Meta-analysis of measures of performance reported in oral cancer and precancer screening studies

Abstract

Objective To elicit a range of values for sensitivity, specificity and other measures of performance in screening for oral cancer and precancer. Method A literature search which included three databases was conducted. Strict inclusion criteria were applied. Values for sensitivity (Sn) and specificity (Sp), from seven investigations, were expressed as a receiver operator characteristic (ROC) curve. Meta-analysis of the combined results was used to produce a summary operator characteristic (SROC) curve. Results The pooled weighted value of Sn from the seven studies was 0.796. From the SROC, the corresponding value of Sp at this level of Sn was 0.977 (95% CI 0.941, 0.991). When Sp was held at 0.977, the corresponding value of Sn from the SROC was 0.796 (95% CI 0.594, 0.912). Conclusions The reports selected for eventual inclusion revealed a high level of heterogeneity with respect to the location of investigations, prevalence of lesions, the personnel used and other factors. The meta-analysis indicated that overall the studies had high discriminatory ability. The estimates of Sn and Sp, and values obtained for other measures of screening performance, were considered suitable for input to a simulation model in assessing the likely cost-utility of a variety of screening scenarios in further planned research.During the past decade, there has been mounting interest in the possibility of instituting screening programmes for oral cancer and precancer. Although a disease of relatively low incidence, oral cancer has high morbidity and mortality and appears to fulfil many of the criteria of a disease suitable for screening population groups at risk. Nevertheless, it would be difficult to envisage the formal acceptance of population screening for oral cancer as a part of health policy without its likely costs and benefits, as well as its feasibility and suitability, having been evaluated. The best evidence of the efficacy of a clinical intervention is provided by a randomised controlled trial (RCT), this being the 'gold standard' for evaluations of effectiveness. However, the cost and logistical difficulties of organising and managing a trial of screening for such a relatively uncommon disease would be formidable. A feasible alternative in such circumstances is the use of simulation modelling. This technique synthesises and analyses data collected from multiple sources, including the literature, and is capable of generating valid cost-effectiveness data. Simulation modelling has the added advantage that by the means of sensitivity analysis, it enables a range of screening scenarios to be examined relatively cheaply and the optimum approach identified. However RCT would allow at the most only a very few programmes to be evaluated and compared simultaneously and would be extremely costly to mount.The use of a simple model to simulate opportunistic screening of patients at risk of oral cancer in general dental practice and provide a tentative determination of the health gain screening might achieve, together with its cost-effec...

Influence of years of professional experience in relation to the diagnostic skill of general dental practitioners (GDPs) in identifying oral cancer and precancerous lesions

“…It is generally accepted that a sensitivity of agreement higher than 80% is acceptable for systematic screening of oral cancer 32 . However, adequate concordance values often hide low values, especially since the derived sensitivity values ranged from 0.60 to 0.95 14,18,32,33 . Visual examination offers a high discriminatory capacity in detecting the disease and in general, oral cancer is diagnosed correctly by dental professionals.…”

“…Summary of values for expressions of the validity of screening for oral cancer and precancer(33) Note PPV positive predictive values NPV negative predictive values…”

Evaluation of Screening Strategies for Improving Oral Cancer Mortality: A Cochrane Systematic Review

“…This is the first systematic review of screening strategies on oral cancer reported in the literature based on randomized controlled trials only. However other reviews of effectiveness 86,97 and test performance 92 have also been undertaken.…”

“…A meta-analysis with regard to the test performance of visual examination as a screening method has previously been performed, but this was not undertaken as part of the systematic review. 92 Clear criteria for inclusion and exclusion were applied. However, the included studies varied in both their study design and circumstances with regard to screening strategy used, population sample, prevalence of dis- ease in those populations, and personnel undertaking screening and their experience as well as training in performing the screening.…”

Utility of oral cancer diagnostic adjuncts in the adult US populations

“…Because adequate evidence on the sensitivity and specificity is not available, we assumed that the oral cancer adjuncts to have the highest sensitivity and specificity possible at 99%, to create a best-case scenario. For the COE, we used the pooled sensitivity value of 79.6% (95% CI: 59.4%-91.2%) and specificity value of 97.7% (95% CI: 94.1%-99.1%) from a meta-analysis study by Moles et al (17).…”