Geriatric assessment prior to cancer treatment: A health economic evaluation.

INTRODUCTION: To address uncertainty regarding the cost-effectiveness of implementing geriatric assessment (GA) in oncology practice, we undertook a synthetic, model-based economic evaluation. MATERIALS AND METHODS: A decision-analytic model with embedded Markov chains was developed to simulate a cost-effectiveness analysis of implementing GA within standard oncological care compared to current practice. This was for patients aged 77 years (the mean age in included trials) receiving chemotherapy or surgery as first-line treatment. Assumptions were made about model parameters, based on available literature, to calculate the incremental net health benefit (INHB) of GA, using a data synthesis. RESULTS: GA has additional costs over standard care alone of between £390 and £576, depending upon implementation configuration. When major assumptions about the effectiveness of GA were modelled, INHB was marginally positive (0.09-0.12) at all cost-effectiveness thresholds (CETs). If no reduction in postoperative complications was assumed, the intervention was shown not to be cost-effective (INHB negative at all CETs). When used before chemotherapy, with minimal healthcare staffing inputs and technological assistance, GA is cost-effective (INHB positive between 0.06 and 0.07 at all CETs). DISCUSSION: Considering emerging evidence that GA improves outcomes in oncology, GA may not be a cost-effective intervention when used for all older adults with cancer. However, with judicious selection of implementation models, GA has the potential to be cost-effective. Due to significant heterogeneity and centre dependent success in implementation and effectiveness, GA is difficult to study in oncology settings. Stakeholders could take a pragmatic approach towards GA introduction with local evaluation favoured over generalisable research. Because GA tends towards utilitarianism and has no safety issues, it is a suitable intervention for more widespread implementation.

Implementation of geriatric assessment in oncology settings: A systematic realist review.

Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.

Outcomes of older adults aged 90 and over with cutaneous malignancies after electrochemotherapy with bleomycin: A matched cohort analysis from the InspECT registry.

BACKGROUND: With extending life expectancy, more people are diagnosed with cutaneous malignancies at advanced ages and are offered nonsurgical treatment. We assessed outcomes of the oldest-old adults after electrochemotherapy (ECT). METHODS: The International Network for Sharing Practices of ECT (InspECT) registry was queried for adults aged ≥90 years (ys) with skin cancers/cutaneous metastases of any histotype who underwent bleomycin-ECT (2006-2019). These were subanalysed with patients aged <90 ys after matching 1:2 for tumor location, number, size, histotype, and previous treatments. We assessed ECT modalities, toxicity (CTCAE), response (RECIST), and patient perception (EQ-5D). RESULTS: Sixty-one patients represented the study cohort (median 92 ys, range 92-104), 122 the control group (median 77 ys, range 23-89). Among the oldest-old, 44 patients (72%) had primary/recurrent skin cancers, 17 (28%) cutaneous metastases. Median tumour size was 15 mm (range, 5-450). The oldest-old adults underwent ECT mainly under local/regional anaesthesia (59% vs 39% p = .012). We observed no differences regarding dose and route of chemotherapy (intravenous vs intratumoral, p = .308), electrode geometry (linear vs hexagonal, p = .172) and procedural duration (18 vs 21 min, p = .378). Complete response (57.4 [95%-CI 44.1%-70.0%] vs 64.7% [95%-CI 55.6%-73.2%], p = .222) and 1-year local control (76.7% vs 81.7, p = .092) rates were comparable. Pain and skin hyperpigmentation were mild in both groups. Skin ulceration persisted longer in the oldest-old patients (4.4 vs 2.4 months, p = .008). CONCLUSIONS: The oldest-old adults with cutaneous malignancies undergo ECT most commonly under local/regional anaesthesia with safety profiles and clinical effectiveness similar to their younger counterparts, except in case of ulcerated tumors.

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis.

Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03-4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03-3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

The effect of radioiodine treatment on the diseased thyroid gland.

