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Walsh T, Warnakulasuriya S, Lingen MW, Kerr AR, Ogden GR, Glenny AM, Macey R. Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev 2021; 12:CD010173. [PMID: 34891214 PMCID: PMC8664456 DOI: 10.1002/14651858.cd010173.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The early detection of oral cavity squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD), followed by appropriate treatment, may improve survival and reduce the risk for malignant transformation respectively. This is an update of a Cochrane Review first published in 2013. OBJECTIVES To estimate the diagnostic test accuracy of conventional oral examination, vital rinsing, light-based detection, mouth self-examination, remote screening, and biomarkers, used singly or in combination, for the early detection of OPMD or OSCC in apparently healthy adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), MEDLINE Ovid (1946 to 20 October 2020), and Embase Ovid (1980 to 20 October 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the test accuracy of any of the aforementioned tests in detecting OPMD or OSCC during a screening procedure. Diagnosis of OPMD or OSCC was provided by specialist clinicians or pathologists, or alternatively through follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction, and quality assessment were carried out by at least two authors independently and in duplicate. Studies were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). We reported the sensitivity and specificity of the included studies. We provided judgement of the certainty of the evidence using a GRADE assessment. MAIN RESULTS We included 18 studies, recruiting 72,202 participants, published between 1986 and 2019. These studies evaluated the diagnostic test accuracy of conventional oral examination (10 studies, none new to this update), mouth self-examination (four studies, two new to this update), and remote screening (three studies, all new to this update). One randomised controlled trial of test accuracy directly evaluated conventional oral examination plus vital rinsing versus conventional oral examination alone. There were no eligible studies evaluating light-based detection or blood or salivary sample analysis (which tests for the presence of biomarkers for OPMD and OSCC). Only one study of conventional oral examination was judged as at overall low risk of bias and overall low concern regarding applicability. Given the clinical heterogeneity of the included studies in terms of the participants recruited, setting, prevalence of the target condition, the application of the index test and reference standard, and the flow and timing of the process, the data could not be pooled within the broader categories of index test. For conventional oral examination (10 studies, 25,568 participants), prevalence in the test accuracy sample ranged from 1% to 51%. For the seven studies with prevalence of 10% or lower, a prevalence more comparable to the general population, the sensitivity estimates were variable, and ranged from 0.50 (95% confidence interval (CI) 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00); the specificity estimates were more consistent and ranged from 0.94 (95% CI 0.88 to 0.97) to 0.99 (95% CI 0.98 to 1.00). We judged the overall certainty of the evidence to be low, and downgraded for inconsistency and indirectness. Evidence for mouth self-examination and remote screening was more limited. We judged the overall certainty of the evidence for these index tests to be very low, and downgraded for imprecision, inconsistency, and indirectness. We judged the evidence for vital rinsing (toluidine blue) as an adjunct to conventional oral examination compared to conventional oral examination to be moderate, and downgraded for indirectness as the trial was undertaken in a high-risk population. AUTHORS' CONCLUSIONS There is a lack of high-certainty evidence to support the use of screening programmes for oral cavity cancer and OPMD in the general population. Frontline screeners such as general dentists, dental hygienists, other allied professionals, and community healthcare workers should remain vigilant for signs of OPMD and OSCC.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Mark W Lingen
- Pritzker School of Medicine, Division of Biological Sciences, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, USA
| | - Graham R Ogden
- Division of Oral and Maxillofacial Clinical Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Screening for mouth cancer: the pros and cons of a national programme. Br Dent J 2018; 225:815-819. [DOI: 10.1038/sj.bdj.2018.918] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/08/2022]
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Oral leukoplakia and proliferative verrucous leukoplakia: a review for dental practitioners. Br Dent J 2017; 223:655-661. [PMID: 29097794 DOI: 10.1038/sj.bdj.2017.881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Abstract
Objectives To provide an overview of the current thinking in terms of the diagnosis and management of oral leukoplakia and proliferative verrucous leukoplakia as relevant to general dental practitioners.Data sources, data selection, data extraction, data synthesis We searched the MEDLINE Ovid, EMBASE databases and the Cochrane Library, (1990 to 16 April 2017), restricting our search to English language with the following key words: leukoplakia, white patch, proliferative verrucous leukoplakia, precancerous lesion, premalignant lesions, potentially malignant oral conditions and potentially malignant oral disorders. The two authors selected key papers and engaged in collaborative data extraction and synthesis of the selected reference material.Conclusions General dental practitioners (GDPs) are likely to encounter patients with a known or yet undiagnosed oral leukoplakia in their clinical practice. The diagnosis is clinically based as there are no pathognomonic histopathological features. The definition of leukoplakia has evolved over the years. The importance of recognition and appropriate management relating to this condition is described particularly as it is one of the oral potentially malignant lesions. The inferred increased risk of malignant transformation is well documented however controversy still persists in terms of the appropriate management for these lesions. Proliferative verrucous leukoplakia is a recalcitrant, often widespread and multifocal distinct type of leukoplakia. It is considered to have a high rate of malignant transformation with implications in terms of lifelong monitoring both clinically and histopathologically. A high index of suspicion is important for general dental practitioners in order to identify such lesions that would require onward referral for further investigation and management.
