Systematic review of the follow‐up of oral dysplasia

Abstract

Objectives. To assess effectiveness, safety, and acceptability of follow‐up regimens for oral dysplasia with regards to malignant transformation rate and duration to transformation. Method. Study design–Systematic literature review with criteria for identifying studies, assessing quality and data extraction. Selection criteria–Cohort studies, case‐control studies, or randomised‐controlled trials (RCTs). Interventions–Clinical follow‐up and surveillance, surgical and non‐surgical treatment, modification of aetiological factors. Outcome measures–Malignant transformation rate, predictive value of clinical prognostic indicators. Data collection and analysis–Using selection criteria, we identified published data by electronic searching. The validity of studies and extracted data was independently assessed by two authors. Quantitative data is compared and summarized in a table. Qualitative data is also discussed. Results. There are no RCTs assessing follow‐up strategies. Nineteen cohort studies (level II and III evidence) reported follow‐up, of which 12 were included in the meta‐analysis. The malignant transformation rate varies widely between studies (6.6–36.0%). Surgical treatment appears to be more effective than non‐surgical modalities, but recurrence is high. Tobacco and alcohol use, site and histological grade of the lesion are associated with progression to cancer. Conclusions. There is currently no evidence‐based or consensus strategy for malignant risk quantification and follow‐up of patients with oral dysplasia. We present a follow‐up protocol based on best evidence. Large randomised‐controlled trials are needed to assess these new strategies, including the use of molecular markers to quantify risk and follow‐up these lesions.