Purpose: Radioiodine (I131) therapy is the treatment mainstay for several benign and malignant thyroid disorders, however I131 is known to cause DNA damage and liberation of thyroidal self-antigens inducing secondary immunoreactivity. The exact mechanisms underpinning cellular death and subsequent induction of autoimmune thyroid disease following I131 treatment have not yet been fully elucidated. This manuscript aims to review the literature concerning the effects of I131 on the thyroid gland.Conclusion: The effects of I131 on malignant thyroid cells appears to depend on absorbed dose with the literature demonstrating a clear initial delay in the triggering of apoptosis in response to I131-mediated cellular damage. Some studies also observed necrotic cellular death following high-dose I131 treatment. Liberation of thyroidal self-antigen following I131 treatment helps to explain phenomena such as the subsequent induction of autoimmune thyroid disease. The clinical utility of cytokines and autoantibodies for prognostication of hypothyroidism and treatment failure following I131 remains uncertain and further appropriately-powered studies are required to clarify their role. The potential role of other cell death mechanisms activated after treatment with I131 should also be explored in order to fully delineate the thyroidal response.

A novel microfluidic device capable of maintaining functional thyroid carcinoma specimens ex vivo provides a new drug screening platform.

BACKGROUND: Though the management of malignancies has improved vastly in recent years, many treatment options lack the desired efficacy and fail to adequately augment patient morbidity and mortality. It is increasingly clear that patient response to therapy is unique to each individual, necessitating personalised, or 'precision' medical care. This demand extends to thyroid cancer; ~ 10% patients fail to respond to radioiodine treatment due to loss of phenotypic differentiation, exposing the patient to unnecessary ionising radiation, as well as delaying treatment with alternative therapies. METHODS: Human thyroid tissue (n = 23, malignant and benign) was live-sliced (5 mm diameter × 350-500 µm thickness) then analysed or incorporated into a microfluidic culture device for 96 h (37 °C). Successful maintenance of tissue was verified by histological (H&E), flow cytometric propidium iodide or trypan blue uptake, immunohistochemical (Ki67 detection/ BrdU incorporation) and functional analysis (thyroxine [T4] output) in addition to analysis of culture effluent for the cell death markers lactate dehydrogenase (LDH) and dead-cell protease (DCP). Apoptosis was investigated by Terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL). Differentiation was assessed by evaluation of thyroid transcription factor (TTF1) and sodium iodide symporter (NIS) expression (western blotting). RESULTS: Maintenance of gross tissue architecture was observed. Analysis of dissociated primary thyroid cells using flow cytometry both prior to and post culture demonstrated no significant change in the proportion of viable cells. LDH and DCP release from on-chip thyroid tissue indicated that after an initial raised level of release, signifying cellular damage, detectable levels dropped markedly. A significant increase in apoptosis (p < 0.01) was observed after tissue was perfused with etoposide and JNK inhibitor, but not in control tissue incubated for the same time period. No significant difference in Ki-67 positivity or TTF1/NIS expression was detected between fresh and post-culture thyroid tissue samples, moreover BrdU positive nuclei indicated on-chip cellular proliferation. Cultured thyroid explants were functionally viable as determined by production of T4 throughout the culture period. CONCLUSIONS: The described microfluidic platform can maintain the viability of thyroid tissue slices ex vivo for a minimum of four days, providing a platform for the assessment of thyroid tissue radioiodine sensitivity/adjuvant therapies in real time.

Evidence-based out-of-hours hospital medicine.

Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management problems with the OOH service are reflected by the high number of quality improvement projects recently published. In this narrative review, five common situations peculiar to the OOH general ward setting are discussed with reference to potential areas of inefficiency and unnecessary management steps: (1) prescription of hypnotics and sedatives; (2) overnight fluid therapy; (3) fever; (4) overnight hypotension and (5) chasing outstanding routine diagnostic tests. It is evident that research and consensus guidelines for many clinical situations in the OOH setting are a neglected arena. Many recommendations made herein are based on expert opinion or first principles. In contrast, the management of significant abnormalities in outstanding blood results is based on well-established guidelines using high-quality systematic reviews.

