CAN CLINICAL IMAGE OF ORAL LEUKOPLAKIA ENVISAGE ITS MALIGNANT POTENTIAL?

Abstract

Background: Fractal analysis (FA) is a non-invasive method that quantifies complex geometric structures by generating a fractal dimension (FD), which can measure the complexity of mucosa. Healthy human tissue has a dense internal similarity at the micro-level. When a pathological process occurs, this internal coherence is broken down, resulting in complexity. FD increases or decreases according to the complexity of the object. Oral Leukoplakia is a potentially malignant oral disorder and the complexity in this lesion can occur due to increase in keratinisation. In such lesions fractal dimensions can be an important tool in detecting the malignant potential of Oral Leukoplakia. Aim:To assess the fractal dimension of Oral leukoplakia and compare it with normal mucosa.by using Clinical Photographs. Materials And Methods:Clinically the lesions were photographed and later evaluated by White and Rudolph and box count method using Image J software. Results:The mean fractal dimension (FD) values increased progressively from normal mucosa (1.10) to normal mucosa with tobacco habits (1.32), lesional mucosa (1.37), and oral cancer (1.39), with a statistically significant difference among groups (p < 0.05). FD values in normal mucosa were significantly lower than in other groups, while differences between habit-associated mucosa, lesional mucosa, and oral cancer were not statistically significant. No significant differences in FD values were observed with respect to gender or type of tobacco use (smoking vs. smokeless). A cutoff value of 1.2745 effectively differentiated normal mucosa from both habit-associated and lesional mucosa, while higher cutoffs 1.3349 and 1.3377 distinguished oral cancer from normal and lesional mucosa, respectively. Conclusion:The present study demonstrates that fractal dimension (FD) analysis is an effective, non-invasive tool for assessing structural complexity in oral mucosa. A clear and progressive increase in FD values was observed indicating increasing disruption of tissue architecture and complexity. However, its limited ability to distinguish between habit associated and lesional mucosa suggests that further refinement may be required for staging disease progression.