Search Results (3)

Background/Objectives: The low-resource, minority and underserved populations (LRMU) that carry the highest risk of oral cancer (OC) experience many barriers to early detection and treatment, resulting in disproportionately poor outcomes. One major barrier to better outcomes is poor compliance with specialist referral for diagnosis and treatment. The goal of this prospective study was to compare specialist referral compliance for Telehealth vs. in-person visits in LRMU individuals screening positive for increased OC risk. Methods: Forty subjects who had screened positive for oral potentially malignant lesions (OPMLs) were recruited from community clinics. The subjects indicated whether they would prefer an in-person or Telehealth specialist visit. They were offered assistance with all aspects of the visit, and then tracked over 3 months for referral compliance. A novel, very low-cost, simple Telehealth platform located within the community clinic was used for the remote specialist visits. Results: In the Telehealth group, 16/24 subjects attended their first scheduled remote specialist visit; 4/24 attended rescheduled visits within 3 months, and 4/24 did not comply at all. All attendees and specialists were able to complete the remote visits in full. Of the 7/16 subjects who completed in-person visits, 3/16 attended their first scheduled visit, and 4/16 complied within 3 months; 9/16 subjects did not comply at all with specialist referral. Significantly more individuals complied with Telehealth specialist referral at 1 month (p = 0.0006) and after 3 months (p = 0.0154). Conclusions: This novel Telehealth platform may improve compliance with specialist referral in low-resource individuals with OPMLs. Full article

Fanconi anemia (FA) patients display an exacerbated risk of oral squamous cell carcinoma (OSCC) and oral potentially malignant lesions (OPMLs) at early ages. As patients have defects in their DNA repair mechanisms, standard-of-care treatments for OSCC such as radiotherapy and chemotherapy, give rise to severe toxicities. New methods for early diagnosis are urgently needed to allow for treatment in early disease stages and achieve better clinical outcomes. We conducted a prospective, longitudinal study wherein liquid biopsies from sixteen patients with no clinical diagnoses of OPML and/or OSCC were analyzed for the presence of mutations in cancer genes. The DNA from saliva and plasma were sequentially collected and deep-sequenced, and the clinical evaluation followed over a median time of approximately 2 years. In 9/16 FA patients, we detected mutations in cancer genes (mainly TP53) with minor allele frequencies (MAF) of down to 0.07%. Importantly, all patients that had mutations and clinical follow-up data after mutation detection (n = 6) developed oral precursor lesions or OSCC. The lead-time between mutation detection and tumor diagnosis ranged from 23 to 630 days. Strikingly, FA patients without mutations displayed a significantly lower risk of developing precursor lesions or OSCCs. Therefore, our diagnostic approach could help to stratify FA patients into risk groups, which would allow for closer surveillance for OSCCs or precursor lesions. Full article

Non-invasive strategies that can identify oral malignant and dysplastic oral potentially-malignant lesions (OPML) are necessary in cancer screening and long-term surveillance. Optical coherence tomography (OCT) can be a rapid, real time and non-invasive imaging method for frequent patient surveillance. Here, we report the validation of a portable, robust OCT device in 232 patients (lesions: 347) in different clinical settings. The device deployed with algorithm-based automated diagnosis, showed efficacy in delineation of oral benign and normal (n = 151), OPML (n = 121), and malignant lesions (n = 75) in community and tertiary care settings. This study showed that OCT images analyzed by automated image processing algorithm could distinguish the dysplastic-OPML and malignant lesions with a sensitivity of 95% and 93%, respectively. Furthermore, we explored the ability of multiple (n = 14) artificial neural network (ANN) based feature extraction techniques for delineation high grade-OPML (moderate/severe dysplasia). The support vector machine (SVM) model built over ANN, delineated high-grade dysplasia with sensitivity of 83%, which in turn, can be employed to triage patients for tertiary care. The study provides evidence towards the utility of the robust and low-cost OCT instrument as a point-of-care device in resource-constrained settings and the potential clinical application of device in screening and surveillance of oral cancer. Full article