RESUMO
Introduction: Scanned fibre endomicroscopes are full point-scanning confocal microscopes with submicron lateral resolution with an optical slice thickness thin enough to isolate individual cell layers, allow active positioning of the optical slice in the z-axis and collection of megapixel images. Here we present descriptive findings and a brief atlas of an acquisition and annotation protocol high resolution in vivo capture of oral mucosal pathology including oral squamous cell carcinoma and dysplasia using a fluorescence scanned fibre endomicroscope with 3 topical fluorescent imaging agents: fluorescein, acriflavine and PARPi-FL. Methods: Digital biopsy was successfully performed via an acquisition protocol in seventy-one patients presenting for investigation of oral mucosal abnormalities using a miniaturized, handheld scanned fibre endoscope. Multiple imaging agents were utilized and multiple time points sampled. Fifty-nine patients had a matched histopathology correlating in location with imaging. The images were annotated back to macrographic location using a purpose-built software, MouthMap™. Results: Acquisition and annotation of cellular level resolved images was demonstrated with all 3 topical agents. Descriptive observations between clinically or histologically normal oral mucosa showed regular intranuclear distance, a regular nuclear profile and fluorescent homogeneity. This was dependent on the intraoral location and type of epithelium being observed. Key features of malignancy were a loss of intranuclear distance, disordered nuclear clustering and irregular nuclear fluorescence intensity and size. Perinuclear fluorescent granules were seen in the absence of irregular nuclear features in lichenoid inflammation. Discussion: High resolution oral biopsy allows for painless and rapid capture of multiple mucosal sites, resulting in more data points to increase diagnostic precision. High resolution digital micrographs can be easily compared serially across multiple time points utilizing an annotation software. In the present study we have demonstrated realization of a high-resolution digital biopsy protocol of the oral mucosa for utility in the diagnosis of oral cancer and precancer..
RESUMO
Multifocal epithelial hyperplasia (MEH) presents as painless, single or multiple nodular or papular lesions with a sessile base, ranging in diameter from 0.1 cm to 1.0 cm, frequently coalescing. Lesion color varies from red to white, depending on the extent of keratinization. The condition appears mainly in children and adolescents and regresses spontaneously. The etiological factors and pathogenesis of MEH are speculative. A 13-year-old boy presented to the Royal Dental Hospital of Melbourne for dental examination revealing several asymptomatic, exophytic, pink, sessile, smooth-surfaced nodules on the lateral borders of the tongue and lingual surface of the lower lip. The subject is of Somalian background and one of 11 siblings aged 2 to 22 years old living with his parents in an overcrowded residence. Examination of other family members revealed the presence of similar lesions in 2 younger sisters. An incisional biopsy confirmed the diagnosis of MEH histopathologically.
