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O173 Oral visual screening reduces oral cancer mortality: evidence from a randomised trial
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Oral and Symposium abstracts, Sunday 20 May
O173 Oral visual screening reduces oral cancer mortality: evidence from a randomised trial R. Sankaranarayanan1 *, K. Ramadas2 , G. Thomas2 , R. Muwonge1 , S. Thara2 , B. Mathew2 , B. Rajan2 . 1 World Health Organization, France, 2 Regional Cancer Centre, India
O175 Virtual panendoscopy a new tool to help evaluating oral cancer: a pilot study S. Sah *, J. Thiruchelvam, J. Makdissi, L. Cheng, I. Hutchison. Queens Hospital and Barts and The London Hospitals, United Kingdom
Introduction: Oral cancer continues to be an important public health problem in South and Southeast Asia, Eastern Europe and Oceania and accounts for 274,300 cases and 145,500 deaths around 2002. We evaluated the effect of visual screening on oral cancer mortality in a cluster randomised controlled trial in India. Methods: Apparently healthy subjects aged 35 years and above, living in 13 clusters, were randomised to 3 rounds of oral visual inspection by trained health workers at 3-year intervals (7 clusters) and those in the remaining 6 clusters to a control group, during 1996 2004, in Trivandrum district, India. Screen positives were referred for further examination by doctors, biopsy and treatment. All eligible subjects were followed up for oral cancer incidence and mortality, which were analysed and compared using cluster analysis. Results: There were 96,517 eligible subjects in the intervention and 95,356 in the control group. 87,637 (90.8%) were screened once, 58,586 (60.1%) twice and 29,148 (30.2%) thrice. Of the 5145 screened positive, 3218 (62.5%) complied with referral. There were 204 oral cancer cases in the visual screening group and 155 cases in the control group. 76 persons died from oral cancer in the intervention group, compared with 83 deaths in the controls (mortality rate ratio 0.82 [95% CI 0.51 1.30]). There were 69 oral cancer deaths among tobacco/alcohol users in the intervention group, compared with 81 deaths in controls (mortality rate ratio 0.68 [95% CI 0.46 1.00]). The mortality rate ratio among male tobacco/alcohol users was 0.58 (95% CI 0.35 0.96) and 0.84 (95% CI 0.47 1.51) among similar females. Discussion: Our findings convincingly establish that oral visual screening can reduce mortality among users of tobacco or alcohol or both emphasizing the need for establishing screening programmes of high-risk individuals in routine health services in high-risk countries. Keywords: oral cancer, screening, control
Introduction: Oral cancer is the 5th or the 6th most common cancer in the UK. Almost 4,700 new cases of oral cancer are diagnosed in the UK each year. Approximately there are 1,600 deaths due to oral cancer, which accounts for approximately 2% of all cancers. Several imaging modalities are used to stage the disease and to identify any synchronous primary tumours. Various steps are taken for this which includes naso-endoscopy, MRI, CT and PET. Virtual endoscopy is a new non-invasive imaging modality. It involves the use of the already obtained data from CT scanning of patients using multi detector CT scanners. The data is manipulated using computer software programme to generate 3D models with fly through capability to examine the upper aero digestive tract. Aim: The aim of this study is to compare virtual panendoscopy and conventional fibre optic endoscopy for the detection of synchronous primary cancer of the head and neck. Material and Methods: Ten consecutive patients diagnosed with oral cancer who had a CT scan of the head and neck in the multidetector CT scanner were included in the study. Those patients also had fibre optic naso-endoscopy as part of their traditional staging process. Soft tissue window data obtained from CT scanning were used. This data was manipulated using a computer software programme to generate 3D models with fly through capability. The findings of this virtual endoscopy were compared to the fibre optic naso-endoscopy. It was done double-blinded as a surgeon and radiologist were unaware of other’s findings. Results: High degree of similarity between virtual panendoscopy and conventional fibre optic endoscopy was seen. However more anatomical details were depicted on virtual panendoscopy where it was not accessible to conventional fibre optic endoscopy. Conclusion: Virtual endoscopy is a new, non invasive diagnostic technique enabling extra information to be used by the surgeon to identify synchronous primary head and neck cancer in patients who are already diagnosed with oral cancer. Large study as a prospective multi centre randomised control trial is planned to confirm findings. Keywords: virtual paendoscopy, synchronous primary