Differentiation of Basal Cell Carcinoma Subtypes in Multi-Beam Swept Source Optical Coherence Tomography (MSS-OCT).

BACKGROUND: Optical coherence tomography (OCT) is a technique that enables real-time in-vivo examination of tissue. This technology provides the clinician with the potential to use a non-invasive tool in the identification and diagnosis of many skin lesions. However, the diagnostic features of basal cell carcinoma have not yet been described with comparison to their histopathology.
OBJECTIVES: To identify and describe key features of basal cell carcinoma (BCC) and its subtypes as they present in multi-beam Swept Source - OCT (MSS-OCT), and to correlate those against conventional histopathology.
METHODS: A total of 40 lesions were assessed by MSS-OCT prior to biopsy. 60-slice OCT images of the lesions were obtained and correlated with histology sections taken in the same plane. OCT scans were assessed retrospectively by a panel to determine the OCT criteria for BCC and its subtypes.
RESULTS: The following diagnostic criteria were identified: hyporeflective ovoid structures (40/40), dark halo boundaries (38/40), epidermal thinning (28/40), and collagen compression (14/40). Lesional tissue also showed a destruction of layers when compared to the surrounding normal tissue. In addition to the shared criteria, other subtypes showed distinct diagnostic criteria.
CONCLUSION: With its higher sensitivity, using MSS-OCT allowed for non-invasive, accurate identification of the key diagnostic features of BCC and its subtypes with high correlation to the histopathologic features found with biopsy.

J Drugs Dermatol. 2016;15(5):545-550.

Optical coherence tomography in the assessment of oral squamous cell carcinoma resection margins.

BACKGROUND: Incomplete surgical removal of cancer is believed to be the main cause of local recurrence and high mortality. This study assessed the use of optical technology (namely optical coherence tomography [OCT]) in examining oral squamous cell carcinoma (OSCC) resection margins to assess if this modality could guide the surgeon during surgical resections. MATERIALS AND METHODS: Twenty-eight T1-T2 N0M0 oral squamous cell carcinoma patients participated in this study. Nineteen patients were males and nine were females. The majority of lesions were in the ventro-lateral tongue, floor of mouth, retromolar trigone and the buccal mucosa. Following tumour resection, the specimen resection margins were optically scanned in the immediate ex vivo phase. Two independent assessors commented on the four resection margins of each specimen. The findings were then compared to the corresponding gold standard histopathology. The average epithelial thickness for both tumor-free and tumor-involved margins was also calculated. RESULTS: The pathology reports of the 112 margins revealed 90 tumor-free margins and 22 tumor-involved margins. Examining the data from both senior operating surgeons (assessors), the overall sensitivity and specificity was found to be 81.5% and 87%, respectively. Whilst the positive predictive value was 61.5% and the negative predictive value was 95%. OCT accuracy for the first assessor was 88% and for the second assessor 84%. The assessors' inter-observer agreement was "very good" for superior, inferior and medial margins; while agreement on the lateral surgical margin status was "good". Using OCT, the mean epithelial thickness at the tumor-free resection margins was 360 µm; while, it was 567 µm for the tumour-involved margins. CONCLUSION: OCT is a valuable tool in the assessment of surgical margins. Tumour-involved margins can be identified by architectural changes and increase in epithelial layer thickness on the OCT image. Further studies are required to assess tumour margins in vivo.

Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'in patients undergoing thyroidectomy for retrosternal goitre, what factors predict sternotomy?' Altogether 165 papers were found as a result of the reported search, of which only 3 prospective studies, 1 review paper and 2 retrospective studies represented the best evidence to answer the clinical question. The authors, journals, date and country of publication, patient group studied, study type, relevant outcomes and results of the papers are tabulated. We conclude that a combination of preoperative clinical and radiological risk factors, alongside informed patient choice can be used to predict the need for sternotomy in thyroidectomy for goitre with retrosternal extension. Clinically, a history of goitre with retrosternal extension beyond 160 months is a risk factor for sternotomy. Thyroid tissue density, posterior mediastinal location and subcarinal extension, as measured using computed tomography (CT) imaging, are independent preoperatively obtained risk factors for sternotomy, which are supported by both prospective and retrospective studies. Thyroid tissue density is the strongest factor and increases the risk of sternotomy 47-fold. Minimal upper sternotomy (sternal-split) can be used instead of median sternotomy where there is evidence of retrosternal extension to the aortic root. CT evidence of an ectopic nodule, a dumbbell-shaped goitre, a conical-shaped goitre constricted by an isthmic thoracic inlet or a thoracic goitre component wider than the thoracic inlet can also predict the need to undergo sternotomy. Finally, informed consent should include a discussion that patients with bilateral multinodular goitre and evidence of intrathoracic extension, who are undergoing total thyroidectomy via cervicotomy, have an independently increased risk of complications, specifically recurrent laryngeal nerve injury. After explanation of these risks, a patient may be unwilling to accept the increased risks of cervicotomy per se versus those of combined cervicotomy and sternotomy.

The endothelin axis in head and neck cancer: a promising therapeutic opportunity?

The incidence of head and neck cancer, predominantly consisting of squamous cell carcinomas (HNSCCs), is continuing to rise worldwide. Invasive HNSCC carries a poor prognosis, and the detrimental sequelae of surgical resection motivate identification of novel modes of therapeutic intervention. The endothelin (ET) axis consists of ET-1, 2 and 3, which are generated by endothelin-converting enzyme (ECE) and engage with the receptors ETA R and ETB R. The ET axis plays a role in the development and progression of various human malignancies. ET axis components have been found to be overexpressed in HNSCC; ET-1 antagonism and inhibition of ECE may therefore represent viable therapeutic opportunities. ET-1 can promote HNSCC progression via stromal-epithelial interactions, suggesting that the stroma may also hold potential for therapies targeting components of the ET axis. The ET axis may also offer components that can be used as biomarkers - for screening, diagnosis, monitoring disease recurrence and prognostic risk stratification of patients - and targets for localised analgesia offering less systemic side effects. This review summarises the current knowledge and potential for clinical opportunities related to the ET axis.

Optical coherence tomography for presurgical margin assessment of non-melanoma skin cancer - a practical approach.

In the clinical setting, optical coherence tomography (OCT) is applicable for the non-invasive diagnosis of skin cancer and may in particular be used for margin definition prior to excision. In this regard, OCT may improve the success rate of removing tumor lesions more effectively, preventing repetitive excision, which may subsequently result in smaller excisions. In this study, we have aimed to evaluate the applicability of OCT for in vivo presurgical margin assessment of non-melanocytic skin tumors (NMSC) and to describe the feasibility of different scanning techniques. A total number of 18 patients planned for excision of lesions suspicious of NMSC were included in this study. Based on OCT, we defined the specific tumor margins on 19 lesions preoperatively using different scanning modalities. Sixty-one margin points and five complete tumor margins were analysed on 18 patients with a total of 19 lesions including 63% basal cell carcinoma (BCC) (n = 12), 16% (n = 3) squamous cell carcinoma (SCC) and 21% of other types of skin tumors (n = 4) were classified. In 84% of the cases (n = 16), the OCT-defined lateral margins correctly indicated complete removal of the tumor. The surgical margins chosen by the surgeon never fell below the OCT-defined margin. Regarding the techniques of marginal definition, punctual tumor border scan in the perpendicular direction, with an extension of free-run scans for unsure cases can hardly be recommended. This study shows that suspected NMSC can effectively be confirmed, and furthermore, resection margin can be minimized under OCT control without reducing the rate of complete removal.

Optical coherence tomography in the assessment of suspicious oral lesions: an immediate ex vivo study.

