Continuous artificial intelligence-assisted DNA aneuploidy cytology for surveilling dysplastic oral leukoplakia treated by photodynamic therapy

Oral leukoplakia (OLK) presents as a white patch or plaque on the oral mucosa that cannot be rubbed off and has been categorized as one of the most common oral potentially malignant disorders (OPMD) [1]. The aim to manage OLK is to prevent malignant transformation and even to eliminate lesions. Photodynamic therapy (PDT) has been well introduced in the management of OLK. When comparing with surgical excision, PDT has been preferred by patients with less postoperative pain, edema, and scarring [2].

The evaluation of PDT response is conventionally designated by the disappearance or reduction of lesion size, which has the limitation to help discriminate high-risk lesions [2]. Scalpel biopsy is reliable but has difficulty in continuously surveilling suspicious lesions. DNA aneuploidy cytology measured by image cytometry (DNA-ICM) was recently introduced for the very early diagnosis of malignant transformation, suggesting that oral lesions with DNA aneuploidy might help to identify the risk of malignancy. Here, we applied the artificial intelligence (AI)-assisted DNA-ICM to continuously monitor non-homogeneous OLK with moderate-to-severe dysplasia among the long-term follow-ups after treatment by 5-aminolevulinic acid-mediated PDT (ALA-PDT). Recurrence of the lesion was identified at the treated site and DNA-ICM revealed 1 aneuploid cell 9 months after the first session of PDT. The patient received the second session of PDT treatment and had a complete response with normal DNA ploidy.

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