Is alveolar ridge keratosis a true leukoplakia? A clinicopathologic comparison of 2,153 lesions
Is alveolar ridge keratosis a true leukoplakia? A clinicopathologic comparison of 2,153 lesions
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DOI：
10.14219/jada.archive.2007.0236
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发表时间：
2007-05-01
影响因子：
3.9
通讯作者：
Neville, Brad W.
中科院分区：
文献类型：
--
作者：
Chi, Angela C.;Lambert, Paul R., III;Neville, Brad W.
背景牙槽嵴角化病（方舟）并没有被广泛认为是一种独特的临床病理学实体，它经常被包括在口腔白斑（OL）的研究中，从而暗示癌前病变的可能性。作者的目标是描述方舟的临床病理特征，并确定将方舟从OL分类中删除是否会显著影响OL中异型增生或癌的I患病率。作者对1995年至2004年提交活检服务的477例方舟病例和1,676例OL病例进行了回顾性连续病例分析。作者将方舟定义为无红斑或溃疡的白色斑块，局限于磨牙后垫或缺牙嵴。显微镜下，大多数方舟病例（97.9%）表现为角化过度，无发育不良。少数发育异常病例（2.1%）与以下一种或多种情况有关：疣状外观、吸烟或饮酒、多发OL病变和既往口腔鳞状细胞癌。从OL中排除方舟使OL病例表现出发育异常或癌的百分比从20.2%增加到24.8%。纳入与排除方舟的结果在OL病例定义中的一致性良好，但低于极好（kappa = 0.6128）。没有高危习惯或其他临床警告体征的患者的方舟似乎是与OL明显不同的病变，与OL病例相比，方舟中明显的异型增生或癌的比例要小得多。然而，需要前瞻性研究来证实这一假设。虽然大多数临床上符合方舟的病例都是良性角化过度，但只有通过活检和组织病理学检查才能排除异常增生或癌。
Background. Alveolar ridge keratosis (ARK) is not widely recognized as a distinct clinicopathologic entity, and it often is included in studies of oral leukoplakia (OL), thereby implying premalignant potential. The authors' ohiectives were to characterize the C clinicopathologic features of ARK and determine whether removing ARK from the OL category would significantly affect the I prevalence of dysplasia or carcinoma in OL.Methods. The authors conducted a retrospective consecutive case review of 477 ARK cases and 1,676 OL cases submitted to their biopsy service from 1995 through 2004. The authors defined ARK as a white plaque without erythema or ulceration and limited to the retromolar pad or edentulous ridge.Results. Microscopically, most ARK cases (97.9 percent) exhibited hyperkeratosis without dysplasia. The few dysplastic cases (2.1 percent) were associated with one or more of the following: verrucous appearance, tobacco or alcohol use, multiple OL lesions and previous oral squamous cell carcinoma, Excluding ARK from OL increased the percentage of OL cases exhibiting dysplasia or carcinoma from 20.2 percent to 24.8 percent. Including versus excluding ARK resulted in good but less than excellent agreement in the OL case definition (kappa = 0.6128).Conclusions. ARK in patients without high-risk habits or other clinical warning signs appears to be a distinctly different lesion from OL, with a much smaller proportion of dysplasia or carcinoma evident among ARK versus OL cases. However, prospective studies are needed to confirm this hypothesis.Cli nical implications. Although most cases clinically consistent with ARK are benign hyperkeratoses, dysplasia or carcinoma can be excluded only by means of biopsy and histopathologic examination.