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Zhang X, Kim KY, Zheng Z, Kim HS, Cha IH, Yook JI. Snail and Axin2 expression predict the malignant transformation of oral leukoplakia. Oral Oncol 2017; 73:48-55. [PMID: 28939076 DOI: 10.1016/j.oraloncology.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 08/06/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Oral leukoplakia (OL) has a well-documented potential risk of malignant transformation into oral squamous cell carcinoma (OSCC), although biomarker(s) predicting malignant potential are limited in capability. The aim of this cross-sectional and retrospective cohort study was to investigate the predictive role of canonical Wnt genes Axin2 and Snail (SNAI1) expression in the malignant transformation of OL lesions. MATERIALS AND METHODS The expression of epithelial-mesenchymal transition (EMT) genes Snail and Axin2, which are regulated by the canonical Wnt pathway, were determined using immunohistochemical staining in an OL cohort consisting of 154 samples of patients with long-term follow-up and then evaluated as risk factors for malignant transformation of OL. RESULTS Increased Axin2 and Snail abundance were found in 107 (69.5%) and 58 (37.7%) of OL patients, respectively. In a multivariate analysis using gender, age, lesion site, Axin2, and Snail as cofactors, both Axin2 and Snail were independent risk factors for malignant transformation with a hazard ratio of 7.47 (95% confidence interval, 2.23-25.02; P=0.001) and 4.41 (95% confidence interval, 1.78-10.93; P=0.001), respectively. A nomogram for predicting 5-, 10-, and 15-year cancer-free survival probability was developed in patients with OL by including gender, age, lesion site, Axin2, and Snail expression with ac-index of 0.760. CONCLUSION The increased abundance of Snail and Axin2 is highly correlated to malignant transformation of OL, making them novel biomarker(s) predicting oral cancer development.
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Affiliation(s)
- Xianglan Zhang
- Department of Pathology, Yanbian University Hospital, Yanji, China; Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Ki-Yeol Kim
- Brain Korea 21 Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Zhenlong Zheng
- Department of Dermatology, Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Hyun Sil Kim
- Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - In Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
| | - Jong In Yook
- Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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Güneri P, Epstein JB. Why are we still unable to accurately determine the malignant potential or the behavior of oral mucosal lesions? Oral Oncol 2017; 71:177-179. [PMID: 28456478 DOI: 10.1016/j.oraloncology.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Pelin Güneri
- Ege University School of Dentistry, Department of Oral and Maxillofacial Radiology, Bornova 35100, Izmir, Turkey.
