Researchers supported by the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, report today their initial success using a customized optical device that allows dentists to visualize in a completely new way whether a patient might have a developing oral cancer.

Called a Visually Enhanced Lesion Scope (VELScope), this simple, hand-held device emits a cone of blue light into the mouth that excites various molecules within our cells, causing them to absorb the light energy and re-emit it as visible fluorescence. Remove the light, and the fluorescence of the tissue is no longer visible.

Because changes in the natural fluorescence of healthy tissue generally reflect light-scattering biochemical or structural changes indicative of developing tumor cells, the VELScope allows dentists to shine a light onto a suspicious sore in the mouth, look through an attached eyepiece, and watch directly for changes in color. Normal oral tissue emits a pale green fluorescence, while potentially early tumor, or dysplastic, cells appear dark green to black.
Testing the device in 44 people, the results of which are published online in the Journal of Biomedical Optics, the scientists found they could distinguish correctly in all but one instance between normal and abnormal tissue. Their diagnoses were confirmed to be correct by biopsy and standard pathology.

"The natural fluorescence of the mouth is invisible to the naked eye," said Dr. Miriam Rosin, a senior author on the paper and a cancer biologist at the British Columbia Cancer Research Center in Vancouver, Canada. "The VELScope literally brings this natural fluorescence to light, helping dentists to answer in a more informed way a common question in daily practices: To biopsy or not to biopsy."

Because developing tumors in the mouth are often easily visible, public health officials have long advocated early detection of oral cancer. But determining whether a suspicious sore is benign or potentially cancerous has remained scientifically problematic. "A major reason is looks alone can be deceiving," said Rosin, referring to the common practice of diagnosing cancer based on the general appearance and staining patterns of tissue biopsy. "What's been badly needed in screening for oral cancer is a way to visualize the biological information within and let it tell you whether or not a lesion is likely to become cancerous."

Rosin said the VELScope goes a long way toward answering this unmet need. "Historically, the problem in developing a fluorescence-reading instrument has been largely organizational," said Rosin, a leader of the British Columbia Oral Cancer Prevention Program. "No one scientific discipline possesses sufficient expertise to build such a sophisticated imaging device, and the needed interdisciplinary groups weren't forming to tackle the problem."

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