Autofluorescence profile of lichen planus: Preliminary characterization
Shaikhi, Khaled A. Othman
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Autofluorescence imaging is a noninvasive, fast and simple technique to obtained additional data from abnormal and/or suspicious oral lesions. However, interpreting autofluorescence imaging should be done with caution because many reactive benign lesions and dysplastic lesions show similar patterns. This study attempts to characterize the autofluorescence characteristics of erosive lichen planus. Aims: To evaluate the extent of oral lichen planus visualized by autofluorescence (AF) examination and compare it with conventional white light examination (WLE). In addition, to correlate AF results with histopathological and direct immunofluoresce data. Study Design: A prospective, comparative single center clinical study was designed to collect data, and to establish the clinical value of autofluorescent imaging in the oral cavity for diagnosis of oral lichen planus. Autofluorescence examination was conducted by the principal investigator using both white light and autofluorescence light at 405nm wavelength. Results: A total of six patients were recruited for this study. The size of lesions measured with WLE did not differ from the area with loss of fluorescence as measured by AF, except in two cases. Statistical analysis for grading between WLE and AF was done. Sensitivity of 100%, P-value 0.121 and measure of agreement (kappa) 0.57 were obtained. Conclusion: In this study, it has been demonstrated that AF examination of oral lichen planus is characterized by: loss of fluorescence in all cases with variable grading (between two and three) and extension in size of the lesion in two cases (difference in measured area). In addition, AF findings in lichen planus have been corroborated by histopathology and DIF data; it correlates with WL findings. No difference between AF and WL was identified. AF was equivalent to WL and in this limited study and was no more effective in discriminating difference of benign buccal mucosal and gingival alterations. Molecular changes in lichen planus characterized through proteomic analysis may potentially further role of AF in lichen planus diagnosis. Further studies with a large sample size are needed. Refinement of the methodology used to record the measurements of the lesions and a revision of the grading system will have to be considered in the future. Future refinements in the autofluorescence apparatus may be able to separate inflammatory lesions from pre-malignat and malignant lesions.