O174 Autofluorescence in tumour surveillance C. Betz, C. Hopper *. University College London Hospitals and UCL Eastman Dental Institute, United Kingdom Introduction: Autofluorescence imaging has an established place in the identification and delineation of upper aerodigestive tract dysplasia and cancer. The technique is simple, non invasive and gives the surgeon instant answers about tumour extent. In this study we applied this technology to patients at first diagnosis of an intraoral lesion and also used the technique to monitor dysplasias and patients with field change disease after their index tumours. Methods: 25 patients were studied using the Storz autofluorescence endoscopy system. Data was acquired and stored on digital media. The findings were compared with histopathology. Results: Malignant lesions all demonstrated a distinct reduction in autofluorescence intensity and were easily distinguished from normal tissue. Hyperaemia and inflammatory changes caused the greatest diagnostic difficulties, whereas hyperkeratotic and hypertrophic tissue showed an increase in autofluorescence. Conclusion: Autofluorescence imaging is a helpful adjunct to clinical and histopathological examination of the upper aerodigestive tract. Keywords: autofluorescence, surveillance, oral cancer, tumour diagnosis
O176 Macroscopic classification of superficial neoplastic lesions of the oral mucosa: a feasibility study on patients with malignant transforming oral lichen planus S. Fedele1 *, L. Lo Russo2 , M. Mignogna2 , S. Porter1 . 1 UCL Eastman Dental Institute, United Kingdom, 2 University of Naples “Federico II”, Italy Introduction: Careful endoscopic classification of macroscopic appearance of superficial neoplasias of the gastrointestinal tract is essential in the early detection and appropriate treatment of cancer, and has contributed to introduce minimally-invasive endoscopic surgery and improve patients’ survival. A similar classification of early oral cancer is lacking. We tested the hypothesis that is possible to extend the diagnostic benefit of a classification based upon the macroscopic appearance of superficial tumours of the digestive tract to superficial carcinoma of the oral mucosa. Methods: We retrospectively examined a group of patients who developed multiple intraepithelial and early invasive malignant oral neoplasias. This comprised 50 patients with oral lichen planus who developed severe dysplastic changes (intraepithelial neoplasia) and early squamous cell carcinoma of the oral mucosa. The current Paris classification of
Oral and Symposium abstracts, Sunday 20 May
O173 Oral visual screening reduces oral cancer mortality: evidence from a randomised trial R. Sankaranarayanan1 *, K. Ramadas2 , G. Thomas2 , R. Muwonge1 , S. Thara2 , B. Mathew2 , B. Rajan2 . 1 World Health Organization, France, 2 Regional Cancer Centre, India
O175 Virtual panendoscopy a new tool to help evaluating oral cancer: a pilot study S. Sah *, J. Thiruchelvam, J. Makdissi, L. Cheng, I. Hutchison. Queens Hospital and Barts and The London Hospitals, United Kingdom
Introduction: Oral cancer continues to be an important public health problem in South and Southeast Asia, Eastern Europe and Oceania and accounts for 274,300 cases and 145,500 deaths around 2002. We evaluated the effect of visual screening on oral cancer mortality in a cluster randomised controlled trial in India. Methods: Apparently healthy subjects aged 35 years and above, living in 13 clusters, were randomised to 3 rounds of oral visual inspection by trained health workers at 3-year intervals (7 clusters) and those in the remaining 6 clusters to a control group, during 1996 2004, in Trivandrum district, India. Screen positives were referred for further examination by doctors, biopsy and treatment. All eligible subjects were followed up for oral cancer incidence and mortality, which were analysed and compared using cluster analysis. Results: There were 96,517 eligible subjects in the intervention and 95,356 in the control group. 87,637 (90.8%) were screened once, 58,586 (60.1%) twice and 29,148 (30.2%) thrice. Of the 5145 screened positive, 3218 (62.5%) complied with referral. There were 204 oral cancer cases in the visual screening group and 155 cases in the control group. 76 persons died from oral cancer in the intervention group, compared with 83 deaths in the controls (mortality rate ratio 0.82 [95% CI 0.51 1.30]). There were 69 oral cancer deaths among tobacco/alcohol users in the intervention group, compared with 81 deaths in controls (mortality rate ratio 0.68 [95% CI 0.46 1.00]). The mortality rate ratio among male tobacco/alcohol users was 0.58 (95% CI 0.35 0.96) and 0.84 (95% CI 0.47 1.51) among similar females. Discussion: Our findings convincingly establish that oral visual screening can reduce mortality among users of tobacco or alcohol or both emphasizing the need for establishing screening programmes of high-risk individuals in routine health services in high-risk countries. Keywords: oral cancer, screening, control
