Source: 7thspace.com
Author: Stefano Fedele
The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth.
There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa.
As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence.
The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking.
Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required.
Source:
Head &Neck Oncology 2009, 1:5
Chemiluminesence is NOT a technique for oral cancer screening. It is a marketing buzz word, coined in 1999 to make what is taking place between two different chemicals in a light stick “appear” to have more scientific pizzaz to it. The company (Zila) that promotes this has been making hay on the lack of understanding of this issue. The proper phraseology for this type of examination is tissue reflectance, when referring to the techniques that use a acetic acid (vinegar) rinse, and a white or colored light source to reflect off the larger nuclei of damaged cells (which may be damaged by numerous other things other than a malignancy). No adjunctive device currently approved for screening defines the difference between a malignancy and a benign condition, and they ar NOT approved by the FDA to claim so. Only the gold standard biopsy is able to do this at the present time. Even brush collection systems which have been around for many years require that a gold standard incision or punch biopsy confirm any findings from this type of diagnostic system.