Evaluation of Diagnostic Aids

Question 1

Historically, oral cancer detection has been based on _______ _______ ______.

Answer 1

conventional oral examination (COE)

-visual and tactile

Question 2

Nearly all cases of ______ arise from precursor epithelial changes.

Answer 2

OSCC

Question 3

What do most cases of OSCC arise from?

Answer 3

precursor epithelial changes (oral epithelial dysplasia)

Question 4

What is oral epithelial dysplasia?

Answer 4

maturational disturbances of epithelial cells

-histopathological marker of premalignancy

Question 5

What proportion of the epithelium stains dark (dysplastic) in a sample of normal tissue? Mild Dysplasia? Severe dysplasia? Carcinoma in-situ?

Answer 5

Normal: 1/3
Mild: 1/2
Severe: 3/4
In-situ: entire thickness

Question 6

True or False: Overall, COE has a good sensitivity and specificity.

Answer 6

True

Question 7

What is the sensitivity percentage for COE? the specificity for COE?

Answer 7

sensitivity: 85%
specificity: 97%

Question 8

True or False: Trained auxiliaries are as accurate as dental practitioners in detecting oral cancer.

Answer 8

True

Question 9

What are three limitations of COE?

Answer 9

1. Many common mimics of cancerous and precancerous lesions
2. Cannot determine which lesions will progress to cancer
3. Precancerous lesions have been found in normal mucosa

Question 10

What is a “screening test?”

Answer 10

test used on people apparently free of disease in order to detect the disease in early stages

Question 11

A ______ test is used to analyze abnormal clinical findings or symptomatic patient in order to establish or suggest dianosis.

Answer 11

case-finding test

Question 12

Of the discussed diagnostic aids, which one is a case-finding test?

Answer 12

Brush Test Oral CDx (previously “brush biopsy”)

Question 13

What is the indication for the Brush Test Oral CDx?

Answer 13

“to test the common, small, harmless-appearing white or red tissue spots” that are found on clinical examination.

Question 14

True or False: The Brush Test provides a diagnosis based on cell culture.

Answer 14

False, does NOT provide a diagnosis. Only 1 of 4 “results”

Question 15

What are the four results that are provided by Brush Test?

Answer 15

Incomplete Specimen (not enough cells)
Negative (no precancerous cells)
Atypical (abnormal cells)
Positive (dysplastic cells)

P.A.I.N…as in, this stuff is a pain to study

Question 16

The Brush Test has recorded several false _____ results.

Answer 16

negative

Question 17

Which of the Diagnostic Aids are “screening” tests?

Answer 17

• ViziLite Plus
• VELscope
• Identafi
• OralID

Question 18

What are the three components of ViziLite Plus?

Answer 18

1. 1% acetic acid (dries tissue)
2. Disposable light stick
3. Toluidine Blue Dye

ViZi uses “T”

Question 19

True or False: TBlue Dye is very specific to dysplastic cells.

Answer 19

False, stains any surface abnormality (false positives)

**ViziLite is unable to discriminate normal tissue from premalignancy*

Question 20

ViziLite uses ______ which is the emission of light as the result of a chemical reaction.

Answer 20

Chemiluminescence

Question 21

What is the proposed mechanism of detection associated with chemiluminescence?

Answer 21

abnormal cells will have altered reflective properties. Normal cells will appear dark, Abnormal = acetowhite

Question 22

_______ is a diagnostic aid that is based on the concept of tissue fluorescence.

Answer 22

VELscope

Question 23

The VELscope emits _____light at 400-460nm and allows for direct visualization through a narrow-band filter. What color will “normal tissue” appear? What color will “abnormal tissue” appear?

Answer 23

blue
pale green = normal
dark = abnormal

Question 24

_____ are molecules that emit energy in the form of fluorescence when excited by light. What are some examples?

Answer 24

Fluorophores

ex: collagen, elastin, NADH, FAD

Question 25

Through the ViziLite, abnormal tissue appears ______. Through the VELscope, abnormal tissue appears ______.

Answer 25

``` ViziLite = white (lite...white) VELscope = dark ```

Question 26

Minimal data supports the role of ViziLite as a screening tool due to its false ____.

Answer 26

false + (90%) and false - (15 cases)

Question 27

In what other way might VELscope be beneficial?

Answer 27

allows for detection of cancer or precancer borders beyond conventional examination alone (visualizing the extend of margins for biopsy) **shows us the "scope" of the lesion**

Question 28

Identafi is a diagnostic aid based on ____-_____ fluorescence and reflectance _________.

Answer 28

multi-spectral | spectroscopy

Question 29

True or False: Identafi is hand-held and cordless.

Answer 29

True

Question 30

How many "color wavelengths" does Identafi use?

Answer 30

Three: white, violet, amber

Question 31

Which color is used for the conventional oral exam (Identafi)?

Answer 31

white

Question 32

What is the violet color used for (Identafi)?

Answer 32

for observing tissue fluorescence (abnormal mucosa appears dark)

Question 33

When is the amber color used (Identafi)?

Answer 33

when suspected abnormalities are detected | -amber light shows reflectance and vasculature

Question 34

Why is the amber light detection of vascularity questionable?

Answer 34

there is no magnification included (how could details possibly be seen)

Question 35

True or False: The clinical application of Identifi has not been proven.

Answer 35

True

Question 36

______ incorporates fluorescence technology with liquid-based cytology.

Answer 36

Oral ID

Question 37

True or False: Oral ID has comparable performance to VELscope and BrushTest.

Answer 37

True

Question 38

____% of oral cancer is diagnosed in Stage III-IV

Answer 38

63

Question 39

What are the high risk sites for oral cancer and dysplasia?

Answer 39

ventro-lateral tongue floor of mouth lateral soft palate (anterior tonsillar pilars)

Question 40

The "High Risk Zone" for oral cancer accounts for ___% of total oral surface, but ____% of cancerous lesions occur in this area.

Answer 40

20% of area | 80% of lesions

Question 41

What are the suspicious physical features that we must watch for?

Answer 41

- crisply defined red, white, or mixed-red-white lesions - persistent ulceration (despite treatment) - induration

Question 42

What are the two best ways to defend against oral cancer?

Answer 42

1. Patient education to raise awareness of oral cancer and the importance of oral examination 2. careful visual and tactile examination with good judgement