Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Background: Advances in treatment approaches for patients with oral squamous cell carcinoma (OSCC) have been unsuccessful in preventing frequent recurrences and distant metastases, leading to a poor prognosis. Early detection and prevention enable an improved 5-year survival and better prognosis. Confocal Laser Endomicroscopy (CLE) is a non-invasive imaging instrument that could enable an earlier diagnosis and possibly help in reducing unnecessary invasive surgical procedures. Objective: To present an up to date systematic review and meta-analysis assessing the diagnostic accuracy of CLE in diagnosing OSCC. Materials and Methods. PubMed, Scopus, and Web of Science databases were explored up to 30 June 2021, to collect articles concerning the diagnosis of OSCC through CLE. Screening: data extraction and appraisal was done by two reviewers. The quality of the methodology followed by the studies included in this review was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random effects model was used for the meta-analysis. Results: Six studies were included, leading to a total number of 361 lesions in 213 patients. The pooled sensitivity and specificity were 95% (95% CI, 92–97%; I2 = 77.5%) and 93% (95% CI, 90–95%; I2 = 68.6%); the pooled positive likelihood ratios and negative likelihood ratios were 10.85 (95% CI, 5.4–21.7; I2 = 55.9%) and 0.08 (95% CI, 0.03–0.2; I2 = 83.5%); and the pooled diagnostic odds ratio was 174.45 (95% CI, 34.51–881.69; I2 = 73.6%). Although risk of bias and heterogeneity is observed, this study validates that CLE may have a noteworthy clinical influence on the diagnosis of OSCC, through its high sensitivity and specificity. Conclusions: This review indicates an exceptionally high sensitivity and specificity of CLE for diagnosing OSCC. Whilst it is a promising diagnostic instrument, the limited number of existing studies and potential risk of bias of included studies does not allow us to draw firm conclusions. A conclusive inference can be drawn when more studies, possibly with homogeneous methodological approach, are performed.

Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy

“…CLE allows for the in vivo visualization of cellular and subcellular structures on the epithelial and subepithelial surface of the anterior human oropharyngeal region with high resolution and frame rates, using acriflavine topically and fluorescein intravenously [ 122 ]. Several studies have demonstrated promising results, including a scoring system to classify benign and malignant tissue in the oral cavity, and an exceptionally high sensitivity and specificity [ 123 , 124 , 125 ]. Another study suggested that CLE may supplant or reduce the need for physical tissue biopsy in the management of oral cancer [ 126 ].…”

Inflammation and Invasion in Oral Squamous Cell Carcinoma Cells Exposed to Electronic Cigarette Vapor Extract

“…Furthermore, OSSC has shown a high recurrence rate (up to 50%) leading to OSCC progression and patients eventually die of tumor recurrence and subsequent metastasis (5,6). OSCC is closely related to environmental factors including tobacco consumption, alcohol habits, nutrition, and viral infections (5,7,8). Of these factors, cigarette smoke is associated with is 7-10 times higher OSCC development when compared to non-smokers (5,8).…”

“…OSCC is closely related to environmental factors including tobacco consumption, alcohol habits, nutrition, and viral infections (5,7,8). Of these factors, cigarette smoke is associated with is 7-10 times higher OSCC development when compared to non-smokers (5,8). Despite concerted social efforts to reduce smoking prevalence, current trends suggest that smoking numbers will continue to increase.…”

Aplicabilidade das estratégias para prevenção e diagnóstico precoce do câncer de boca: uma revisão guarda-chuva

“…46 artigos incluídos nesta revisão guarda-chuva, 17 não relataram o uso de ferramentas para avaliação do risco de viés dos estudos primários revisados(68, 69, 72-75, 79, 81, 82, 85, 88, 93, 96, 99, 101, 107) Outros 3 artigos relataram o uso de escalas/ critérios próprios(76,95,106), o que pode prejudicar a reprodutibilidade e não é aconselhável uma vez que existem ferramentas testadas e publicadas com embasar a presente revisão guarda-chuva(37,70, 71,76,78,80,83,89,92,94,98,102,103,105,106,108).É muito debatido na literatura se existe uma correlação entre a qualidade de um artigo e o fator de impacto da revista (FI) em que ele está publicado. O FI é um indicador calculado anualmente pela base de dados Web of Science, sendo uma ferramenta quantitativa para classificar, avaliar, categorizar e comparar periódicos de mesma área.…”

“…Concluiu-se que a baixa quantidade de estudos existentes no continente e a falta de estudos do tipo ECR não permitem validar a Novas tecnologias, utilizadas com maior frequência em outros órgãos, também vem sendo testadas para lesões de boca. O artigo de Sethi et al(102) analisou a acurácia da endomicroscopia confocal a laser no diagnóstico de CEB, uma técnica mais comumente empregada para neoplasias gástricas que utiliza um corante fluorescente e uma sonda microscópica para avaliação do tecido em tempo real.Embora se observe viés e heterogeneidade, este estudo afirma que a endomicroscopia confocal a laser pode ter uma influência clínica notável no diagnóstico de CEB, por meio de sua alta sensibilidade e especificidade, que apresentaram valores de 95% e 93% respectivamente. Entretanto, devido aos custos envolvidos na compra dos equipamentos e capacitação técnica, a endomicroscopia confocal a laser tende a apresentar menor custo-benefício para aplicação durante o rastreamento de lesões, sendo mais promissora para definição de margens de segurança no transcirúrgico.O uso da Inteligência Artificial vem sendo cada vez mais comum na área da saúde, buscando aprimorar o diagnóstico de condições através de técnicas de Telessaúde.…”