The innovation of AI-based software in oral diseases: clinical-histopathological correlation diagnostic accuracy primary study.

BACKGROUND: Machine learning (ML) through artificial intelligence (AI) could provide clinicians and oral pathologists to advance diagnostic problems in the field of potentially malignant lesions, oral cancer, periodontal diseases, salivary gland disease, oral infections, immune-mediated disease, and others. AI can detect micro-features beyond human eyes and provide solution in critical diagnostic cases. OBJECTIVE: The objective of this study was developing a software with all needed feeding data to act as AI-based program to diagnose oral diseases. So our research question was: Can we develop a Computer-Aided Software for accurate diagnosis of oral diseases based on clinical and histopathological data inputs? METHOD: The study sample included clinical images, patient symptoms, radiographic images, histopathological images and texts for the oral diseases of interest in the current study (premalignant lesions, oral cancer, salivary gland neoplasms, immune mediated oral mucosal lesions, oral reactive lesions) total oral diseases enrolled in this study was 28 diseases retrieved from the archives of oral maxillofacial pathology department. Total 11,200 texts and 3000 images (2800 images were used for training data to the program and 100 images were used as test data to the program and 100 cases for calculating accuracy, sensitivity& specificity). RESULTS: The correct diagnosis rates for group 1 (software users), group 2 (microscopic users) and group 3 (hybrid) were 87%, 90.6, 95% respectively. The reliability for inter-observer value was done by calculating Cronbach's alpha and interclass correlation coefficient. The test revealed for group 1, 2 and 3 the following values respectively 0.934, 0.712 & 0.703. All groups showed acceptable reliability especially for Diagnosis Oral Diseases Software (DODS) that revealed higher reliability value than other groups. However, The accuracy, sensitivity & specificity of this software was lower than those of oral pathologists (master's degree). CONCLUSION: The correct diagnosis rate of DODS was comparable to oral pathologists using standard microscopic examination. The DODS program could be utilized as diagnostic guidance tool with high reliability & accuracy.

Optical coherence tomography: Promising imaging technique for the diagnosis of oral mucosal diseases.

OBJECTIVE: This review aims to summarize the latest application of optical coherence tomography (OCT) in oral mucosal diseases, promoting an accurate and earlier diagnosis of such disorders, which are difficult to be differentiated. SUBJECTIVE AND METHODS: References on the application of OCT in oral mucosal diseases were mainly obtained from PubMed, Embase, Web of Science and Scopus databases, using the keywords: "optical coherence tomography and 'oral mucosa/oral cancers/oral potentially malignant diseases/oral lichen planus/oral leukoplakia/oral erythroplakia/discoid lupus erythematosus/oral autoimmune bullous diseases/oral ulcers/erythema multiforme/oral mucositis'". RESULTS: It is found that OCT is showing a promising application potential in the early detection, diagnosis, differential diagnosis, monitoring of oral cancer and oral dysplastic lesions, as well as the delineation of tumor margins. OCT is also playing an increasingly important role in the diagnosis of oral potentially malignant disorders, oral mucosal bullous diseases, oral ulcerative diseases, erythema multiforme, and the early detection of oral mucositis. CONCLUSION: Optical coherence tomography, as a novel optical technique featured by real-time, noninvasive, dynamic and high-resolution imaging, is of great use to serve as an adjunct tool for the diagnosis, differential diagnosis, monitoring and therapy evaluation of oral mucosal diseases.

Potential use of optical coherence tomography in oral potentially malignant disorders: in-vivo case series study.

BACKGROUND: Evidence confirms that the use of Optical Coherence Tomography (OCT) in oral medicine can be a reliable aid for the diagnosis and management of Oral Potentially Malignant Disorders (OPMDs). Several authors described the ability of this system to detect the structural changes of the epithelia involved by the OPMDs. The purpose of this case series is to provide a suggestion for interpretation of OCT images from different OPMDs, compared to OCT images of healthy tissues. METHODS: A sample of 11 OPMDs patients was recruited and analyzed with OCT. The images obtained were then compared with an OCT repertoire image. In this work the reflectance degree was considered, together with the analysis of the increased/decreased thicknesses of the various layers. Keratin Layer (KL), Epithelial Layer (EP), Lamina Propria (LP), Basal Membrane (BM) assessment, for each lesion, was performed. RESULTS: OCT measurements of KL, EP and LP layers, together with BM assessing, should aid the physicians to recognize and describe different oral lesions, relating them to the corresponding oral pathology. CONCLUSION: More studies like this, on larger samples, are needed to validate the results and provide, in the future, a kind of manual that could guide clinicians to correctly interpret the OCT images in relation to the causing pathologies. TRIAL REGISTRATION: The present trial has been registered with ISRCTN (#17,893,224).

