Non-invasive three-dimensional thickness analysis of oral epithelium based on optical coherence tomography—development and diagnostic performance

OBJECTIVES: Evaluating structural changes in oral epithelium can assist with the diagnosis of cancerous lesions. Two-dimensional (2D) non-invasive optical coherence tomography (OCT) is an established technique for this purpose. The objective of this study was to develop and test the diagnostic accuracy of a three-dimensional (3D) evaluation method. METHODS: The oral lip mucosa of 10 healthy volunteers was scanned using an 870-nm spectral-domain OCT device (SD-OCT) with enhanced depth imaging (EDI). Four raters semi-automatically segmented the epithelial layer twice. Thus, eighty 3D datasets were created and analyzed for epithelial thickness. To provide a reference standard for comparison, the raters took cross-sectional 2D measurements at representative sites. The correlation between the 2D and 3D measurements, as well as intra- and inter-rater reliability, were analyzed using intraclass correlation coefficients (ICC). RESULTS: Mean epithelial thickness was 280 ± 64μm (range 178–500 μm) and 268 ± 49μm (range 163–425 μm) for the 2D and 3D analysis, respectively. The inter-modality correlation of the thickness values was good (ICC: 0.76 [0.626–0.846]), indicating that 3D analysis of epithelial thickness provides valid results. Intra-rater and inter-rater reliability were good (3D analysis) and excellent (2D analysis), suggesting high reproducibility. CONCLUSIONS: Diagnostic accuracy was high for the developed 3D analysis of oral epithelia using non-invasive, radiation-free OCT imaging. CLINICAL SIGNIFICANCE: This new 3D technique could potentially be used to improve time-efficiency and quality in the diagnosis of epithelial lesions compared with the 2D reference standard.