Introduction: Oral cancer is the 5th or the 6th most common cancer in the UK. Almost 4,700 new cases of oral cancer are diagnosed in the UK each year. Approximately there are 1,600 deaths due to oral cancer, which accounts for approximately 2% of all cancers. Several imaging modalities are used to stage the disease and to identify any synchronous primary tumours. Various steps are taken for this which includes naso-endoscopy, MRI, CT and PET. Virtual endoscopy is a new non-invasive imaging modality. It involves the use of the already obtained data from CT scanning of patients using multi detector CT scanners. The data is manipulated using computer software programme to generate 3D models with fly through capability to examine the upper aero digestive tract. Aim: The aim of this study is to compare virtual panendoscopy and conventional fibre optic endoscopy for the detection of synchronous primary cancer of the head and neck. Material and Methods: Ten consecutive patients diagnosed with oral cancer who had a CT scan of the head and neck in the multidetector CT scanner were included in the study. Those patients also had fibre optic naso-endoscopy as part of their traditional staging process. Soft tissue window data obtained from CT scanning were used. This data was manipulated using a computer software programme to generate 3D models with fly through capability. The findings of this virtual endoscopy were compared to the fibre optic naso-endoscopy. It was done double-blinded as a surgeon and radiologist were unaware of other’s findings. Results: High degree of similarity between virtual panendoscopy and conventional fibre optic endoscopy was seen. However more anatomical details were depicted on virtual panendoscopy where it was not accessible to conventional fibre optic endoscopy. Conclusion: Virtual endoscopy is a new, non invasive diagnostic technique enabling extra information to be used by the surgeon to identify synchronous primary head and neck cancer in patients who are already diagnosed with oral cancer. Large study as a prospective multi centre randomised control trial is planned to confirm findings. Keywords: virtual paendoscopy, synchronous primary
O174 Autofluorescence in tumour surveillance C. Betz, C. Hopper *. University College London Hospitals and UCL Eastman Dental Institute, United Kingdom Introduction: Autofluorescence imaging has an established place in the identification and delineation of upper aerodigestive tract dysplasia and cancer. The technique is simple, non invasive and gives the surgeon instant answers about tumour extent. In this study we applied this technology to patients at first diagnosis of an intraoral lesion and also used the technique to monitor dysplasias and patients with field change disease after their index tumours. Methods: 25 patients were studied using the Storz autofluorescence endoscopy system. Data was acquired and stored on digital media. The findings were compared with histopathology. Results: Malignant lesions all demonstrated a distinct reduction in autofluorescence intensity and were easily distinguished from normal tissue. Hyperaemia and inflammatory changes caused the greatest diagnostic difficulties, whereas hyperkeratotic and hypertrophic tissue showed an increase in autofluorescence. Conclusion: Autofluorescence imaging is a helpful adjunct to clinical and histopathological examination of the upper aerodigestive tract. Keywords: autofluorescence, surveillance, oral cancer, tumour diagnosis
O176 Macroscopic classification of superficial neoplastic lesions of the oral mucosa: a feasibility study on patients with malignant transforming oral lichen planus S. Fedele1 *, L. Lo Russo2 , M. Mignogna2 , S. Porter1 . 1 UCL Eastman Dental Institute, United Kingdom, 2 University of Naples “Federico II”, Italy Introduction: Careful endoscopic classification of macroscopic appearance of superficial neoplasias of the gastrointestinal tract is essential in the early detection and appropriate treatment of cancer, and has contributed to introduce minimally-invasive endoscopic surgery and improve patients’ survival. A similar classification of early oral cancer is lacking. We tested the hypothesis that is possible to extend the diagnostic benefit of a classification based upon the macroscopic appearance of superficial tumours of the digestive tract to superficial carcinoma of the oral mucosa. Methods: We retrospectively examined a group of patients who developed multiple intraepithelial and early invasive malignant oral neoplasias. This comprised 50 patients with oral lichen planus who developed severe dysplastic changes (intraepithelial neoplasia) and early squamous cell carcinoma of the oral mucosa. The current Paris classification of