Diffused light visualisation of oral leukoplakia

Objectives: The aim of this study is to assess the efficacy of acetic acid mouth wash and diffused light illumination (MicroLux/DL) in the visualisation of oral mucosal lesions suspected of dysplasia. Methods: Patients presenting to the University of Queensland Oral Medicine Clinic with clinically suspicious oral epithelial leukoplakia will initially be examined under routine incandescent operatory light. The location, size, ease of visibility, border distinctness and presence of satellite lesions will be recorded. Ease of visibility will be ranked on a hierarchical scale of 1-4 with 4 being high visibility. Borders will be classified dichotomously as either diffuse or sharp. Following rinsing for 60 seconds with a 1% acetic acid mouth rinse, a further unblended clinical examination will then be repeated using the MicroLux/DL diffused light illumination kit under dimmed light. The same clinical measurements will be recorded. A provisional clinical diagnosis will be made and an incisional biopsy taken to provide a definitive histopathological diagnosis. Results: Preliminary results indicate that diffused light visualisation offers no additional clinical benefit over standard clinical examination. Against the standard examination the diffuse light system showed high sensitivity but low specificity for epithelial dysplasia detection. There was no significant difference with respect to ease of visibility, border distinctness or number satellite lesions detected. Conclusions: While ease of lesion visibility and border distinctness are enhanced by the use of diffused light illumination; for clinically detected oral epithelial lesions, further examination using the diffuse light offers no additional benefit with respect to clinically important management decisions such as biopsy location and diagnosis. Further investigations assessing the use of diffused light examination as a visualisation tool by less trained personnel are being considered.