Advancing Precision Imaging for Enhanced Diagnosis and Treatment of Oral Lesions

May 2024

Integrative Biology and Infectious Diseases Branch

Division of Extramural Research

Goal

The goal of this concept is to enhance accuracy, detection, diagnosis, and personalized treatment of oral lesions and inflammatory processes using advanced imaging technologies. By integrating cutting-edge imaging modalities into clinical workflows, optimizing lesion detection methods, and refining single-cell analysis, this concept seeks to bridge existing gaps in precision imaging for oral diseases. The long-term goal is to establish standardized quantitative imaging metrics, integrate imaging into clinical trials, and combine imaging data with multi-omics information for comprehensive profiling of oral lesions. Through collaborative research efforts, this concept strives to accelerate the translation of breakthrough discoveries in imaging into clinical applications, ultimately advancing the management of acute and chronic oral health conditions and improving patient outcomes.

Background

Pathological lesions in the oral cavity and oropharynx are highly diverse, ranging from benign to severe conditions like infections and malignancies. These lesions present diagnostic challenges due to their diverse appearance and etiology. While some lesions can be diagnosed based on clinical presentation, others require analytical and quantitative evaluation to avoid misdiagnosis, and delayed or improper care.

Histopathology, the current gold standard for diagnosing oral lesions, has limitations such as low specificity and sensitivity, subjectivity, and reliance on clinician judgment. This hinders reliable categorization of lesions, leading to delayed intervention and compromised outcomes. Effective diagnostic methods are needed to complement or replace conventional pathology and enable earlier intervention. Recent advances in precision imaging offer promising solutions to address these unmet clinical needs. Precision imaging includes advanced, quantitative technologies like radiomics and molecular imaging, which eliminate subjectivity and provide insights into disease severity and progression.

Despite the potential of precision imaging for early detection and personalized treatment strategies, gaps persist in areas such as early detection, inflammatory subtype characterization, personalized treatment planning, and treatment monitoring. Current clinical evaluation methods lack spatial specificity or rely on invasive procedures. Bridging these gaps through advanced imaging techniques is crucial for improving patient outcomes in oral healthcare. Chronic unresolved inflammation is implicated in various diseases, including oral and head and neck cancers. Integration of imaging data with multi-omics information offers a promising approach to profile inflammatory and other disease processes comprehensively, enabling early detection and personalized treatment.

Gaps and Opportunities

Treating lesions in the oral cavity and oropharynx remains challenging due to the reliance on subjective clinical features and histopathological diagnosis. Existing methods, such as fluorescence and toluidine stain, lack specificity and have high false-negative rates, limiting their diagnostic value. There is a critical need for more precise and sensitive tools for early detection and diagnosis, especially considering the significant health risks associated with oral lesions, including all types of infectious, inflammatory, pre-cancerous, and cancerous lesions of the soft and hard oral tissues.

While recent advancements in imaging technologies offer promise, gaps persist in precision imaging for characterizing inflammation, pre-cancer, and cancer in oral lesions. Molecular imaging significantly adds to the understanding of disease pathogenesis and is considered the gold standard in visualizing inflammation and pre-cancerous and cancerous lesions noninvasively. The specificity of the molecular probes provides risk prediction and stratification to identify patients most likely to benefit from a targeted intervention under monitoring therapy response. However, the practical limitations of its clinical deployment restrict its use in clinical practice. Key areas for improvement include early detection through imaging biomarkers, characterization of inflammatory and infectious subtypes, personalized treatment planning, intraoperative imaging for precision surgery, monitoring treatment response, early recurrence detection, and patient stratification based on inflammation and molecular profiles.

Integration of advanced imaging techniques into clinical trials is essential for evaluating their impact on patient outcomes and accelerating the translation of breakthrough discoveries into clinical applications. Furthermore, leveraging interventional oncology and surgery procedures and artificial intelligence (AI) holds promise in optimizing treatment responses and improving procedural outcomes.

By addressing these gaps through collaborative research efforts, we can revolutionize clinical practice, enhance the management of acute and chronic oral health conditions, and ultimately improve patient outcomes.

Specific Areas of Interest

This concept aims to drive basic and translational research, with a focus on enhancing accuracy and novel development in differential diagnosis, therapy, and disease monitoring in the oral cavity and oropharynx, including all types of infectious, inflammatory, pre-cancerous, and cancerous lesions of the soft and hard oral tissues. Key areas of opportunity for translational research include:

• Incorporating new imaging modalities into clinical workflows to better characterize and grade oral lesions, as well as assess disease extent and severity.
• Developing reliable techniques to detect lesions that may be missed by conventional examination procedures.
• Optimizing single-cell analysis to elucidate cellular and physiological differences within heterogeneous oral lesions.
• Creating and optimizing image-guided biopsy, surgery, and ablative therapies to enhance oral disease management.
• Designing agents targeting biological pathways to identify early disease markers, treat conditions, and monitor therapeutic responses.
• Exploring imaging-based biomarkers for early detection of inflammation and aggressive phenotypes in both cancerous and non-cancerous oral lesions.
• Utilizing imaging to differentiate inflammatory and immune cell subtypes within head and neck cancers, correlating findings with molecular and immunological data and biomarkers.
• Developing imaging strategies to tailor anti-inflammatory and immunotherapeutic treatments based on individual responses and inflammatory and immune patterns.
• Employing imaging to track dynamic changes in inflammation and tumor microenvironment during and after treatment, particularly in response to immunotherapies or targeted therapies.
• Establishing imaging protocols for early identification of inflammatory and molecular changes indicative of cancer recurrence, aiding in post-treatment surveillance.

Emphasis on the establishment of standardized quantitative imaging metrics, integration into clinical trials for assessing treatment efficacy, and the integration of imaging with multi-omics data for comprehensive inflammation profiling in both cancer and non-cancer oral lesions are highly encouraged.

References

• Liu CH, Abrams ND, Carrick DM, Chander P, Dwyer J, Hamlet MRJ, et al. Imaging inflammation and its resolution in health and disease: Current status, clinical needs, challenges, and opportunities. FASEB J. 2019 Dec;33(12):13085-13097. doi: 10.1096/fj.201902024.
• Floridi C, Cellina M, Irmici G, Bruno A, Rossini N, Borgheresi A, et al. Precision imaging guidance in the era of precision oncology: An update of imaging tools for Interventional Procedures. J Clin Med. 2022 Jul 12;11(14):4028. doi: 10.3390/jcm11144028.
• Sinigaglia M, Assi T, Besson FL, Ammari S, Edjlali M, Feltus W, et al. Imaging-guided precision medicine in glioblastoma patients treated with immune checkpoint modulators: Research trend and future directions in the field of imaging biomarkers and artificial intelligence. EJNMMI Res. 2019 Aug 20;9(1):78. doi: 10.1186/s13550-019-0542-5.
• Lee H, Park J, Im HJ, Na KJ, Choi H. Discovery of potential imaging and therapeutic targets for severe inflammation in COVID-19 patients. Sci Rep. 2021 Jul 8;11(1):14151. doi: 10.1038/s41598-021-93743-2.
• West H, Dangas K, Antoniades C. Advances in clinical imaging of vascular inflammation: A state-of-the-art review. J Am Coll Cardiol Basic Trans Science. 2024 May, 9 (5) 710–732.