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UBC Theses and Dissertations

Evaluation of DNA image cytology for detection and risk prediction of oral dysplasia - clinical and community settings Datta, Madhurima


It is believed the majority of oral cancers are preceded by an oral potentially malignant lesion (OPML). Histopathological diagnosis of an OPML is required to determine the presence of dysplasia. However, it is challenging for clinicians to identify which lesions to biopsy. The increasing degree of dysplasia is associated with increasing risk of malignant transformation. Although low-grade dysplasias make up the majority of the dysplasias diagnosed, it is difficult to predict their individual risk of malignant progression. DNA ploidy, measured using DNA image cytometry (DNA-ICM), has shown to be a biomarker for dysplasia and malignancy in various sites including the oral cavity. In this thesis, three research projects were developed to explore the role of DNA-ICM as a triage and screening tool for oral LGD. The first project revealed that the combination of DNA ploidy and chromatin organization measurement using LGD lesion brushings was a strong predictor of progression. Further, temporal assessment of ploidy helped us identify risk patterns of progression among oral LGDs, which can be useful for clinicians to determine triage and management of LGDs. The second project aimed to conduct oral cancer screening in a high-risk population in British Columbia (BC) and assess the use of DNA-ICM and fluorescent visualization (FV) as adjunct screening tools. Our results confirmed previous findings, where South Asian immigrants in BC showed a higher prevalence of low-grade dysplasia than the general Vancouver population. No abnormal DNA-ICM findings were noted in the small number of dysplasias detected. The final project aimed to assess the effectiveness of DNA-ICM combined with cytology and FV as an adjunct screening tool for community oral cancer screening in rural India. Results showed that DNA-ICM along with cytology showed satisfactory sensitivity and specificity in detecting dysplasias and identified additional lesions that required biopsy. This work shows that DNA-ICM when combined with cytology can serve as a non-invasive, cost-effective screening tool and aid clinicians to triage LGDs to detect progression early. This work also helps gain understanding on the role of DNA aneuploidy in oral cancer.

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