Associated Centre/s: Clinical and Diagnostic Oral Sciences
Associated Research: Oral Cancer
Clinical Biometrics is the field of obtaining quantitative measurements from biological tissue and using this data to provide detailed information that will lead to better health outcomes and personalised treatment for patients. Histopathology is the gold standard for evaluation of oral mucosal biopsies however this technique relies upon selection of the most representative site for biopsy whereby current practice is dependent on visual inspection of the oral mucosa to determine the biopsy site. This approach has significant challenges such as:
- Visual inspection of gross morphological changes is subjective
- Site that is biopsied is small therefore the site representing the most serious pathology may be missed
- Where there are large areas of affected tissue more than one biopsy may be required.
Professor Farida Fortune, Dr Pete Tomlins, Dr Eleni Hagi-Pavli and Dr Oluyori Adegun are using optical measurements of oral tissue to develop a robust and objective screening and monitoring device for the early detection of oral cancer. The inter-disciplinary strengths of this team, have enabled the group to begin linking the clinical manifestation and underlying biology of oral cancer with physical parameters. The group led by Professor Fortune has developed a new non-invasive approach using scattering attenuation microscopy (SAM) which is based upon optical coherence tomography (OCT) to improve oral cancer diagnosis, reduce the number of biopsies a patient will undergo and screen for oral cancer. SAM uses volumetric datasets to produce quantitative 2D images of tissue. It measures attenuation of the scattering of light from cell nuclei producing a measure of the cellular changes that is indicative of oral precancer.
SAM is quantitative and objective and gives a detailed view of the lesion and because it is based upon a physical measurement so it can be stored and compared at each patient visit. SAM is capable of rapidly surveying large areas and can therefore provide objective follow-up, objective staging and earlier treatment with the ultimate result of improved prognosis.
Of patients presenting in primary care with oral cancer and pre-cancer, 15% are pre-cancerous and a further 25% present with stage 1 cancer. The remaining 60% are evenly distributed between cancer at stages 2, 3 and 4. The resulting resource cost for the 5000 oral cancer cases detected in the UK annually over 3 years costs £130m for stage 2, 3 and 4 only. (These figures are based upon published data of the distribution of disease and stage). SAM has enormous potential to decrease the costs by detecting malignant transformation at an early stage. If SAM were to identify even 10% of cancers and prevent progression to stages 2-4 it would result in an NHS saving of £17m over 3 years.
SAM images of normal oral mucosa (A) and moderate dysplasia (B). Increased dysplastic severity is denoted by the transition from red through to blue colouration. Physically, the colour map reflects the measured degree of light scattering from cell nuclei. Both images cover a tissue width of approximately 1.5 mm.
Professor Farida Fortune
+44 20 7882 7154 (Tel)
+44 20 7377 7022 (Fax)
Dental Dean's Office
2nd Fl. Institute of Dentistry
Queen Mary's School of Medicine & Dentistry
London E1 2AD