Adjunctive Techniques for Oral Cancer Examination and Lesion Diagnosis: A Systematic Review of the Literature

Department of Dental Ecology, General Practice Residency Program, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC 27599-7450, USA.
Journal of the American Dental Association (1939) (Impact Factor: 2.01). 08/2008; 139(7):896-905; quiz 993-4. DOI: 10.14219/jada.archive.2008.0276
Source: PubMed


Adjunctive techniques that may facilitate the early detection of oral premalignant and malignant lesions (OPML) have emerged in the past decades.
The authors undertook a systematic review of the English-language literature to evaluate the effectiveness of toluidine blue (TB), ViziLite Plus with TBlue (Zila Pharmaceuticals, Phoenix), ViziLite (Zila Pharmaceuticals), Microlux DL (AdDent, Danbury, Conn.), Orascoptic DK (Orascoptic, a Kerr Company, Middleton, Wis.), VELscope (LED Dental, White Rock, British Columbia, Canada) and OralCDx (Oral CDx Laboratories, Suffern, N.Y.) brush biopsy. They abstracted data relating to study design, sampling and characteristics of the study group, interventions, reported outcomes and diagnostic accuracy of adjunctive aids from 23 articles meeting inclusion and exclusion criteria, including availability of histologic outcomes.
The largest evidence base was for TB. A limited number of studies was available for ViziLite, ViziLite Plus with TBlue and OralCDx. Studies of VELscope have been conducted primarily to assess the margins of lesions in known OPML. The authors identified no studies of Microlux DL or Orascoptic DK. Study designs had various limitations in applicability to the general practice setting, including use of higher-risk populations and expert examiners.
There is evidence that TB is effective as a diagnostic adjunct for use in high-risk populations and suspicious mucosal lesions. OralCDx is useful in assessment of dysplastic changes in clinically suspicious lesions; however, there are insufficient data meeting the inclusion criteria to assess usefulness in innocuous mucosal lesions. Overall, there is insufficient evidence to support or refute the use of visually based examination adjuncts. Practical Implications. Given the lack of data on the effectiveness of adjunctive cancer detection techniques in general dental practice settings, clinicians must rely on a thorough oral mucosal examination supported by specialty referral and/or tissue biopsy for OPML diagnosis.

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Available from: Joel B Epstein, Aug 31, 2015
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    • "Fluorescent imaging is based on fluorophore concentrations , fluorescent collagen cross-links, tissue scattering characteristics , hemoglobin absorption properties, and tissue thickness [42] [43] [44] [45] [46]. Thus, when exposed to various forms of light or energy, mucosal tissues reveal different absorbance, reflectance and fluorescent profiles that may assist in detection of dysplastic/neoplastic tissue [47] [48]. Various devices that utilize chemiluminescence [49] [50] [51] [52], autofluorescence [42,46,48,51,53–58] and multi-spectral imaging [59] [60] have been introduced in order to assist detection and determination to biopsy to facilitate diagnosis of PMD and OSCC with variable results. "
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    • "Few studies evaluated the efficacy of Microlux/DL (McIntosh et al., 2009). To our knowledge, the current study is the first to evaluate Microlux/DL both as a screening device and as a case finding (diagnostic) device (Lingen et al., 2008; Patton et al., 2008). "
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