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Duarte CA, 8500 Whilshire Blvd, Suite 800, Beverly Hills, CA 90211, USA
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Yagyuu T, Hatakeyama K, Imada M, Kurihara M, Matsusue Y, Yamamoto K, Obayashi C, Kirita T. Programmed death ligand 1 (PD-L1) expression and tumor microenvironment: Implications for patients with oral precancerous lesions. Oral Oncol 2017; 68:36-43. [PMID: 28438290 DOI: 10.1016/j.oraloncology.2017.03.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/27/2017] [Accepted: 03/12/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cancer immunoediting represents a relatively novel concept attempting to explain the process of tumor escape from the host immune system response. Here, we attempted to elucidate the role of programmed death ligand 1 (PD-L1), the tumor microenvironment, and tumor escape mechanisms that allow malignant transformation of oral precancerous lesions. MATERIALS AND METHODS Patients with oral precancerous lesions managed at the Nara Medical University Hospital, Japan, (n=120) were enrolled in this study. Epithelial dysplasias were graded by experienced pathologists, and subepithelial PD-L1-, CD163-, and CD8-positive cells were counted in the superficial lamina propria of oral mucosa. Epithelial PD-L1 expression was evaluated according to the staining intensity. The association of clinicopathological factors with epithelial dysplasia, malignant-free survival time, and significance of risk factors for malignant transformation were determined. RESULTS Multivariate analysis showed that the subepithelial CD163-positive cell count was the only significant risk factor for high-grade epithelial dysplasia (P<0.001), while subepithelial CD163- and PD-L1-positive cell counts, and epithelial PD-L1 positivity were significantly associated with malignant-free survival (P=0.004, 0.04, and <0.001, respectively). Subepithelial PD-L1-positive cell count and epithelial PD-L1 positivity were significantly associated with malignant transformation (P=0.01 and 0.04, respectively). CONCLUSION Our results indicate that PD-L1-expressing dysplastic epithelial and recruited subepithelial cells in oral precancerous legions may evade the host immune system, and that the inhibition of PD-1/PD-L1 pathway may potentially prevent malignant transformation of oral precancerous legions as well as can treat advanced cancers.
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Affiliation(s)
- Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Mitsuhiko Imada
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Miyako Kurihara
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Yumiko Matsusue
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
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Pivovar A, Gonçalves Dos Santos ZFD, Torres-Pereira CC. Oral cancer screening for high-risk individuals in the primary healthcare setting using an active approach. J Oral Pathol Med 2017; 46:786-791. [DOI: 10.1111/jop.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Allana Pivovar
- Graduate Program in Dentistry; Federal University of Paraná School of Dentistry; Curitiba Paraná Brazil
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Lodi G, Franchini R, Warnakulasuriya S, Varoni EM, Sardella A, Kerr AR, Carrassi A, MacDonald LCI, Worthington HV. Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database Syst Rev 2016; 7:CD001829. [PMID: 27471845 PMCID: PMC6457856 DOI: 10.1002/14651858.cd001829.pub4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral leukoplakia is a relatively common oral lesion that, in a small proportion of people, precedes the development of oral cancer. Most leukoplakias are asymptomatic; therefore, the primary objective of treatment should be to prevent onset of cancer. This review updates our previous review, published in 2006. OBJECTIVES To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 4), MEDLINE Ovid (1946 to 16 May 2016), Embase Ovid (1980 to 16 May 2016) and CancerLit via PubMed (1950 to 16 May 2016). We searched the metaRegister of Controlled Trials (to 10 February 2015), ClinicalTrials.gov (to 16 May 2016) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 16 May 2016). We placed no restrictions on the language or date of publication when searching electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled people with a diagnosis of oral leukoplakia and compared any treatment versus placebo or no treatment. DATA COLLECTION AND ANALYSIS We collected data using a data extraction form. Oral cancer development, demonstrated by histopathological examination, was our primary outcome. Secondary outcomes were clinical resolution of the lesion, improvement of histological features and adverse events. We contacted trial authors for further details when information was unclear. When valid and relevant data were available, we conducted a meta-analysis of the data using a fixed-effect model when we identified fewer than four studies with no heterogeneity. