Prospective evaluation of oral premalignant lesions using a multimodal imaging system: a pilot study

Abstract

Background: Multimodal optical imaging, incorporating reflectance and fluorescence modalities, is a promising tool to detect oral premalignant lesions in real-time.

Methods: Images were acquired from 171 sites in 66 patient visits for clinical evaluation of oral lesions. An automated algorithm was used to classify lesions as high- or low-risk for neoplasia. Biopsies were acquired at clinically indicated sites and those classified as high-risk by imaging, at the surgeon's discretion.

Results: Twenty sites were biopsied based on clinical examination or imaging. Of these, 12 were indicated clinically and by imaging; 58% were moderate dysplasia or worse. Four biopsies were indicated by imaging evaluation only; 75% were moderate dysplasia or worse. Finally, four biopsies were indicated by clinical evaluation only; 75% were moderate dysplasia or worse.

Conclusion: Multimodal imaging identified more cases of high-grade dysplasia than clinical evaluation, and can improve detection of high grade precancer in patients with oral lesions.

Keywords: cancer; image analysis; optical imaging; oral lesion; prevention.

Figure 1

Study Procedure. A, Flowchart of study procedure. A head and neck surgeon assessed patients with oral lesion(s) per standard of care, and determined the appropriate clinical management plan. The lesion(s) were then evaluated using the MMIS. Finally, interventions were performed if indicated by the clinical management plan. Additional biopsies were acquired based on MMIS evaluation, at the clinician's discretion. B, Schematic of MMIS evaluation. Clinically suspicious regions (green outline) and AF heat map suspicious regions (red outline) were identified. These regions were explored with the HRME, and images were saved at representative sites (white dots) [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 2

Multimodal Imaging System. A, Macroscopic WL and AF image acquisition. Image acquisition occurs with the room lights off; for visualization purposes the lights were left on. The laptop and HRME are visible in the background. B, HRME image acquisition. The probe is gently touched to the mucosa after topical application of proflavine dye. The laptop and macroscopic imaging instrumentation are visible in the background [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 3

Patient Visit Example. A and B, WL and AF image of a right ventral tongue lesion for which the clinical management plan was “no biopsy or surgical resection.” Two clinically suspicious regions (anterior and posterior green outlines) were outlined. Note: The brightness of both images was doubled to improve visualization. C and D, WL and AF image including heat map overlay. Three additional suspicious regions based on the heat map (anterior, middle, and posterior red outlines) were outlined. E and F, WL and AF image, with location of HRME sites indicated (white dots). G and H, HRME images acquired from Sites 1, 2, and 3, which had a clinical impression of “abnormal, high risk.” Their MMIS classifications were low risk, low risk, and high risk, respectively. A biopsy was acquired at Site 3 due to the MMIS evaluation, and revealed moderate dysplasia [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 4

H&E slide of false negative site. The 4 mm punch biopsy (left panel) contained approximately 3 mm of histopathologically normal mucosa, and approximately 1 mm of severe dysplasia at the edge. The tissue in the black rectangle contains the severe dysplasia, which can be appreciated when viewed at a higher resolution (right panel) [Color figure can be viewed at http://wileyonlinelibrary.com]