A systematic review of test performance in screening for oral cancer and precancer
The University of Manchester, Manchester, England, United Kingdom Oral Oncology
(Impact Factor: 3.61).
04/2004; 40(3):264-73. DOI: 10.1016/j.oraloncology.2003.08.013
Nine databases were searched for studies on test performance in screening for oral cancer and precancer in primary care. Of 481 papers, full texts of 47 were scrutinised by two reviewers. Only prospective investigations of population screening involving examination of the oral mucosa, with gold standard verification (examination by an expert of subjects screened positive and at least a proportion of negatives), were selected. Seven papers describing eight studies were finally included (kappa=0.83). The weighted pooled value of sensitivity, from random effects meta-analysis, was 0.848 (95% CI 0.730, 0.919). The corresponding value for specificity was 0.965 (95% CI 0.930, 0.982). Main sources of clinical heterogeneity occurred between large house-to-house case finding programmes from SE Asia, utilising primary health workers, and smaller studies from England and Japan. Meta-analysis regression showed no difference (P=0.99) in the generally high level of discriminatory ability of the test between these two groups.
Available from: Mona Hassan Ahmed Hassan
- "Furthermore, the American Dental Association council on scientific affairs expert panel on screening for oral squamous cell carcinomas has suggested that clinicians should be aware of signs of potentially malignant lesions during routine visual and tactile examinations in all patients, specially for heavy tobacco or alcohol consumers and recommended the need for additional oral cancer screening using adjunctive aids (Rethman et al., 2010). Oral cancer screening remains controversial (Downer et al., 2004; Bassiony, 2009). More importantly, COE is unable to detect potentially malignant lesions that are present in apparently normal mucosa (Lingen et al., 2008). "
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To evaluate the effectiveness of Microlux/DL with and without toluidine blue in screening of potentially malignant and malignant oral lesions.
Materials and methods:
In this diagnostic clinical trial clinical examination was carried out by two teams: 1) two oral medicine consultants, and 2) two general dentists. Participants were randomly and blindly allocated for each examining team. A total of 599 tobacco users were assessed through conventional oral examination (COE); the examination was then repeated using Microlux/DL device and toluidine blue. Biopsy of suspicious lesions was performed. Also clinicians opinions regarding the two tools were obtained.
The sensitivity and, specificity and positive predictive value (PVP) of Microlux/DL for visualization of suspicious premalignant lesions considering COE as a gold standard (i.e screening device) were 94.3%, 99.6% and 96.2% respectively, while they were 100%, 32.4% and 17.9% when considering biopsy as a gold standard. Moreover, Microlux/DL enhanced detection of the lesion and uncovered new lesions compared to COE, whereas it did not alter the provisional clinical diagnosis, or alter the biopsy site. On the other hand, adding toluidine blue dye did not improve the effectiveness of the Microlux/DL system.
The Microlux/DL seems to be a promising adjunctive screening device.
Available from: Pegah Mosannen Mozafari
- "(95% CI 0.73, 0.92) and specificity of 0.97(95%. CI 0.93, 0.98), Indicating a satisfactory test performance for oral examination (Downer et al. 2004). This study also suggested that trained auxiliaries are able to screen with a degree of accuracy similar to dental practitioner. "
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ABSTRACT: The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required.
Available from: Paulo Frazão
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