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We assessed risk of bias in studies by using the Cochrane tool. We assessed the overall quality of the evidence by using standardised criteria (Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE)). MAIN RESULTS We included 14 studies (909 participants) in this review. Surgical interventions, including laser therapy and cryotherapy, have never been studied by means of an RCT that included a no treatment or placebo arm. The included trials tested a range of medical and complementary treatments, in particular, vitamin A and retinoids (four studies); beta carotene or carotenoids (three studies); non-steroidal anti-inflammatory drugs (NSAIDs), specifically ketorolac and celecoxib (two studies); herbal extracts (four studies), including tea components, a Chinese herbal mixture and freeze-dried black raspberry gel; bleomycin (one study); and Bowman-Birk inhibitor (one study).We judged one study to be at low risk of bias, seven at unclear risk and six at high risk. In general, we judged the overall quality of the evidence to be low or very low, so findings are uncertain and further research is needed.Five studies recorded cancer incidence, only three of which provided useable data. None of the studies provided evidence that active treatment reduced the risk of oral cancer more than placebo: systemic vitamin A (RR 0.11, 95% CI 0.01 to 2.05; 85 participants, one study); systemic beta carotene (RR 0.71, 95% CI 0.24 to 2.09; 132 participants, two studies); and topical bleomycin (RR 3.00, 95% CI 0.32 to 27.83; 20 participants, one study). Follow-up ranged between two and seven years.Some individual studies suggested effectiveness of some proposed treatments, namely, systemic vitamin A, beta carotene and lycopene, for achieving clinical resolution of lesions more often than placebo. Similarly, single studies found that systemic retinoic acid and lycopene may provide some benefit in terms of improvement in histological features. Some studies also reported a high rate of relapse.Side effects of varying severity were often described; however, it seems likely that interventions were well accepted by participants because drop-out rates were similar between treatment and control groups. AUTHORS' CONCLUSIONS Surgical treatment for oral leukoplakia has not been assessed in an RCT that included a no treatment or placebo comparison. Nor has cessation of risk factors such as smoking been assessed. The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer. Treatments such as vitamin A and beta carotene may be effective in healing oral lesions, but relapses and adverse effects are common. Larger trials of longer duration are required to properly evaluate the effects of leukoplakia treatments on the risk of developing oral cancer. High-quality research is particularly needed to assess surgical treatment and to assess the effects of risk factor cessation in people with leukoplakia.
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Affiliation(s)
- Giovanni Lodi
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Roberto Franchini
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Saman Warnakulasuriya
- King's College LondonClinical and Diagnostic SciencesBessemer RoadDenmark Hill CampusLondonUKSE5 9RW
| | - Elena Maria Varoni
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Andrea Sardella
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - Alexander R Kerr
- New York University College of DentistryDepartment of Oral and Maxillofacial Pathology, Radiology and Medicine345 East 24th StreetSchwartz BuildingNew YorkUSA10010
| | - Antonio Carrassi
- Università degli Studi di MilanoDipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheVia Beldiletto 1/3MilanItaly20142
| | - L CI MacDonald
- School of Dentistry, The University of ManchesterCochrane Oral HealthJ R Moore Building, Oxford RoadManchesterUK
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral HealthJ R Moore Building, Oxford RoadManchesterUK
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Holmstrup P, Dabelsteen E. Oral leukoplakia-to treat or not to treat. Oral Dis 2016; 22:494-7. [DOI: 10.1111/odi.12443] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 02/06/2023]
Affiliation(s)
- P Holmstrup
- Section of Periodontology, Microbiology and Community Dentistry, School of Dentistry, Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen N Denmark
| | - E Dabelsteen
- Section of Periodontology, Microbiology and Community Dentistry, School of Dentistry, Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen N Denmark
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Scully C. Challenges in predicting which oral mucosal potentially malignant disease will progress to neoplasia. Oral Dis 2015; 20:1-5. [PMID: 24320967 DOI: 10.1111/odi.12208] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 01/18/2023]
Abstract
Probably the greatest challenge to those managing patients with oral diseases is the dilemma of attempting to predict which oral erythroplakias, leukoplakias, lichenoid and other potentially malignant mucosal disease (PMD) such as oral submucous fibrosis will progress to neoplasia--notably oral squamous cell carcinoma (OSCC). The paper reviews progress over the past decade and the application to the clinical situation.
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Affiliation(s)
- C Scully
- University College of London, London, UK
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11
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Speight PM, Abram TJ, Floriano PN, James R, Vick J, Thornhill MH, Murdoch C, Freeman C, Hegarty AM, D'Apice K, Kerr AR, Phelan J, Corby P, Khouly I, Vigneswaran N, Bouquot J, Demian NM, Weinstock YE, Redding SW, Rowan S, Yeh CK, McGuff HS, Miller FR, McDevitt JT. Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials. Oral Surg Oral Med Oral Pathol Oral Radiol 2015. [PMID: 26216170 DOI: 10.1016/j.oooo.2015.05.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. STUDY DESIGN Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. RESULTS Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. CONCLUSIONS The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.
