Fluorescence Lifetime Imaging Endoscope for Early Detection of Oral Cancer
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abstract
According to the Qatar National Cancer Strategy, the number of all cancer cases is expected to rise as population rises in Qatar and oral cancer could form up to a quarter or one third of all cancer cases in the country. Oral cancer can be caused by a number of risk factors such as smoking, heavy use of alcohol, chewing of some bitter nuts and the new human papilloma virus (HPV), all of which are increasingly common amongst the youth of Qatar. The 5-year survival rate is ~80% for early stages of oral cancer but decreases to ~50% and ~30% for intermediate and advanced stages, respectively. Therefore, early detection holds great promise for improving survival rates. Unfortunately, benign oral mucosal lesions are difficult to distinguish from precancer or early invasive cancer even for experienced clinicians. As a result, only ~30% of patients are diagnosed at early stages despite the fact that the oral cavity is easily accessible for direct examination. Fast and noninvasive tools for screening the oral cavity would significantly improve early detection. Here we propose to quantify biochemical and physiological biomarkers of premalignancy and malignancy by means of endogenous fluorescence lifetime imaging (FLIM). Endogenous FLIM provides direct access to the concomitant functional and biochemical changes accompanying tissue transition from benign to precancerous and cancerous. Since FLIM can noninvasively measure different and complementary biomarkers of precancer and cancer, we hypothesize that it will provide superior sensitivity and specificity for detecting early oral epithelial cancer, compared to any other imaging technology heretofore evaluated. We thus propose to develop and validate a novel imaging clinical tool for noninvasive real-time detection of precancerous and cancerous lesions by accomplishing the following specific aims. Aim 1: To design and build a clinically compatible instrument suitable for in vivo noninvasive endogenous FLIM imaging of epithelial tissue in the oral cavity. Aim 2: To develop algorithms for in vivo detection of oral precancer and cancer based on FLIM imaging. Aim 3: To validate prospectively in a pilot clinical study the ability of the optical imaging system to detect noninvasively oral premalignant and malignant lesions. The resulting clinical tool will allow noninvasive real-time detection of epithelial precancerous and cancerous lesions in the oral mucosa and could potentially be used to assist at every step involved on the clinical management of oral cancer patients. Moreover, the demonstrated success of this clinical tool in oral epithelial cancer will herald future success with other cancers of the epithelium, which accounts for more than 80% of all cancers.
