Oral premalignant lesions: is a biopsy reliable?

PURPOSE The purpose of the present retrospective study was to learn whether a biopsy of oral premalignant lesions, leukoplakia and erythroplakia, shows histopathological findings representative of the whole surgically removed lesion. Moreover, to see whether histopathological characteristics of the whole lesion are significant for future malignant development after surgery. MATERIALS AND METHODS A total of 101 lesions in 96 patients were included, 42 lesions (41%) being homogenous and 50 (50%) non-homogenous leukoplakias, whereas nine (9%) were erythroplakias. The lesions were biopsied and subsequently surgically removed on the average of 10.4 months after biopsy. Surgical specimens were examined in two or more step sections distributed throughout the specimen. The histological findings of the biopsies were compared with those of the whole lesions. After surgical intervention the patients were followed (mean 6.8 years, range: 1.5-18.6), and new biopsies taken in case of recurrences. Smokers (73%) were encouraged to quit smoking and candidal infections were treated. The possible influence of different variables on the risk of malignant development was estimated by means of logistic regression analysis. RESULTS Histological examination of the whole lesions showed that seven lesions (7%) harboured a carcinoma and 70 lesions (69%) showed a degree of epithelial dysplasia or carcinoma in situ. Eleven lesions (12%) developed carcinoma after a mean follow-up period of 7.5 years. A comparison of the degree of dysplasia in the biopsies with that of the whole lesion demonstrated variation with concurrent diagnosis in 49% of the lesions and in 79% after inclusion of lesions with one degree up or down the scale of epithelial dysplasia. CONCLUSION The estimated odds ratio showed that none of the associated variables including presence of any degree of epithelial dysplasia in the whole lesion, site, demarcation and smoking had influence on the risk of malignant development.

[1]  F. Kee,et al.  Potentially malignant oral lesions in northern Ireland: a 20-year population-based perspective of malignant transformation. , 2001, Oral diseases.

[2]  A. Karabulut,et al.  Observer variability in the histologic assessment of oral premalignant lesions. , 1995, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[3]  T. Axéll,et al.  International seminar on oral leukoplakia and associated lesions related to tobacco habits , 1984 .

[4]  K. Stoltze,et al.  Long-term treatment outcome of oral premalignant lesions. , 2006 .

[5]  P. V. van Diest,et al.  Comparative molecular and histological grading of epithelial dysplasia of the oral cavity and the oropharynx , 2003, The Journal of pathology.

[6]  D. Macdonald,et al.  Oral epithelial atypia in denture induced hyperplasia, lichen planus and squamous cell papilloma. , 1975, International journal of oral surgery.

[7]  H Lumerman,et al.  Oral epithelial dysplasia and the development of invasive squamous cell carcinoma. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[8]  Dr. J. J. Pindborg,et al.  Histological Typing of Cancer and Precancer of the Oral Mucosa , 1997, World Health Organization.

[9]  H. Mincer,et al.  Observations on the clinical characteristics of oral lesions showing histologic epithelial dysplasia. , 1972, Oral surgery, oral medicine, and oral pathology.

[10]  C. Scully,et al.  Oral mucosal dysplastic lesions and early squamous cell carcinomas: underdiagnosis from incisional biopsy. , 2003, Oral diseases.

[11]  M. Gorsky,et al.  Oral leukoplakia and malignant transformation. A follow‐up study of 257 patients , 1984, Cancer.

[12]  J. Reibel,et al.  Subjectivity in evaluating oral epithelial dysplasia, carcinoma in situ and initial carcinoma. , 1985, Journal of oral pathology.

[13]  C. R. Leemans,et al.  Genetically Altered Fields as Origin of Locally Recurrent Head and Neck Cancer , 2004, Clinical Cancer Research.

[14]  G. Snow,et al.  p53 expression above the basal cell layer in oral mucosa is an early event of malignant transformation and has predictive value for developing oral squamous cell carcinoma , 1998, The Journal of pathology.

[15]  S. Lippman,et al.  Predicting cancer development in oral leukoplakia: ten years of translational research. , 2000, Clinical cancer research : an official journal of the American Association for Cancer Research.

[16]  I. Kramer,et al.  The clinical features and risk of malignant transformation in sublingual keratosis , 1978, British Dental Journal.

[17]  C. R. Leemans,et al.  A genetic explanation of Slaughter's concept of field cancerization: evidence and clinical implications. , 2003, Cancer research.

[18]  E. Eisenberg,et al.  Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[19]  F. Mehta,et al.  A follow-up study of sixty-one oral dysplastic precancerous lesions in Indian villagers. , 1977, Oral surgery, oral medicine, and oral pathology.

[20]  C. R. Leemans,et al.  Molecular Diagnosis of Surgical Margins and Local Recurrence in Head and Neck Cancer Patients , 2004, Clinical Cancer Research.

[21]  J. Bánóczy,et al.  Follow-up studies in oral leukoplakia. , 1977, Journal of maxillofacial surgery.

[22]  S. Silverman,et al.  Malignant transformation and natural history of oral leukoplakia in 57,518 industrial workers of gujarat, india , 1976, Cancer.

[23]  K. Schepman,et al.  Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. , 1998, Oral oncology.

[24]  M. Brook The contribution of dentifrices to oral health: the future. , 1980, Community dentistry and oral epidemiology.

[25]  T. Axéll,et al.  Oral white lesions with special reference to precancerous and tobacco- related lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18-21 1994. International Collaborative Group on Oral White Lesions. , 1996, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[26]  R. Irani,et al.  Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. , 1980, Community dentistry and oral epidemiology.

[27]  Y. Kameyama,et al.  Effect of excisional wounding on DMBA-induced hamster tongue carcinogenesis. , 1986, Journal of oral pathology.