BACKGROUND: Optical coherence tomography (OCT) is an evolving optical technology that is capable of delivering real-time, high-resolution signatures of tissue. OBJECTIVES: The purpose of this immediate ex vivo prospective clinical study was: (1) to assess the sensitivity and specificity of OCT on biopsy material in identifying potentially malignant and malignant oral lesions, (2) to determine the inter-observer agreement in the analysis of specific image parameters, and (3) to find out the oral epithelial thickness for different pathology groups. MATERIALS AND METHODS: This prospective study involved 125 suspicious oral lesions from 125 patients. The lesions were surgically biopsied and subjected to OCT in the immediate ex vivo phase. Two independent readers (surgeon and pathologist) examined the OCT images and assessed several cellular features including keratin layer, epithelial layer, basement membrane and lamina propria, and recorded their findings using special OCT reading score. The sensitivity, specificity and accuracy of OCT to predict "the future need for surgical biopsy in case of any similar lesion" were calculated. The epithelial thickness was also measured. The degree of agreement between the two readers was recorded. RESULTS: The pathological diagnosis revealed that the majority of lesions demonstrated microinvasive carcinomas (n=43). Forty-one had different degree of dysplasia. Benign oral lesions were less common and included 22 keratosis, 11 non-specific lesions, 6 mucocels and 2 papillomas. Optical coherence tomography achieved a sensitivity of 85% and a specificity of 78% in the assessment of oral potentially malignant and malignant disorders. The positive and negative predictive values were 86.5% and 77.5%, respectively. The accuracy was 82% and the kappa coefficient of inter-observer agreement was 0.72 on "the need for biopsy". OCT imaging of oral lesions provided valuable information on the oral epithelial thickness. CONCLUSION: This study proposes that OCT can accurately identify wide spectrum of oral tissue pathologies. Further studies can assess the role of OCT in evaluating and guiding surgical biopsies and monitoring disease.

Optical coherence tomography-based optimization of mohs micrographic surgery of Basal cell carcinoma: a pilot study.

BACKGROUND: Optical coherence tomography (OCT) is a noninvasive imaging technique that uses a low-power infrared laser to image up to 2 mm beneath the skin's surface. OBJECTIVE: To test the feasibility and diagnostic value of using in vivo OCT to define excision margins before Mohs micrographic surgery (MMS) of basal cell carcinoma (BCC). METHODS: Patients with biopsy confirmed BCC undergoing MMS were recruited (n = 52). Excision margins defined by experienced dermatologists were compared with those of OCT-assessed borders and validated with histologic assessments. RESULTS: Forty-one (79%) lesions were clear after one MMS procedure; 11 (21%) lesions required a second MMS stage after excision of the clinician-predicted boundary. Generally, the OCT instrument indicated that the estimated clinical margin was 0.4-mm larger than the OCT margin. For lesions requiring a single MMS stage, OCT indicated that lesions were 1.4 ± 1.3 mm smaller than the Mohs excision. Before excision of lesions requiring more than one MMS stage, OCT always indicated that the lesion boundary would extend outside the planned MMS defect boundary. CONCLUSIONS: The present study shows the prospective utility of using OCT to refine clinically estimated borders for MMS. OCT assessment has the potential to reduce the excised area without compromising the integrity of tumor-free borders.

