Clinical Evaluation of the Optical Filter for Autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLES®) in the Management of Potentially Premalignant Disorders: A Retrospective Study

Abstract

Background: Any oral potentially malignant disorders (OPMDs) must be regularly monitored through clinical examination to detect any possible malignant transformation. Conventional intraoral exams, however, can be difficult because these conditions may resemble benign lesions. For this reason, several non-invasive diagnostic technologies have been developed to help the clinician in detecting and distinguishing between cancerous and benign lesions. Epithelial dysplasia can be considered the most important predictor of malignant evolution. Therefore, in this study we aim to evaluate the ability of an optical filter for autofluorescence Glasses for Oral Cancer Curing Light Exposed (GOCCLES^®) and of toluidine blue staining in identifying dysplastic areas in patients with OPMDs.

Methods: In this retrospective study, medical records, photographs and videos of 25 patients with oral lesions were analyzed. Forty-two biopsy samples in 25 patients with OPMDs and at least one suspicious oral mucosa lesion that were evaluated in white light, autofluorescence with optical filter GOCCLES^®, toluidine blue staining and then biopsied with histopathological analysis were analyzed.

Results: The sensitivity and specificity for the autofluorescence evaluation with GOCCLES^® for identifying dysplasia or carcinoma were 66% and 48%, respectively. The positive and negative predictive values were 34% and 77%, respectively, and the accuracy was 53%. The sensitivity and specificity for toluidine blue staining were 91% and 68%, respectively. The positive and negative predictive values were 55% and 95%, respectively, and the accuracy was 75%.

Conclusions: The optical filter for autofluorescence (GOCCLES^®) and toluidine blue staining are simple, inexpensive, rapid and non-invasive procedures that can assist the clinician in distinguishing OPMDs from healthy mucosa but they are not able to distinguish benign and malignant lesions.

Keywords: autofluorescence; biopsy; dysplasia; oral cancer; oral potentially malignant disorders; retrospective study; toluidine blue.

Figure 1

The GOCCLES^® clip (Glasses for Oral Cancer Curing Light Exposed Screening) medical device.

Figure 2

Roc Curve.

Figure 3

Clinical appearance, blue toluidine staining and autofluorescence analysis of three different lesions. Case 1 shows a lichenoid lesion in white light (A) considered non-suspicious at clinical examination, which was negative by blue toluidine staining (B) and autofluorescence visualization (C). The histopathologic analysis shows acanthosis, hyperparacheratosis, infiltrated lichenoid lymphocyte with vacuolization of the basal layer (D). Case 2 shows a suspicious red lesion (E), that was positive by blue toluidine staining (F) and autofluorescence visualization (G). Biopsy (H) revealed a condition of moderate dysplasia with areas of severe dysplasia. Case 3 shows a proliferative suspicious lesion (I) that was negative by blue toluidine staining (L) and autofluorescence visualizaion (M). The histopathologic diagnosis was a verrucous carcinoma (N).