Importance of the vaporization margin during CO2 laser treatment of oral leukoplakia: A survival study

Objectives

The main purpose of this study was to assess the response of oral leukoplakia to CO₂ laser vaporization treatment, as well as determining possible factors that may affect recurrence of lesions.

Materials and methods

A retrospective study was conducted, in which the medical records of patients who had been clinically and histologically diagnosed with oral leukoplakia and treated with CO₂ laser between 1996 and 2019 at the Oral Medicine Teaching Unit of the Faculty of Dentistry of the University of Santiago de Compostela were reviewed.

Results

Fifty-eight patients were included: 36 female and 22 male subjects, with a mean age of 63.7 years old (SD ±13.1). The average follow-up time was 57.5 months (SD ±57.9). A relapse rate of 52.6% was determined. Of all the studied variables, the margin was the only one for which a statistically significant association with recurrence of lesions was demonstrated (p < 0.05).

Conclusion

The vaporization of lesions using CO₂ laser with a safety margin of at least 3 mm from the clinical limits of OL is a key factor in preventing recurrence.     

Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening

Background

Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs.

Aim

The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies.

Methods

Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high-risk human papillomavirus (hrHPV) analysis.

Results

Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy.

Conclusion

Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP.     

Oral potentially malignant disorders: a practical review for the diagnostic pathologist

This article provides a broad overview of oral potentially malignant disorders (OPMD) and associated entities. The review opens with an update on the terminology surrounding OPMD before summarizing the lesions and conditions currently recognized as OPMD by the World Health Organization (WHO). Approaches to diagnosing oral epithelial dysplasia (OED) are discussed in the context of the WHO's recently modified architectural and cytological criteria for OED. The spectrum of reactive epithelial changes – which may mimic OED - is explored for comparison. The review then focuses on four significant OPMD - proliferative verrucous leukoplakia, oral submucous fibrosis, HPV-associated OED, and oral lichen planus – with clinical and histopathological examples. Next, potential pitfalls - non-preneoplastic lesions that can mimic OPMD clinically and histopathologically - are highlighted; these include chronic hyperplastic candidosis, verruciform xanthoma, granular cell tumour, and hairy leukoplakia. Molecular tests for identifying and stratifying OPMD are commented on briefly as - to date - histopathology remains the most reliable prognosticator. Clinicopathological correlation is critical to accurate histopathological diagnosis, risk stratification, and clinical management. The review closes by highlighting clinical features – e.g., associated redness – indicative of high risk.     

High density of CD8 T cell and immune imbalance of T lymphocytes subsets are associated with proliferative verrucous leukoplakia

Oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) are oral potentially malignant disorders (OPMDs) that microscopically show no or varying degrees of dysplasia. Even sharing clinical and microscopic aspects, PVL shows a more aggressive clinical behaviour, with a malignant transformation rate greater than 40%. Inflammatory infiltrate associated with dysplastic lesions may favour malignant transformation of OPMDs. This study aimed to evaluate the density of T cells and cytokines in dysplastic lesions from OL and PVL patients. Additionally, we evaluated whether soluble products produced in vitro by dysplastic keratinocytes are capable of modulating apoptosis rates and Th phenotype (Th1, Th2, Th17 and Treg) of peripheral blood mononuclear cells. The density of CD3, CD4 and CD8 T cells was assessed by immunohistochemistry. Cytokines and chemokines profile from frozen tissue samples were analysed using the LUMINEX system. Apoptosis rates and Th phenotype modulation were evaluated by flow cytometry. Our results showed an increase in the number of CD8 T cell in the subepithelial region from PVL dysplastic lesions in relation to OL samples. PVL showed increased levels of IL-5 and a decrease in IL-1β and IFN-γ levels compared to OL. Soluble products of PVL and oral carcinoma cell cultures were able to reduce apoptosis rate and promote an imbalance of Th1/Th2 and Th17/Treg. The high-subepithelial density of CD8 T cells and immune imbalance of T lymphocytes subsets probably play an important role in the pathogenesis of PVL and may explain its more aggressive behaviour in relation to OL.     

