Detection of potentially malignant oral lesions using Reflectance Confocal Microscopy

Objectives:

This study has been designed to characterize the features of normal mucosa, pan chewers and smokers mucosa, potentially malignant lesions and squamous cell carcinoma of the oral mucosa using reflectance confocal microscopy.

Methods:

25 patients from the college of dental surgery, saveetha university who underwent screening for suspected lesions of premalignant and malignant oral lesions were selected for the study along with normal patients who underwent impaction. Reflectance confocal images were obtained at multiple image plane depths from biopsies within six hours of fixation. After imaging, the biopsies were fixed in 10% formalin and submitted for routine histopathological examination. Reflectance confocal images were compared with the histological images from the same sample to determine the tissue features which contribute to early cellular changes, image contrast and early diagnosis. Quantification of keratin density and nuclear density in the confocal images was performed using image analysis software.

Results:

Confocal images were successfully obtained from all the 25 biopsy samples and depth related changes in cell diameter and nuclear density were observed in different regions and multiple anatomical sites within the oral cavity. In squamous cell carcinoma, densely packed, pleomorphic tumor nuclei were seen with distinct differences in nuclear density and morphology distinguishable from the normal mucosa. Significant differences based on cell and nuclear morphology was also observed between premalignant and malignant oral lesions.

Conclusion:

Our results support the potential for this tool to play a significant role in clinical evaluation of oral lesions, early diagnosis of premalignant and malignant oral lesions and real time identification of tumor margins. This study is a maiden attempt in world literature and first of its kind in relation to observation on pan chewers and smokers mucosa. It is the first reported study in oral squamous cell carcinoma in the Indian population.