Relationship between the immunohistological examination and fluorescence visualization of oral squamous cell carcinoma

Keisuke Sugahara; Yu Koyama; Masahide Koyachi; Satoru Matsunaga; Kento Odaka; Kei Kitamura; Kei Nakajima; Kenichi Matsuzaka; Shinichi Abe; Akira Katakura

doi:10.3892/ol.2020.11772

Relationship between the immunohistological examination and fluorescence visualization of oral squamous cell carcinoma

Oncol Lett. 2020 Sep;20(3):2153-2160. doi: 10.3892/ol.2020.11772. Epub 2020 Jun 24.

Authors

Keisuke Sugahara^{1

2}, Yu Koyama¹, Masahide Koyachi¹, Satoru Matsunaga^{2

3}, Kento Odaka⁴, Kei Kitamura⁵, Kei Nakajima⁶, Kenichi Matsuzaka⁶, Shinichi Abe³, Akira Katakura¹

Affiliations

¹ Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo 101-0061, Japan.
² Oral Health Science Center, Tokyo Dental College, Tokyo 101-0061, Japan.
³ Department of Anatomy, Tokyo Dental College, Tokyo 101-0061, Japan.
⁴ Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo 101-0061, Japan.
⁵ Histology and Developmental Biology, Tokyo Dental College, Tokyo 101-0061, Japan.
⁶ Clinical Pathophysiology, Tokyo Dental College, Tokyo 101-0061, Japan.

Abstract

Disorders of the oral mucosa are considered easy to diagnose since they can be visualized and examined directly. A change in the color of the oral mucosa reflects histopathological changes and is an important diagnostic parameter. However, the subjective perception of color varies. To determine the extent of resection for oral mucosa conditions, it is necessary to digitize the color and perform objective assessments. In recent years, fluorescence visualization devices and analysis software that measure tissue luminance G have been employed for the identification of oral mucosa diseases. Fluorescence visualization is presumably based on the decrease in epithelial flavin adenine dinucleotide content and luminance G values due to the destruction of collagen cross-links [fluorescence visualization loss (FVL)]. However, cases with differences between luminance values and histopathological presentation exist. Therefore, additional factors may affect fluorescence visualization. The present study used a portable, non-contact oral mucosa fluorescence visualization device for luminance measurements in seven patients with oral squamous cell carcinoma. Furthermore, Picro-Sirius Red and immunohistochemical staining were performed for CK13, CK17, Ki67, p53 and E-cadherin in the FVL(+) (lesion) and FVL(-) (resection stump) areas to elucidate the principle of fluorescence visualization. Fluorescence was significantly lower in the FVL(+) than in the FVL(-) areas, and the mean luminance G value was 56. The Picro-Sirius Red stain revealed collagen destruction in the FVL(+) areas but no collagen disruption in the FVL(-) areas. CK13 was negative in the FVL(+) and positive in the FVL(-) areas, whereas the opposite pattern was observed for CK17. In the FVL(+) area, p53 staining was positive. E-cadherin expression was enhanced in the FVL(-) areas and reduced in the FVL(+) areas. Furthermore, the luminance G value tended to be lower in cases with weaker E-cadherin staining. The aforementioned results suggest that decreased E-cadherin expression may be a factor that regulates fluorescence visualization.

Keywords: fluorescence visualization; oral mucosal disease; oral squamous cell carcinoma; pathological approach.