Fluorescence Influence on Screening Decisions for Oral Cancer

Objectives: The aim of the present study was to assess the capability of the VELscope system to image the tissue auto-fluorescence of potentially malignant oral lesions and to assess the diagnostic accuracy, sensitivity, and specificity of this method. Methods: 10 patients were evaluated by conventional oral examination (COE) followed by direct visual fluorescence evaluation (DVFE) using VELscope. Areas clinically suspicious detected by COE or with positive DVFE (visual fluorescence loss (VFL)) have been further investigated using surgical biopsy. The association between COE and DVFE has also been assessed and compared with the gold standard, i.e. histopathology. Results: Eight positive biopsies for malignant lesions were detected using COE and DVFE. Only one positive biopsy for a premalignant lesion was not in accordance with COE and DVFE. One of the lesions, determined on the VELscope and COE as a non-malignant lesion was also confirmed by the biopsy. Therefore, the VELscope system had a sensitivity of 100% and specificity of 50% in discriminating in situ normal mucosa from carcinoma or invasive carcinoma, compared with histology. The predictive positive value was 88.89% and the negative predictive value was 100% (95% confidence interval). Conclusions: DFVE allows for simple and cost-effective margin determinations, in order to detect and screen oral precancerous and early cancerous disorders. We found that for the moment the VELscope system could not replace the histopathology procedure. Nonetheless, its usefulness for clinical examination was determined, as well as for monitoring oral lesions and guiding biopsies. Therefore, this method may add sensitivity to oral tissue examinations and be an effective adjunct procedure for high-risk patients.