Евалуација на методи за рана детекција на оралните премалигни и малигни лезии

Abstract

Despite the numerous advances and innovations in the treatment of malignant diseases in the last 50 years, only 50% of cases achieve a five-year survival. The low survival rate of patients with oral cancer can be attributed to the advanced stage of the disease at the time of diagnosis, as more than 60% of patients come to a medical examination at a more advanced clinical stage of the disease. One approach to addressing this problem is to improve the ability and preparedness of physicians in a timely manner by employing modern diagnostic procedures to identify potentially malignant lesions as well as primary and asymptomatic carcinoma lesions to detect oral cancer at their earliest possible or initial stage. Taking into account the numerous literature data that elaborate the positive and negative experiences of applying additional modern diagnostic procedures in the detection of oral potentially malignant and malignant lesions, and in the absence of more subtle studies performed in our country, we set out the main objectives of this study: • to determine the accuracy of clinical examination by conventional oral examination by inspection and palpation in detection of potentially malignant and malignant lesions • to determine the accuracy, sensitivity (SE) and specificity (SP) of toluidine blue test in the detection of potentially malignant and initial malignant lesions compared to gold standard surgical biopsy • to determine the accuracy, sensitivity (SE), and specificity (SP) of the cell exfoliative cytology test in detecting potentially malignant and initial malignant lesions compared to the gold standard surgical biopsy • to determine the accuracy, sensitivity (SE) and specificity (SP) of the Velscope screening method in detecting potentially malignant and initial malignant lesions compared to the gold standard surgical biopsy. • to evaluate the efficacy in diagnosing potentially malignant and malignant lesions when the clinical examination is combined with one of the screening methods listed. In order to realize the goals set in the research, a total of 120 patients were divided into two groups: the examined and the control group. The study group consisted of 90 patients diagnosed with malignant, potential malignant and suspected malignant lesions. The study group was divided into three subgroups. The first subgroup was formed by 30 patients with clinically potentially malignant oral lesions. Thirty patients with clinically suspected oral malignant lesions were included in the second subgroup of subjects, while the third subgroup of patients formed 30 patients with a history of malignant oral disease. The control group consisted of 30 patients with healthy and intact oral mucosa. All selected patients were followed according to the American Joint Commission on Cancer Diagnosis Protocol, with pre-operative preparation, diagnostics, surgical excision and postoperative clinical follow-up. The selection of patients in the study and control group was made according to certain inclusion and exclusion criteria. The realization of the research and selection of participants from the study group was conducted at the University Clinic of Maxillofacial Surgery at the University "Ss. Cyril and Methodius" in Skopje and the Clinic for Oral pathology and periodontology at the University Dental Clinical Center “St.Pantelejmon” in Skopje. Clinical examination was performed at the cited institutions and diagnostic procedures vital staining with Toluidine Blue, oral brush biopsy and Velscope imaging system were performed in subjects from all three subgroups. The histopathological analysis of the specimens of the study group was performed at the Institute of Pathological Anatomy at the Faculty of Medicine at the University of" Ss. Cyril and Methodius "in Skopje. The database is analyzed with the statistical programs STATISTICA 7.1 and SPSS for Windows ver. 20. Statistical series according to defined variables of interest are tabulated and graphically presented. By evaluating the results of our study, we have shown that both screening methods, vital staining with toluidine blue-TB and oral Brush biopsy have significant diagnostic value in all three groups of subjects, with higher diagnostic value of both methods in patients with highly suspected OSCC lesions. The VELscope method in this study gave the weakest results in the detection of dysplasia and OSCC especially in the group of patients with potentially malignant lesions. This method also gives more false positive results and can cause stress to the patient and unnecessary additional interventions. The use of the VELscope system as an additional means of detection has significant diagnostic value in patients with highly suspected oral lesions for cancer - N2, as well as in patients with oral lesions and a history of malignant oral disease - local recurrences (N3). The combination of COE method and oral Brush biopsy proved to be the best option for detecting potentially malignant and malignant oral lesions and we recommend it as the best screening procedure especially for patients with long-term premalignant lesions and in high-risk patients. In the specialist dental practice where the patient frequency is highest, the most accurate, easiest and non-invasive screening method is the combination of COE and vital staining with toluidine blue. We suggest the Toluidine blue method to be an integral part of oral cancer screening in any specialist dental practice. For the detection of potentially malignant diseases in the dental practice, COE is preferable in combination with the TB method, but in the diagnosis of lesions that are highly susceptible to oral cancer it is advisable to use oral Brush biopsy as a more accurate and reliable method besides COE. Positive and suspicious results of the proposed screening methods COE and Toluidine blue or COE and oral brush biopsy must be followed up by a pathological examination at the earliest possible time with a surgical biopsy.