnaire was generated via the online program Qualtrics and distributed to the pediatric dentists. The questionnaire consisted of four categories: (1) demographics; (2) information about bisphosphonate-related osteonecrosis of the jaw (BRONJ); (3) role and confidence; and (4) management strategies of pediatric patients taking bisphosphonates. Results: A total of 65 responses were recorded in the survey; however, 12 responses were excluded, as they were incomplete, hence the response rate was 43 percent. The results showed that 40 percent of participants were directly involved in managing children on bisphosphonates, 47 percent of participants had no role, 37 percent of respondents acknowledged the importance of completing invasive dental treatment before BP therapy, and 13 percent were unsure. The majority of respondents (83 percent) had previously received information on BRONJ, and 37 percent of dentists agreed to complete invasive dental procedures before bisphosphonate therapy. There were multiple responses to the questions concerning antibiotic prophylaxis, the use of chlorhexidine gluconate mouth rinses, and "drug holidays." Conclusions: This study showed an agreement for good communication between dentist and physician. However, there were controversies among other management strategies.