Pediatric Neck Masses: Imaging Guidelines and Recommendations.

Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.

Potencial del uso de la radiografía panorámica como ayuda diagnóstica en derechohabientes de una institución de seguridad social / Potential for the use of panoramic radiography as a diagnostic aid in beneficiaries of a social security institution

Introducción: A pesar de que actualmente la radiografía panorámica es un instrumento auxiliar de diagnóstico de uso común, desafortunadamente sus beneficios no se aprovechan en su totalidad y su empleo se limita al uso en determinadas áreas de la odontología y en ocasiones se omiten hallazgos que pueden tener un significado clínico importante. Material y métodos: Estudio transversal y descriptivo de una muestra aleatoria de 500 estudios de imagen (radiografías panorámicas) durante el periodo de enero a mayo de 2018 analizadas por expertos estandarizados y empleando estadística descriptiva básica mediante el paquete estadístico Excel. Resultados: Se incluyeron 500 estudios, 67% correspondió a mujeres en un rango de cinco a 91 años de edad con una mediana de 43 años, 48% presentó alteraciones siendo las más frecuentas pérdida del proceso alveolar 45%, alteraciones en articulación temporomandibular 34%, y calcificación del ligamento estilohioideo 31%. Conclusión: Se reportaron hallazgos clínico-radiográficos significativos, resaltando la necesidad de un análisis cuidadoso de los métodos auxiliares de diagnóstico que permitan visualizar de manera contextual el tratamiento odontológico de los pacientes y/o reportar al especialista correspondiente otro tipo de hallazgos (AU))

Introduction: Although panoramic radiography is currently a commonly used diagnostic auxiliary instrument, unfortunately its benefits are not fully exploited and its use is limited to use in certain areas of Dentistry and eventually findings that may have important clinical significance are omitted. Material and methods: Crosssectional and descriptive study of a random sample of 500 imaging studies (panoramic radiographs) during the period from January to May 2018, analyzed by standardized experts and using basic descriptive statistics using the Excel statistical package. Results: 500 studies were included corresponding to 67% women and an age range from five to 91 years of age with a median of 43 years, 48% presented alterations, the most frequent being loss of the alveolar process 45%, alterations in the temporomandibular joint 34%, and calcification of the hyoid ligament 31%. Conclusion: In this study significant clinical-radiographic findings are reported, highlighting the need for a careful analysis of auxiliary diagnostic methods that allow visualize the dental treatment of the patients and / or report other findings to the corresponding specialist (AU)

Evaluation of oral potentially malignant disorders with autoflorescence, reflectance spectroscopy and vital staining and their correlation with histopathology - Hospital based prospective study.

OBJECTIVES: To evaluate diagnostic efficacy of Identafi® and toluidine blue in screening of Oral Potentially Malignant Disorders (OPMDs). MATERIALS AND METHODS: Forty nine patients (63 lesions) with OPMDs visiting Department of Oral Medicine and Radiology, B.P.Koirala Institute of Health Science (BPKIHS) were included in the study. After thorough history and oral examination, screening was done by Identafi® followed by toluidine blue staining. Then incisional biopsy under local anesthesia was performed from the site showing positive change followed by histopathological examination. RESULTS: The overall sensitivity and specificity of Identafi®'s violet light was 73% and 46.2%. The overall sensitivity and specificity of Identafi®'s green-amber light were 78.4% and 15.4% respectively. The overall sensitivity and specificity of toluidine blue were 51.4 and 84.6 respectively. A statistically-significant association was observed between the toluidine blue and histopathology results, (p = 0.04), p value set at ≤ 0.05. CONCLUSION: Identafi®'s violet light and green amber light are more sensitive in detecting true positives. Toluidine blue is highly specific in ruling out true negative cases. The screening of OPMDs will help in selecting proper biopsy site followed by early diagnosis and intervention, hence increasing the prognosis, outcome and decrease complications associated with it.

Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience.

OBJECTIVES: Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center. MATERIALS AND METHODS: A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects. RESULTS: In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy. CONCLUSION: Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.

Amyloidosis in the head and neck: CT findings with clinicopathological correlation.