Structural validation of oral mucosal tissue using optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a non-invasive optical technology using near-infrared light to produce cross-sectional tissue images with lateral resolution. OBJECTIVES: The overall aims of this study was to generate a bank of normative and pathological OCT data of the oral tissues to allow identification of cellular structures of normal and pathological processes with the aim to create a diagnostic algorithm which can be used in the early detection of oral disorders. MATERIAL AND METHODS: Seventy-three patients with 78 suspicious oral lesions were referred for further management to the UCLH Head and Neck Centre, London. The entire cohort had their lesions surgically biopsied (incisional or excisional). The immediate ex vivo phase involved scanning the specimens using optical coherence tomography. The specimens were then processed by a histopathologist. Five tissue structures were evaluated as part of this study, including: keratin cell layer, epithelial layer, basement membrane, lamina propria and other microanatomical structures. Two independent assessors (clinician and pathologist trained to use OCT) assessed the OCT images and were asked to comment on the cellular structures and changes involving the five tissue structures in non-blind fashion. RESULTS: Correct identification of the keratin cell layer and its structural changes was achieved in 87% of the cohort; for the epithelial layer it reached 93.5%, and 94% for the basement membrane. Microanatomical structures identification was 64% for blood vessels, 58% for salivary gland ducts and 89% for rete pegs. The agreement was "good" between the clinician and the pathologist. OCT was able to differential normal from pathological tissue and pathological tissue of different entities in this immediate ex vivo study. Unfortunately, OCT provided inadequate cellular and subcellular information to enable the grading of oral premalignant disorders. CONCLUSION: This study enabled the creation of OCT bank of normal and pathological oral tissues. The pathological changes identified using OCT enabled differentiation between normal and pathological tissues, and identification of different tissue pathologies. Further studies are required to assess the accuracy of OCT in identification of various pathological processes involving the oral tissues.

Quantitative analysis of optical coherence tomography and histopathology images of normal and dysplastic oral mucosal tissues.

Selecting the most representative site for biopsy is crucial in establishing a definitive diagnosis of oral epithelial dysplasia. The current process involves clinical examination that can be subjective and prone to sampling errors. The aim of this study was therefore to investigate the use of optical coherence tomography (OCT) for differentiation of normal and dysplastic oral epithelial samples, with a view to developing an objective and reproducible approach for biopsy site selection. Biopsy samples from patients with fibro-epithelial polyps (n = 13), mild dysplasia (n = 2), and moderate/severe dysplasia (n = 4) were scanned at 5-µm intervals using an OCT microscope and subsequently processed and stained with hematoxylin and eosin (H&E). Epithelial differentiation was measured from the rate of change (gradient) of the backscattered light intensity in the OCT signal as a function of depth. This parameter is directly related to the density of optical scattering from the cell nuclei. OCT images of normal oral epithelium showed a clear delineation of the mucosal layers observed in the matching histology. However, OCT images of oral dysplasia did not clearly identify the individual mucosal layers because of the increased density of abnormal cell nuclei, which impeded light penetration. Quantitative analysis on 2D-OCT and histology images differentiated dysplasia from normal control samples. Similar analysis on 3D-OCT datasets resulted in the reclassification of biopsy samples into the normal/mild and moderate/severe groups. Quantitative differentiation of normal and dysplastic lesions using OCT offers a non-invasive objective approach for localizing the most representative site to biopsy, particularly in oral lesions with similar clinical features.

Optical Coherence Tomography Used as a Modality to Delineate Basal Cell Carcinoma prior to Mohs Micrographic Surgery.

Optical coherence tomography (OCT) has potential as a modality for in vivo imaging of non-melanoma skin cancer (NMSC). By allowing identification of sub-surface margins of NMSC lesions, the use of OCT could improve the rate of complete excision and reduce the average number of stages during Mohs micrographic surgery (MMS). The objective of this study was to use OCT to delineate the apparent sub-surface margins of NMSC lesions prior to their excision by MMS. Lesions were scanned with reference to a physical marker on the skin, and the apparent margins were then identified from the OCT images and marked on the skin. Photographs of these margins and the Mohs defect were correlated and compared. OCT appears capable of visualizing the transition from lesional to normal tissue. In this case study, margins marked by use of the OCT system before surgery exhibit excellent correlation with the MMS defect. OCT offers the promise of better outcomes by enabling accurate margin mapping of NMSC in advance of MMS. Priorities now are to demonstrate this capability in a larger study, and to understand clearly indications and contraindications for use.

The future of medical diagnostics: review paper.

While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis.We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.