Non-invasive detection of oral potentially malignant and malignant lesions using an optical multispectral screening device.

Oral carcinogenesis is a multistep process that usually arises in the superficial epithelial layer covering the lining of the body cavities. The early changes in the oral mucosa reflect as oral precancers or oral potentially malignant disorders (OPMD). The most common OPMD are erythroplakia and leukoplakia, with their chances of malignant transformation being approximately 90% and 10%, respectively. The development of epithelial precancers is initiated through changes in nuclear shape, size, and density of cells and overall thickening of the epithelial layer. Conventional oral examination (COE) with white light is the most common technique for detection of malignant changes in the oral cavity. This often poses a diagnostic challenge for the clinicians in differentiation of normal and early malignant changes. Thus, biopsy of the site is the accepted clinical procedure for diagnosis of the lesion. A major hurdle here is to identify visually, the most malignant location for a biopsy. As the selection of a site is subjective, the chosen site may not always be representative of the disease and this often leads to repeated biopsies and discomfort to the patients. A novel device known as OralScan was recently introduced by Sascan Meditech, Thiruvananthapuram, for screening and early detection of oral cancers. The clinical application of the device in different clinical scenarios are discussed in this case series report.

Bimodal multispectral imaging system with cloud-based machine learning algorithm for real-time screening and detection of oral potentially malignant lesions and biopsy guidance.

SIGNIFICANCE: Screening and early detection of oral potentially malignant lesions (OPMLs) are of great significance in reducing the mortality rates associated with head and neck malignancies. Intra-oral multispectral optical imaging of tissues in conjunction with cloud-based machine learning (CBML) can be used to detect oral precancers at the point-of-care (POC) and guide the clinician to the most malignant site for biopsy. AIM: Develop a bimodal multispectral imaging system (BMIS) combining tissue autofluorescence and diffuse reflectance (DR) for mapping changes in oxygenated hemoglobin (HbO2) absorption in the oral mucosa, quantifying tissue abnormalities, and guiding biopsies. APPROACH: The hand-held widefield BMIS consisting of LEDs emitting at 405, 545, 575, and 610 nm, 5MPx monochrome camera, and proprietary Windows-based software was developed for image capture, processing, and analytics. The DR image ratio (R610/R545) was compared with pathologic classification to develop a CBML algorithm for real-time assessment of tissue status at the POC. RESULTS: Sensitivity of 97.5% and specificity of 92.5% were achieved for discrimination of OPML from patient normal in 40 sites, whereas 82% sensitivity and 96.6% specificity were obtained for discrimination of abnormal (OPML + SCC) in 89 sites. Site-specific algorithms derived for buccal mucosa (27 sites) showed improved sensitivity and specificity of 96.3% for discrimination of OPML from normal. CONCLUSIONS: Assessment of oral cancer risk is possible by mapping of HbO2 absorption in tissues, and the BMIS system developed appears to be suitable for biopsy guidance and early detection of oral cancers.