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 Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 478-479

Microlux and in vivo confocal microscopy in the diagnosis of potentially malignant and malignant lesions of the oral cavity


Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India

Date of Web Publication13-May-2015

Correspondence Address:
L S Vagish Kumar
Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya Research Centre, Yenepoya University, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.148934

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How to cite this article:
Vagish Kumar L S. Microlux and in vivo confocal microscopy in the diagnosis of potentially malignant and malignant lesions of the oral cavity. Clin Cancer Investig J 2015;4:478-9

How to cite this URL:
Vagish Kumar L S. Microlux and in vivo confocal microscopy in the diagnosis of potentially malignant and malignant lesions of the oral cavity. Clin Cancer Investig J [serial online] 2015 [cited 2020 Sep 22];4:478-9. Available from: http://www.ccij-online.org/text.asp?2015/4/3/478/148934

Sir,

Oral cancer causes several deaths throughout the world each year. The high mortality rate attributed to oral cancer is mostly due to late detection or diagnosis of potentially malignant and malignant lesions of the oral cavity. Currently, several screening modes are available to the clinical fraternity to detect these lesions. Among them, the recently emerging technologies include Microlux and in vivo confocal microscopy.

Microlux DL is based on the principle of tissue reflectance. In this technique, the patient rinses 1% acetic acid solution for 60 s in the oral cavity. [1] The acetic acid rinse eliminates surface debris and dehydrates the epithelial cells which cause their nuclei to appear prominent. [2] The room light should be lowered at the start of the procedure. The oral cavity is then examined with the help of blue-white light (440 nm) generated by a battery operated light emitting diode fiber optic source. [1] The normal oral epithelium will visually appear as light bluish, whereas the abnormal epithelium as a distinct aceto-white. [3] A recent study concluded that Microlux aids in the diagnosis of oral premalignant and malignant lesions. [4] Microlux does not distinguish between benign and malignant lesions. However, it increases the probability of detecting the lesion and revealing new lesions when compared with conventional oral examination. Microlux is a promising adjunct screening device in this direction. [1]

Confocal microscopy is a reflectance imaging technique in cell biology. [5] It is a cost effective technique and can be used in developing countries. [6] It has the advantage of optical sectioning and high-resolution imaging by blocking the light originating from tissue layers above and below the focal plane. [3] In vivo confocal images from the oral cavity using a miniaturized fiber optic confocal reflectance microscope shows the characteristic features such as nuclear irregularity, enlargement, crowding, changes in nuclear to cytoplasmic ratio, changes in capillary network and spacing, which is used to differentiate oral squamous cell carcinoma from normal oral mucosa. [7] It helps to acquire high-resolution images in real time to evaluate morphological changes in tissues in the cellular level. It uses a diode laser as a source of monochromatic and coherent light. The basic principle lies in the difference in reflectivity of the tissues. [8] Contrast is based on differences in refractive index, which can be enhanced using simple contrast agents such as acetic acid or using fluorescent dyes such as fluorescein and 5-aminolevulinic acid. Furthermore, exogenous contrast agents such as topical acriflavine and intravenous fluorescein can be used. [9] The advantage of this technique is that it requires no surgical procedure and histopathologic sectioning and staining. [10] A recent study validated the use of this technique to evaluate tissue architecture and cell morphology of the oral cavity. [8]

Though the techniques especially in vivo confocal microscopy are in the developmental stage, they are promising and advantageous in the early detection of oral cancer. More research and progress in biomedical instrumentation technology may maximize the efficiency of these emerging technologies, leading to decreased mortality rate due to oral cancer.

 
  References Top

1.
Ibrahim SS, Al-Attas SA, Darwish ZE, Amer HA, Hassan MH. Effectiveness of the Microlux/DLTM chemiluminescence device in screening of potentially malignant and malignant oral lesions. Asian Pac J Cancer Prev 2014;15:6081-6.  Back to cited text no. 1
    
2.
Kalmar JR. Advances in the detection and diagnosis of oral precancerous and cancerous lesions. Oral Maxillofac Surg Clin North Am 2006;18:465-82.  Back to cited text no. 2
    
3.
Cheng YL, Wright J. Advances in diagnostic adjuncts for oral squamous cell carcinoma. Open Pathol J 2011;5:3-7.  Back to cited text no. 3
    
4.
Al-Attas S, Ibrahim S, Darwish Z, Amer H, Hassan M. Detection of oral potentially malignant lesions among tobacco users; Identafi and Microlux versus histopathology. J Am Sci 2014;10:24-30.  Back to cited text no. 4
    
5.
Masthan KM, Babu NA, Dash KC, Elumalai M. Advanced diagnostic aids in oral cancer. Asian Pac J Cancer Prev 2012;13:3573-6.  Back to cited text no. 5
    
6.
Yu B, Ferris DG, Liu Y, Nagarajan VK. Emerging optical techniques for detection of oral, cervical and anal cancer in low-resource settings. Austin J Biomed Eng 2014;1:15.  Back to cited text no. 6
    
7.
Maitland KC, Gillenwater AM, Williams MD, El-Naggar AK, Descour MR, Richards-Kortum RR. In vivo imaging of oral neoplasia using a miniaturized fiber optic confocal reflectance microscope. Oral Oncol 2008;44:1059-66.  Back to cited text no. 7
    
8.
García-Hernández A, Roldán-Marín R, Iglesias-Garcia P, Malvehy J. In vivo noninvasive imaging of healthy lower lip mucosa: A correlation study between high-definition optical coherence tomography, reflectance confocal microscopy, and histology. Dermatol Res Pract 2013;2013:205256.  Back to cited text no. 8
    
9.
Shin D, Vigneswaran N, Gillenwater A, Richards-Kortum R. Advances in fluorescence imaging techniques to detect oral cancer and its precursors. Future Oncol 2010;6:1143-54.  Back to cited text no. 9
    
10.
Kumar S, Dekate K, Patel S, Haque S. Oral cancer: The dentist′s intervention. J Contemp Dent 2013;3:74-7.  Back to cited text no. 10
    




 

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