Digital biopsies for early detection of oral cancers
Oral health professionals may soon be able to detect oral cancers more effectively thanks to a new project led by the Melbourne Dental School and Victorian technology company OptiScan.
The insidious nature of oral cancer means it is often detected at a later stage; up to half of individuals who are diagnosed have large tumours as oral cancer is often painless and unseen.
A further challenge is the limited tools to detect and monitor potential oral cancers and skin lesions over time, forcing clinicians to remove suspicious lesions by scalpel biopsy and assess pathology.
A new project led by Dr Tami Yap (BDSc 2006, PhD 2019, DClinDent 2019) and Professor Michael McCullough (BDSc 1982, PhD 1995, MDSc (ParaClin) 1997) of the Melbourne Dental School will aim to identify individuals who are likely to develop oral cancer, without invasive biopsies.
THE BENEFITS OF ‘DIGITAL BIOPSIES’
Oral cancers are often preceded by changes to the colour and thickness of the skin of the mouth. Only three to five per cent of people with these changes will develop an oral cancer, but without a biopsy, it is very difficult to determine which lesions are cancerous or not. These biopsies can be painful and invasive.
After the biopsy, the sample is assessed by a pathologist to see if there is any cancer present or not. The assessment by the pathologist can only be made on the small piece of skin that has been sampled, which may limit its effectiveness.
With the hand-held confocal laser endomicroscope (CLE), tissue can be viewed in 3D with 1,000-times magnification. This could allow clinicians and surgeons to diagnose cancerous tissue in real time, reducing or eliminating the need to have one or more biopsies taken and sent to a laboratory for analysis.
The earlier the diagnosis can be made, and the less tissue we remove, the better for the patient.
A NEW APPROACH TO TRACKING ORAL HEALTH
Alongside trialing the CLE, our project will also develop software to comprehensively record an annotated map of the patient’s mouth with OptiScan as well as our other project partner, MoleMap.
This will allow us to compare a patient’s mouth map the next time they come in, so we can see if anything has changed. We can also use special dyes that show us all the cells in the skin surface or a dye which only binds to molecules that are found more commonly in cancer, thus identifying ‘hot spots’ of skin growth.
Our broader MouthmapTM project will enable us to collect a large amount of data to compare this new CLE technology to diagnosis using standard light microscopy, establishing a new standard of diagnosis and allowing advancement of both human and computer algorithm-based learning. We hope this will provide a solid foundation to advance towards clinical trials and recommendations for changes in standard of care.
The participants of this clinical study will be recruited by invitation, including from Victoria’s main oral precancer referral centre, networked with regional community centres where only health care card and pension card holders are eligible for treatment. This is important because lower socioeconomic status as well as increased age are both considered risk factors for oral cancer.
Our goal is that this technology will help reduce the requirement of scalpel biopsy in the future, allowing for a more comprehensive assessment of skin changes in the mouth and earlier detection of oral cancer.
The Melbourne Dental School trial is due to commence in September this year, by referral. The Melbourne Dental School has partnered with OptiScan, a Victorian company awarded a grant of almost $1 million by the Australian Government through the Medical Research Future Fund in collaborative clinical research projects to improve screening and early diagnosis of oral cancer. This project was one of 21 national projects funded in 2020 through the BioMedTech Horizons Program and administered by MTPConnect.