Diagnostic utility of microsurgical carbon-dioxide laser excision of oral potentially malignant lesions (OPMLs) vs incisional biopsy: a retrospective histopathological review

Publication date: Available online 14 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr. Jacinta Vu, A/Prof. Hedley G. Coleman, A/Prof Carsten E. Palme, A/Prof. Faruque Riffat, A/Prof. Mark Schifter, Prof. Hans Zoellner

Objective

Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral micro-surgical carbon dioxide (CO₂) laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation reduced post-surgical morbidity and easier post-operative clinical surveillance.

Study Design

Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPML that demonstrated the following histopathologic diagnoses on CIB: verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently went on to have LEB of their OPML.

Results

Histological diagnosis was upgraded after LEB in 14 (45%) patients (p<0.001), with unexpected cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%).

Conclusions

Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs when compared to reliance on the CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regards to earlier detection of OSCC.

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