中国口腔白斑恶变率的Meta分析

背景 口腔癌具有较高的发病率,大多数口腔癌是由口腔潜在恶性疾患造成,口腔白斑是常见的口腔潜在恶性病变。口腔白斑恶变不仅会影响患者的身心健康,而且会给患者家庭和社会带来沉重的经济负担。由于受到样本量、地区差异等因素的限制,我国口腔白斑患者恶变的流行病学特征结果不一。目的 系统评价中国人群口腔白斑的恶变率。方法 计算机检索中国知网、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据知识服务平台、PubMed、Web of Science、Embase、Cochrane Library,获取有关中国人群口腔白斑恶变率的队列研究,检索时限均为建库至2022年2月,由2名研究员独立筛选文献,对纳入的研究进行质量评价与数据提取,采用Stata15.0软件进行统计学分析。结果 最终纳入30篇队列研究,包括109 047例患者。Meta分析结果显示,我国口腔白斑患者恶变率为9.0%[95%CI(7.0%,11.3%)]。亚组分析结果显示,男性患者口腔白斑恶变率为7.6%[95%CI(5.1%,10.6%)],女性患者口腔白斑恶变率为13.2%[95%CI(9.5%,17.4%)];<6...     

紧密连接蛋白在声带白斑伴咽喉反流患者声带黏膜中的表达

Abstract:ObjectiveTo study the roles of tight junction proteins (TJPs) in vocal mucosal barrier damage via probing their differential expressions in vocal mucosa of patients suffering from vocal leukoplakia accompanied with laryngopharyngeal reflux (LPR).Methods26 patients suffering from vocal leukoplakia were divided into two groups (i.e., groups with and without LPR) (13 cases in each group) according to the results of 24 h esophageal pH monitoring. Mucosal specimens of vocal cord were collected from all the patients during operation. HE staining was used to score the pathological changes of the mucosa. Transmission electron microscope (TEM) was utilized to observe the morphology of mucosal tight junction, and Western blot to detect the expressions of Claudin 1 and ZO 1.ResultsCompared with the group without LPR, marked inflammatory cell infiltration and poor structural integrity of the epithelium were observed via HE staining, TEM demonstrated significant decrease of electron dense materials around the tight junction and obvious morphological changes of the tight junction, and Western blot showed decreased expressions of Claudin 1 and ZO 1 in the specimens from the group with LPR. Furthermore, immunofluorescence assay confirmed that expressions of Claudin 1 and ZO 1 were decreased within cytoplasm in those from the group with LPR.ConclusionRefluxed materials may cause structural damage of tight junction and abnormal expressions of TJPs, thus leading to structural damage of intercellular junction, intercellular spaces dilatation and enhancement of epithelial permeability, which may be an important mechanism of vocal mucosal barrier damage in vocal leukoplakia accompanied with LPR.     

支撑喉镜下声带白斑的手术治疗及预后分析

目的分析声带白斑临床因素对预后的影响，比较CO2激光与喉显微手术切除声带白斑的疗效。方法回顾性分析2010年1月～2012年12月收治的60例声带白斑患者的临床资料。分析患者性别、年龄、吸烟、饮酒、胃食管反流、手术方式与声带白斑预后的关系。按数字随机法将患者分成常规组30例，激光组30例。常规组患者采用支撑喉镜下冷器械喉显微手术，激光组采用支撑喉镜下CO2激光切除声带白斑病变组织。常规组和激光组患者均在术前1周，术后1周、1个月和3个月分别行电子喉镜、频闪喉镜检查、GRBAS、VHI主观评分和客观嗓音分析。结果60例声带白斑患者中，长期吸烟51例（85.00％），长期饮酒49例（81.67％），伴胃食管反流35例（58.33％）。多因素分析表明，患者的性别、年龄、吸烟、饮酒和胃食管返流在声带白斑的复发和声带白斑恶变的影响差异均无统计学意义（Ｐ＞0.05）。研究结果显示，术后1周声带白斑激光组的声带伤口恢复略好于常规组术后1周患者。而激光组和常规组患者电子喉镜检查、频闪喉镜黏膜波观察和主客观嗓音分析在术后1～3个月结果统计分析差异无统计学意义（P>0.05）。激光组和常规组患者，在术后1～4年进行随访，随访的结果是常规组的复发率明显高于激光组复发率（6.67％，2/30）。结论声带白斑发病与吸烟、饮酒、胃食管反流相关，但在其复发及恶变影响方面无统计学意义（P>0.05）。常规组近期效果较激光组稍好，但声带白斑治疗的远期效果CO2激光喉显微手术疗效优于常规手术。