PURPOSE: To characterize the CT imaging features of head and neck amyloidosis and correlate with extent of disease and clinical outcomes. MATERIALS AND METHODS: This retrospective study included 80 patients with head and neck amyloidosis who underwent soft tissue neck CT imaging between November 2003 and April 2018. The CT imaging features including lesion distribution, morphology (focal, diffuse/circumferential, or combined), presence and pattern of calcification, (punctate or diffuse), and thickness of airway lesion were evaluated and compared with the extent of amyloidosis (localized or systemic), and clinical course (stable, no recurrence, or progression requiring repeated surgical treatment). RESULTS: Localized disease (83.8%, 67/80) was most common with AL type (97.6%, 41/42) representing nearly all cases of head and neck amyloidosis. The larynx was the most frequently affected organ (60.0%, 48/80), specifically the glottis (43.8%, 35/80). Calcification was seen in 65.0% of cases (52/80). Non-airway or tongue lesions were significantly associated with systemic (92.3%, 12/13) as opposed to localized amyloidosis (4.5%, 3/67; P < 0.001). Repeated surgical treatment was significantly associated with laryngeal amyloidosis (35.3%, 12/34; P = 0.002) and multi-centric disease (33.3%, 10/30; P = 0.048). Airway wall thickness in patients who required repeated surgical treatment was significantly greater than in patients with stable or no recurrent disease (P = 0.016). CONCLUSION: Knowledge of the imaging features of head and neck amyloidosis can aid the diagnosis, disease monitoring, and prediction of patients requiring repeated surgical intervention.

Potential role of autofluorescence imaging in determining biopsy of oral potentially malignant disorders: A large prospective diagnostic study.

Autofluorescence examination of oral tissues using the VELscope has been suggested as an adjunctive tool for cancer detection and diagnosis. This study aimed to determine the diagnostic value of VELscope in a large prospective study of 517 patients with oral potentially malignant disorders (OPMD). For the outcome assessments of discrimination of carcinoma form general OPMD and distinguishing high-risk lesions (moderate/severe dysplasia and carcinoma) from low-risk lesions (no/mild dysplasia), high sensitivity (100% and 95.9% respectively) and negative predictive value (100% and 98.2% respectively) were observed. All the carcinoma and showed loss of autofluorescence (LAF) and only 3 (0.6%) moderate/severe dysplasia were observed without LAF. These data indicate that the cases without LAF using VELscope substantially rule out the presence of high-risk lesions including cancer. This may prove to be useful specially to alleviate patient anxiety regarding a clinically suspicious oral lesion without the LAF, and to avoid a unnecessary biopsy for these cases. Collectively, a perspective to highlight was that a no biopsy strategy may be appropriate for OPMD without LAF using VELscope after conventional oral examination.

Mucosal vitiligo in angles of the mouth: clinical and fluorescence aspects

SUMMARY Vitiligo is the most common depigmenting, chronic acquired disease of the skin and mucosa. However, vitiligo of an unclassified type and mucosal subtype affecting only one area of the mucosa is considered quite uncommon. The diagnosis of vitiligo, regardless of its type, is clinical. Nonetheless, a device that allows the visualization of the tissue fluorescence may be useful for confirming the diagnosis. We present the use of wide-field optical fluorescence device for complementary examination and diagnosis of unusual cases of mucosal vitiligo located only in angles of the mouth.

RESUMO O vitiligo é a doença crônica adquirida despigmentante mais comum da pele e/ou da mucosa. Entretanto, o vitiligo do tipo não classificado e subtipo de mucosa afetando apenas uma área da mucosa é considerado bastante incomum. O diagnóstico de vitiligo, independentemente do seu tipo, é clínico. No entanto, o uso de um dispositivo que permite a visualização da fluorescência tecidual pode ser útil para a confirmação do diagnóstico de vitiligo. Apresentamos o uso do dispositivo de exame complementar de fluorescência óptica de campo amplo para o diagnóstico de um caso incomum de vitiligo de mucosa localizado apenas em ângulos da boca.

Development of an integrated multimodal optical imaging system with real-time image analysis for the evaluation of oral premalignant lesions.

