Optical coherence tomography detects and semi-quantifies early mucositic change

Objective: The purpose of this study was to utilize in vivo optical coherence tomography (OCT) to detect chemotherapy-induced oral mucositis in patients receiving neoadjuvant chemotherapy for breast cancer. Methods: Fifteen patients being treated for breast cancer were evaluated clinically and imaged non-invasively with OCT 0, 2, 4, 7, and 11 days after initiating neoadjuvant chemotherapy treatment. The Oral Mucositis Assessment Scale (OMAS) served as the gold standard for clinical evaluation while OCT images were scored by one blinded investigator using an imaging-based scoring system. Results: The following events were identified using OCT: (1) change in epithelial thickness and subepithelial tissue integrity (beginning on day 2), (2) loss of surface keratinized layer continuity (beginning on day 4), (3) loss of epithelial integrity (beginning on day 4). Using a cumulative imaging-based score, differences between each pair of successive time points were significant (p<0.005, Kruskal-Wallis nonparametric test), demonstrating the potential for mapping progressive mucositis using OCT. Imaging data tended to give higher scores compared to clinical scores early on; correspondence was good at days 7 and 11 (non-significant Wilcoxon rank-sum test and moderate Spearman and Pearson correlation coefficients). These data indicate that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established and the clinical manifestation of the condition was more advanced, the imaging and clinical scores converged. Conclusion: Chemotherapy-induced oral changes were identified prior to their clinical manifestation using OCT, and the proposed scoring system for oral mucositis was validated for the semi-quantification of mucositic change.

Supported by: NIH (LAMMP) RR01192, DOE DE903-91ER 61227, NIH EB-00293 CA91717, NSF BES-86924. NIH (EB-00293, NCI-91717, RR-01192, EB0002SS, EB002494 and AR47551)