NATIVE CELLULAR FLUORESCENCE OF NEOPLASTIC UPPER AERODIGESTIVE MUCOSA

Objective: To identify alterations in the biochemical composition and histoarchitectural structure of the lining epithelium that signal mali gnant transformation in carcinogen-exposed upper aerodigestive mucosa by quantitation of native cellular fluorescent properties. Design: Cas e series. Setting: Head and Neck Service, Department of Surgery, Memor ial Sloan-Kettering Cancer Center, New York, NY. Patients and Methods: Thirty-one patients with previously untreated mucosal neoplasias of t he oral cavity and pharynx were studied by means of a hand-held fibero ptic probe attached to a xenon lamp-based fluorescent spectrometer. Fl uorescence analyses of the lesions and contralateral normal sites were performed in each patient on the basis of specific emission and excit ation wavelengths. Differences between normal tissue and neoplastic mu cosa were tested for statistical significance by paired t test and Hot elling's T-2 test. Results: The ratios of fluorescence intensities of neoplastic mucosa and contralateral normal sites were significantly di fferent in three of the four fluorescence scans (excitation of 300 nm and emission of 320 to 580 nm; excitation of 340 nm and emission of 36 0 to 660 nm; and excitation of 200 to 360 nm and emission of 380 nm) w hen analyzed individually (P<.05). The ratios in the scans with excita tion of 240 to 430 nm and emission of 450 nm were not significantly di fferent. All four scans, when analyzed together, demonstrated signific ant differences between normal and neoplastic tissues (P<.01). Conclus ions: Neoplastic mucosa of the upper aerodigestive tract within an ind ividual patient will express native cellular fluorescent properties in vivo that differ from those of normal upper aerodigestive epithelia. This may represent a noninvasive screening method for head and neck sq uamous cell cancers.