Elsevier

Oral Oncology

Volume 43, Issue 8, September 2007, Pages 820-824
Oral Oncology

A pilot case control study on the efficacy of acetic acid wash and chemiluminescent illumination (ViziLite™) in the visualisation of oral mucosal white lesions

https://doi.org/10.1016/j.oraloncology.2006.10.005Get rights and content

Summary

Conventional screening practice for oral lesions involves visual scrutiny of the oral tissues with the naked eye under projected incandescent or halogen illumination. Visualisation is the principal strategy used to assess patients’ lesions at risk for malignant transformation; hence, any procedure which highlights such lesions should aid the clinician. The aim of this pilot study was to examine the efficacy of acetic acid wash and chemiluminescent light (ViziLite™) in enhancing visualisation of oral mucosal white lesions, and its ability to highlight malignant and potentially malignant lesions. Fifty five patients referred for assessment of an oral white lesion, were prospectively screened with ViziLite, and an incisional scalpel biopsy performed for a definitive diagnosis. The size, location, ease of visibility, border distinctness, and presence of satellite lesions were recorded. The ViziLite tool enhanced intra-oral visualisation of 26 white lesions. Indeed, all lesions appeared “aceto-white”, regardless of the definitive diagnosis. Examination of the oral tissues with ViziLite illumination did not change the provisional diagnosis, nor alter the biopsy site. ViziLite illumination does not discriminate between keratotic, inflammatory, malignant or potentially malignant oral mucosal white lesions and thus, a high index of suspicion, expert clinical judgment, and scalpel biopsy are still essential for proper patient care.

Introduction

It is estimated that more than 500,000 patients worldwide suffer from oral cancer.1 It is well known that improved prognosis relies on early detection. The critical need for early detection of oral cancer drives the development of non-invasive or minimally-invasive methods to detect potentially malignant and malignant changes in the oral cavity. Delayed referral of affected patients with potentially malignant or malignant disease to specialist centres can severely hamper the outcome and negatively affect prognosis for oral squamous cell carcinoma.2, 3 This may result from the difficulties that primary health care providers experience in detecting changes in the oral mucosa or potentially malignant oral mucosal lesions.4 Recent evidence suggests that general dental practitioners in the United Kingdom had knowledge gaps in their awareness of oral cancer risk factors and the application of preventative measures,5 even though most performed visual screening of the oral mucosa for their patients.

Conventional screening practice for oral neoplastic lesions involves visual scrutiny of the oral tissues with the naked eye under projected incandescent or halogen illumination. Visualisation is the principal strategy used to assess patients’ lesions at risk of malignant transformation, hence any procedure which highlights neoplastic lesions should aid the clinician in this endeavour. By far the most developed approach to physical characterization of oral mucosa is the use of light and it’s interaction with tissue.6

Contrast agents such as toluidine blue and Lugol’s iodine,7, 8, 9, 10, 11 have been invariably used to identify malignant lesions and to allow a more definitive interpretation of lesions that may be potentially malignant. When applied topically or administered as an oral rinse, toludine blue binds to DNA and RNA, and has been purported to help with the identification of such lesions.12

More recently the procedure of acetic acid-induced whitening of the oral mucosa, to enhance and highlight dysplastic lesions has been proposed,13 similar to that found in cervical tissues.14, 15, 16 ViziLite™ is one commercially available tool that makes use of acetic acid-induced whitening of oral tissues and chemiluminescent light to purportedly improve identification, evaluation and monitoring of white oral mucosal abnormalities in populations at increased risk for oral cancer.17 Although ViziLite™ is widely used in the United States for examination of oral white lesions by dental professionals, and is rebated by health insurance companies, there is scant evidence in the literature to support its use or effectiveness. The aim of this study therefore was to assess the efficacy of acetic acid mouth wash and chemiluminescent illumination (ViziLite™) in the visualisation of oral mucosal white lesions in a tertiary oral medicine referral centre.

Section snippets

Materials and methods

Fifty five patients referred to an oral medicine specialist service over a 3 month period for assessment of an oral mucosal white lesion were prospectively screened with ViziLite™ (Zila Pharmaceuticals, Phoenix, Arizona, USA) according to the manufacturer’s instructions.17 The only inclusion criterion for this study was referral for examination of an oral mucosal white lesion, and participation in the study was voluntary. The study was conducted according to Human Ethics Guidelines approved by

Results

Twenty six males and 29 females were involved in this study, with less than half of the patients overall being smokers (Table 1). Fifty five primary lesions and 25 satellite lesions were identified by normal visual inspection (Table 2). The provisional clinical and definitive histopathological diagnoses for all white lesions are shown in, Table 3 and these included benign epithelial hyperplastic lesions, potentially malignant lesions, and mucosal inflammatory conditions.

Although

Discussion

The ViziLite tool, using chemiluminescent light, is marketed to be used as an adjunct to traditional oral examination by incandescent light to improve identification, evaluation and monitoring of white oral mucosal abnormalities in populations at increased risk for oral cancer, and the manufacturer recommends its use by trained health care providers.17 The manufacturer claims that following the application of a cytoplasmic dehydration agent such as an acetic acid solution, leukoplakic lesions

Conflict of interest statement

The authors declare that they have no financial or personal relationship with ViziLite or Zila Pharmaceuticals, or any other party that could inappropriately influence or bias the results of this study.

Acknowledgement

The authors would like to thank Mrs Jenny Chaston for her clinical assistance.

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