Oral premalignant lesions (OPLs), such as leukoplakia, are at risk of malignant transformation to oral cancer. Clinicians can elect to biopsy OPLs and assess them for dysplasia, a marker of increased risk. However, it is challenging to decide which OPLs need a biopsy and to select a biopsy site. We developed a multimodal optical imaging system (MMIS) that fully integrates the acquisition, display, and analysis of macroscopic white-light (WL), autofluorescence (AF), and high-resolution microendoscopy (HRME) images to noninvasively evaluate OPLs. WL and AF images identify suspicious regions with high sensitivity, which are explored at higher resolution with the HRME to improve specificity. Key features include a heat map that delineates suspicious regions according to AF images, and real-time image analysis algorithms that predict pathologic diagnosis at imaged sites. Representative examples from ongoing studies of the MMIS demonstrate its ability to identify high-grade dysplasia in OPLs that are not clinically suspicious, and to avoid unnecessary biopsies of benign OPLs that are clinically suspicious. The MMIS successfully integrates optical imaging approaches (WL, AF, and HRME) at multiple scales for the noninvasive evaluation of OPLs.

Differential diagnostic value of diffusion-weighted and dynamic contrast-enhanced MR imaging in non-cystic lesions in floor of the mouth.

METHODS:: A total of 82 patients were included in this study. The apparent diffusion coefficient (ADC) values and time-signal intensity curves (TICs) were measured. Clinical characteristics, ADC value, and TIC pattern were compared between benign and malignant FOM lesions. Receiver operating characteristic curve and logistic regression analyses were performed to evaluate respective and combined value of ADC value and TIC pattern for differential diagnosis. The retrospective study was approved by our institutional review board, and the need for informed consent was waived. RESULTS:: The area under the curve ADC value and TIC pattern were 0.71 and 0.73, respectively. The combined use of ADC value and TIC pattern increased the area under the curve value to 0.81 [95% confidence interval (CI), (0.66-0.97)]. ADC < 1.23 × 10-3 mm2 s-1 (odds ratio, 45.8; 95% CI, 2.8-737.9) and both the plateau and washout TIC patterns (OR, 6.8; 95% CI, 1.8-24.8) were significantly associated with malignancy of FOM lesions. CONCLUSIONS:: Our results suggest that both diffusion-weighted imaging and DCE-MRI could contribute to the differential diagnosis of non-cystic FOM lesions, especially when used in combination.

Multidetector Row Computed Tomography in Maxillofacial Imaging.

Multidetector row CT (MDCT) offers superior soft tissue characterization and is useful for diagnosis of odontogenic and nonodontogenic cysts and tumors, fibro-osseous lesions, inflammatory, malignancy, metastatic lesions, developmental abnormalities, and maxillofacial trauma. The rapid advances in MDCT technology, including perfusion CT, dual-energy CT, and texture analysis, will be an integrated anatomic and functional high-resolution scan, which will help in diagnosis of maxillofacial lesions and overall patient care.

A novel fetal sequence patogenesis resulting in oral meningoencephalocele.

OBJECTIVES: To analyze a rare triad of intracranial fetal pathologies and clinical study of the novel defined sequence pathogenesis based on prenatal and postmortem findings. METHODS: Complex multidisciplinary clinical analysis and review of up-to-date literature. RESULTS: In an 18-gestational-week fetus the screening ultrasound scan resembled the semilobar type of holoprosencephaly and oral tumor. After the indicated termination of pregnancy, the histopathology results confirmed another pathologies - oral meningoencephalocele, teratoma of the sellar area and large arachnoidal cyst of the anterior cerebral fossa. The surprising final results were evaluated by specialists in prenatal diagnosis, histopathology, genetics, neurology, and radiology. CONCLUSION: We defined the final diagnosed triad oral meningoencephalocele - intracranial sellar teratoma- arachnoidal cyst as a novel sequence defect malformation. In the detailed sequence pathogenesis, the intracranial sellar teratoma created an aperture for meningoencephalocele in the cranial base and the arachnoidal cyst facilitated, by its growth and pressure, the protrusion of the brain tissues (Fig. 4, Ref. 10). Text in PDF www.elis.sk.

Treatment-refractory ALK-positive inflammatory myofibroblastic tumour of the oral cavity.

We present a challenging case of a previously healthy 23-year-old man who developed an inflammatory myofibroblastic tumour of the hard palate, harbouring a rearrangement of the anaplastic lymphoma kinase (ALK) locus. Despite surgical intervention, radiotherapy and ALK-inhibition therapy, the tumour recurred locally and metastasised to regional lymph nodes, and the patient passed away roughly 9 months after diagnosis from local progression. The rapid progression of this patient's disease and its resistance to treatment demonstrate the potentially aggressive clinical course of inflammatory myofibroblastic tumours. ALK-inhibition therapy was unsuccessful in this ALK-positive tumour, highlighting the need for further investigation of markers predictive of disease progression and treatment response.