Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions

Abstract

BackgroundOral squamous cell carcinoma is the most common form of malignancy of the lip and oral cavity, often being proceeded by potentially malignant disorders (PMD). Early detection can reduce the malignant transformation of PMD and can improve the survival rate for oral cancer. The current standard of scalpel biopsy with histology is painful for patients and involves a delay whilst histology is completed; other tests are available that are unobtrusive and provide immediate results. ObjectivesPrimary objective: To estimate the diagnostic accuracy of index tests for the detection of oral cancer and PMD of the lip and oral cavity, in people presenting with clinically evident lesions.Secondary objective: To estimate the relative accuracy of the different index tests. Search methodsThe electronic databases were searched on 30 April 2013. We searched MEDLINE (OVID) (1946 to April 2013) and four other electronic databases (the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Group's Trials Register, EMBASE (OVID) and MEDION (Ovid)). There were no restrictions on language in the searches of the electronic databases. We conducted citation searches and screened reference lists of included studies for additional references. Selection criteriaWe selected studies that reported the diagnostic test accuracy of the following index tests when used as an adjunct to conventional oral examination in detecting PMD or oral squamous cell carcinoma of the lip or oral cavity: vital staining, oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis (which test for the presence of biomarkers in blood or saliva). 1 Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions (Review)

Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students

“…Based on a recent Cochrane analysis [36], oral cytology showed 90% sensitivity and 94% specificity in detecting oral lesions. Its performance was better in comparison with vital staining and light-based techniques, as these can erroneously provide more false positive results due to lower specificity and are difficult to interpretate by the non-expert clinician.…”

The clinical utility of contemporary oral epithelial dysplasia grading systems

“…29,31 Other attempts have also been made in developing tools/methods to improve screening and detection of OPMD such as using toluidine blue dye, brush biopsy sampling, fluorescence-based methods and also light reflectance/absorption methods. 32,33 However, none of these adjunct methods have been conclusively proven to improve detection of OPMD or increase accuracy of biopsy sampling. 32,33 Lack of prognostic ability is also compounded by 'field-change' in OPMD patients.…”

“…32,33 However, none of these adjunct methods have been conclusively proven to improve detection of OPMD or increase accuracy of biopsy sampling. 32,33 Lack of prognostic ability is also compounded by 'field-change' in OPMD patients. As such, an OED grade based on a biopsy at one site is not truly representative of the entire oral mucosa.…”

“…38 Although not perfect, OED grading in conjunction with clinical findings is still the most frequently used method to risk stratify and manage patients with OPMD. 1,2,4,33,38 Methods assessing aneuploidy and loss of heterozygosity, though promising, are still not highly accurate in predicting clinical outcome in OPMD patients. Studies have recommended that these techniques be used in conjunction with OED grading to risk stratify patients.…”

Role of Artificial Intelligence in the Early Diagnosis of Oral Cancer. A Scoping Review

“…However, in answer to this third question, it must be taken into account that while fluorescence may be an adjunct or complement to oral examination in the diagnosis of oral precancer and cancer [73], it cannot be postulated as a substitute for biopsy [74]. This affirmation was ratified in the last Cochrane review, in which it was stated that none of the complementary tests, such as vital staining, oral cytology, light-based detection, and oral spectroscopy, replace biopsy for the diagnosis of oral cancer [75].…”