Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature.
ABSTRACT 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.
- SourceAvailable from: Shamimul Hasan[Show abstract] [Hide abstract]
ABSTRACT: Oral cancer accounts for a significantly higher percentage of all cancer cases. Survival rates of oral cancers are relatively low in comparison to other major cancers, although incidence rates are as low as 3%. Oral cancer is the most common cancer among Indian males and third most common cancer among Indian females. Delay in diagnosis, metastases, and the presence of secondary tumors are the major reasons for the poor prognosis of oral cancers. Innocuous potentially malignant lesions have higher chances for malignant transformation and early diagnosis of these lesions is necessary for improving survival rates. The patient's overall outcome can be enhanced through early diagnosis and management of these potentially malignant lesions, as the risk factors are well documented for oral cancers. Currently available clinical diagnostic tools developed for the early detection of oral cancers includes toluidine blue dye (TB) (tolonium chloride), Oral brush biopsy, chemiluminescence using Vizilite, salivary diagnostics, and several imaging devices such as Velscope and multispectral optical imaging systems. This paper provides a detailed review about the various diagnostic aids in the detection of oral cancers and also emphasizes a dentist's role in combating this dreadful entity.International Journal of Pharmacy and Pharmaceutical Sciences 01/2015; · 1.59 Impact Factor
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ABSTRACT: Stage of disease at the diagnosis of oral cancer is thought to be a significant factor in prognosis and outcome (International Agency for Research on Cancer/World Health Organization, 2014). Unfortunately, we continue to diagnose almost 2/3 of these cancers at advanced stages of disease despite the ongoing research for devices/methods to aid the clinicians in detection and accurate oral mucosal lesion diagnosis. This paper explores both the nature of oral cancer and the adjuncts available for detection, and presents the current issues in diagnostic delays of oral cancer detection.Oral Oncology 09/2014; · 3.03 Impact Factor
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ABSTRACT: IntroductionIn recent decades, optical techniques utilising the principles of chemiluminescence and tissue autofluorescence have emerged to facilitate the early detection of any oral mucosal changes suspicious of cancer.PurposeTo evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of oral cancer and oral potentially malignant disorders (OPMDs).MethodsA systematic review of the published literature to evaluate the effectiveness of the ViziLite® and ViziLite® Plus with toluidine blue, MicroLux™/DL and the VELscope™ as aids in the detection of oral cancer and OPMDs.ResultsTwenty-five primary studies published between 2004 and 2013 satisfied our criteria for selection – 13 utilised chemiluminescence and 12 tissue autofluorescence. Some had utilised both study methods on the same population. Chemiluminescence shows good sensitivity at detecting any OPMDs and oral cancer. However, it preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss (FVL) often extends beyond the clinically visible lesion. However, in addition to OPMDs, VELScope may detect erythematous lesions of benign inflammation resulting in false-positive test results.Conclusion There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.Journal of Oral Pathology and Medicine 09/2014; · 1.87 Impact Factor