Reliability of Colposcopic Descriptive Appearances in Oral Pre-Cancers-A Clinico-Patho-Colposcopic Study

Research Article

Austin J Cancer Clin Res 2015;2(6): 1051.

Reliability of Colposcopic Descriptive Appearances in Oral Pre-Cancers-A Clinico-Patho-Colposcopic Study

Nayyar AS*

Department of Oral Medicine and Radiology, Government Dental College and Research Institute, India

*Corresponding author: Abhishek Singh Nayyar, Department of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore-560002, Karnataka, India

Received: May 19, 2015; Accepted: August 08, 2015; Published: August 10, 2015

Abstract

Context: The single most important factor that is known to improve the end result of head and neck cancer is the early diagnosis of these cancers while they are still localized and can be treated with a high probability of cure. Early diagnosis of cancer plays a life saving pivotal role in overall management. The technique of colposcopy enables evaluation of changes in surface topography and vascular patterns of the lining mucosa thus, aiding in selecting the most appropriate site of biopsy ruling-out the possibility of taking biopsy from the most representative area supposed to reveal epithelial dysplasia. In view of intraoral application of micro-colposcopy, it was felt that colposcopy might provide a useful aid for the early enough diagnosis of oral pre-cancerous and cancerous lesions and conditions affecting the oral mucosa to improve the prognosis.

Aim: To clinico-pathologically correlate cases of oral pre-cancers; correlate the surface characteristics revealed by micro-colposcopy with the histopathological diagnoses of the sites under observation; and map out the areas of surface dysplasia to indicate the full extent of epithelial changes before taking the biopsy specimen to take specimen from areas most representatives of dysplasic features (guided biopsies).

Settings and Design: Methods and Material: A total 27 subjects were studied including 10 cases each of oral submucous fibrosis and hyperkeratotic lesions including homogeneous and non-homogeneous leukoplakias, 6 cases of oral lichen planus and a case of clinically suspected oral squamous cell carcinoma.

Results: In the present study, a sensitivity of colposcopic screening test came-out to be about 71% while specificity was about 92%. Positive predictive value was 91%.

Conclusion: Although the degree of abnormality in colposcopic findings can be predicted by the vascular patterns of the lesion, the major advantage of colposcopy is to outline the most suspicious lesion for histologic diagnosis by directed biopsy which is the mainstay in establishing the correct diagnosis. Colposcopy is valuable in the detection of early cancerous lesions; however the final diagnosis must rely on a meticulous histopathological examination by an expert pathologist.

Keywords: Colposcopy; Oral pre-cancerous lesions and conditions; Histopathological

Key Message

In the study of dysplasia, the essential role of colposcopy is to locate the site, to define the peripheral limits of lesions and to indicate the most appropriate biopsy site, rather than to attempt to reach a histological diagnosis.

Introduction

The single most important factor that is known to improve the end result of head and neck cancer is the early diagnosis of these cancers while they are still localized and can be treated with a high probability of cure. Early diagnosis of cancer plays a life saving pivotal role in overall management. Tremendous amount of research has been done in this area, especially stressing clinical and radiological diagnosis and recognition, in order to facilitate successful treatment. However, there is dearth of specialized, yet simple technique which might give us diagnostic and/or prognostic pointers on this perplexing disease [1,2].

In the oro-facial region, the need for non-invasive techniques for the early detection of changes in the oral tissues has long been recognized. With current methods of examination, surface characteristics have not been shown to have a specific relationship to possible changes in the subsurface layers, particularly at the epithelial/ lamina propria junction. The micro-colposcope appears to have many features that would be favorable for observing and documenting the surface topographic changes of the oral tissues [3]. The technique of colposcopy provides an optical method for examining the illuminated cervix and lower genital tract in higher magnification. Essentially the colposcopic examination involves the visualization of the lining layer of vagina, cervix and lower endo-cervical canal [4].

The stereoscopic magnification in colposcopy enables evaluation of changes in surface topography and vascular patterns of the lining mucosa thus, aiding in selecting the most appropriate site of biopsy ruling-out the possibility of taking biopsy from the most representative area supposed to reveal epithelial dysplasia [4-7].

In view of intra-oral application of micro-colposcopy, it was felt that colposcopy might provide a useful aid for the early enough diagnosis of oral pre-cancerous and cancerous lesions and conditions affecting the oral mucosa to improve the prognosis.

Materials and Methods

The study was conducted in Department of Oral Medicine and Radiology. The patients were selected from those attending OPD of Department of Oral Medicine and Radiology during the period of May 2013-May 2014. The protocol of the study was approved by Institutional Ethics Committee. A total 27 subjects (Figure 1ae) were studied including 10 cases each of oral submucous fibrosis and hyperkeratotic lesions including homogeneous and nonhomogeneous leukoplakias, 6 cases of oral lichen planus and a case of clinically suspected oral squamous cell carcinoma. The significance of the number of samples was analyzed statistically before their inclusion into the study. For each of the subjects, a detailed case history and thorough clinical examination was carried out and under good illumination, intra-oral examination of the lesion was performed. Inspection and palpatory findings were recorded in a prepared proforma. Following clinical and followed by colposcopic examination (Figure 2) of the lesions, the most representative site of the lesions were selected for biopsy. When the area selected for biopsy by clinical criteria and colposcopic examination was superimposed, then only one common biopsy sample was obtained. When two different areas were selected from the same lesion, two different areas which were marked with different colors were biopsied and subjected to histopathological examination. Comparison of the histopathlogical diagnosis obtained with routine clinical examination and direct intra-oral microscopy was performed, and the data was subjected to statistical analysis.