筛选工具可以找出口腔癌 减少进行切片的数目


  January 26, 2007 -- 一项新研究显示,化学萤光与甲苯胺蓝染色作为传统辅助口腔外观检查的辅助工具,可能改善确认口腔黏膜病灶且降低切片的需求;透过结合传统技术与更先进的技术,我们可以更精确地诊断且决定口腔癌病患最佳的选择。主要作者Joel Epstein教授,同时也是牙医学院口腔医学与诊断科学部门主任、芝加哥伊利诺大学口腔癌症跨学科计划主任在一项新闻稿中表示,这个诊断口腔癌症的技术将可以让我们更容易地确认严重的病灶,显著地减少不必要的切片,避免伪阳性结果风险。
  
  Epstein教授以及一研究团队于最近的2007年Rancho Mirage加州多专业头颈部癌症座谈会中发表这项研究结果,该筛选工具已经于美国上市,由亚利桑那州凤凰城Zila公司制造;该技术结合该公司的ViziLite,一种萤光显色工具,以及TBlue630,一种获得专利医药级的以甲苯胺蓝染色异染性染料。
  
  在与Medscape的面谈中,Epstein教授强调早期侦测癌前病灶、以及早期口腔癌将影响治疗与预后;他表示,传统外观上辨识以及徒手检查仍然是确认口腔病灶的黄金标准,但是在会议中全体出席会议中报告的,该团队指出应用这项新的技术,合并传统技术使用可以改善亮度或是敏锐度达60%以上。
  
  【萤光染色显影提高病灶可见度】
  研究者于84位病患身上确认出97个临床上可疑病灶,病灶在白帜光下显像,并进一步以萤光显像方式观察其特征,这可能协助侦测可疑的口腔病灶,同时他们也纪录甲苯胺蓝于病灶上留滞的情形。
  
  研究者根据世界卫生组织标准病理切片条件对每个可疑病灶切片进行诊断,他们发现化学萤光染色可以提升病灶可见度,且这些病灶以甲苯胺蓝染色合并切片可以降低58.6%的伪阳性率,不但如此,还保留了100%的阴性预测值。
  
  Epstein教授向Medscape表示,这项试验的设计针对标准光线检验下找出的病灶,其中并未包括新的病灶;未来将需要进一步的研究确认这个问题,以及包括其它竞争中的产品,他附带表示,仍然有许多辅助工具正在研究中。
  
  研究者的结论是,化学萤光显像提升口腔病灶的可见度,且其技术与甲苯胺蓝染色可以减少原位性或侵入性扁平细胞恶性肿瘤未发生严重病变进行切片的需求。

Screening Tool Flags Oral Canc

By Allison Gandey
Medscape Medical News

January 26, 2007 –- A new study suggests that chemiluminescent lighting and toluidine blue staining as an adjunct to conventional oral visual examination may improve the identification of oral mucosal lesions and reduce the number of required biopsies. "By combining conventional techniques with more modern techniques, we were able to better diagnose and determine the best options for patients with oral cancer," lead author Joel Epstein, DMD, professor and head of the department of oral medicine and diagnostic sciences, College of Dentistry, and director of the interdisciplinary program in oral cancer at the University of Illinois at Chicago, said in a news release. "This approach to diagnosing oral cancer may lead to easier identification of serious pathology, significantly lessening the need for unnecessary biopsies without additional risk of false negatives."

Dr. Epstein and a team of researchers presented their findings at the recent 2007 Multidisciplinary Head and Neck Cancer Symposium in Rancho Mirage, California. The screening tool is already available in the United States and is produced by Zila Inc, in Phoenix, Arizona. The method combines the company's ViziLite, a chemiluminescent light, with TBlue630, a patented, pharmaceutical-grade toluidine blue-based metachromatic dye.

During an interview with Medscape, Dr. Epstein emphasized that early detection of oral premalignant lesions and early-stage oral cancer will affect treatment and outcomes. He noted that conventional visual and manual examination remain the gold standard for the identification of oral mucosal lesions. But presenting at the plenary session at the meeting, his group showed that applying this new method to conventional screening improved the brightness or sharpness of more than 60% of lesions.

Chemiluminescent Lighting Improved Lesion Visibility

The researchers identified 97 clinically suspicious lesions in 84 patients. Lesions spotted under incandescent light were further assessed under chemiluminescent illumination followed by toluidine blue stain. The team documented differences between the conventional visual examination and chemiluminescent light for characteristics that may help in the detection of suspicious oral lesions. They also recorded the retention of toluidine blue.

The researchers biopsied every suspicious lesion and diagnosed it based on standard histologic criteria according to World Health Organization criteria. They found that chemiluminescent lighting improved lesion visibility and that those biopsied with toluidine blue stain had fewer false positives — a rate of 58.6% fewer — while maintaining a 100% negative predictive value.

"The design of this study accounted only for lesions identified by standard exam lighting, it did not include new lesions," Dr. Epstein told Medscape. Additional studies will investigate this question, and other, competing products are also being considered. "This is the furthest along, but there are a number of other adjuncts as well," he added.

The researchers conclude that chemiluminescent illumination improved visualization of oral mucosal lesions and and it and toluidine blue lead to a reduced number of biopsies of lesions without severe dysplasia or in situ or invasive squamous cell carcinoma.

2007 Multidisciplinary Head and Neck Cancer Symposium: Abstract 12. Presented January 19, 2007.

    
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