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Affiliation(s)
- Paul M Speight
- Academic Unit of Oral & Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Timothy J Abram
- Rice University, Department of Bioengineering, Houston, TX, USA
| | | | | | | | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Craig Murdoch
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Christine Freeman
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Anne M Hegarty
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Katy D'Apice
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - A Ross Kerr
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Joan Phelan
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Patricia Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Ismael Khouly
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Nadarajah Vigneswaran
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Jerry Bouquot
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Nagi M Demian
- The University of Texas Health Science Center at Houston, Department of Oral and Maxillofacial Surgery, Houston, TX, USA
| | - Y Etan Weinstock
- The University of Texas Health Science Center at Houston, Department of Otolaryngology-Head and Neck Surgery, Houston, TX, USA
| | - Spencer W Redding
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - Stephanie Rowan
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - Chih-Ko Yeh
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry, San Antonio, TX, USA
| | - H Stan McGuff
- The University of Texas Health Science Center at San Antonio, Department of Pathology, San Antonio, TX, USA
| | - Frank R Miller
- The University of Texas Health Science Center at San Antonio, Department of Otolaryngology-Head and Neck Surgery, San Antonio, TX, USA
| | - John T McDevitt
- Rice University, Department of Bioengineering, Houston, TX, USA; Department Biomaterials, Bioengineering Institute, New York University, New York, NY, USA; Rice University, Department of Chemistry, Houston, TX, USA.
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12
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Macey R. An Automated System Targeting Outpatients at High Risk for Oral Cancer Improves Recruitment to Screening Programs for Premalignant or Early-stage Cancerous Lesions. J Evid Based Dent Pract 2015; 15:68-9. [DOI: 10.1016/j.jebdp.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brocklehurst P, Pemberton MN, Macey R, Cotton C, Walsh T, Lewis M. Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions. Br Dent J 2015; 218:525-9. [DOI: 10.1038/sj.bdj.2015.344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/09/2022]
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Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:343-52. [DOI: 10.1016/j.oooo.2013.09.017] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/22/2013] [Accepted: 09/29/2013] [Indexed: 12/11/2022]
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Nankivell P, Williams H, Webster K, Pearson D, High A, MacLennan K, Senguven B, McConkey C, Rabbitts P, Mehanna H. Investigation of p16INK
4a
as a prognostic biomarker in oral epithelial dysplasia. J Oral Pathol Med 2013; 43:245-9. [DOI: 10.1111/jop.12128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE); Birmingham UK
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
- University Hospital Coventry and Warwickshire; Coventry UK
| | - Hazel Williams
- Institute of Head and Neck Studies and Education (InHANSE); Birmingham UK
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Keith Webster
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | | | - Alec High
- Histopathology Department; Leeds Teaching Hospitals Trust; Leeds UK
| | | | - Burcu Senguven
- Leeds Institute of Cancer Studies and Pathology; University of Leeds; Leeds UK
| | - Christopher McConkey
- Clinical Trials Unit; Warwick Medical School; University of Warwick; Coventry UK
| | - Pamela Rabbitts
- Leeds Institute of Cancer Studies and Pathology; University of Leeds; Leeds UK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE); Birmingham UK
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
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Walsh T, Liu JLY, Brocklehurst P, Glenny A, Lingen M, Kerr AR, Ogden G, Warnakulasuriya S, Scully C. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev 2013; 2013:CD010173. [PMID: 24258195 PMCID: PMC7087434 DOI: 10.1002/14651858.cd010173.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The early detection and excision of potentially malignant disorders (PMD) of the lip and oral cavity that require intervention may reduce malignant transformations (though will not totally eliminate malignancy occurring), or if malignancy is detected during surveillance, there is some evidence that appropriate treatment may improve survival rates. OBJECTIVES To estimate the diagnostic accuracy of conventional oral examination (COE), vital rinsing, light-based detection, biomarkers and mouth self examination (MSE), used singly or in combination, for the early detection of PMD or cancer of the lip and oral cavity in apparently healthy adults. SEARCH METHODS We searched MEDLINE (OVID) (1946 to April 2013) and four other electronic databases (the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Group's Trials Register, EMBASE (OVID), and MEDION) from inception to April 2013. The electronic databases were searched on 30 April 2013. There were no restrictions on language in the searches of the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the diagnostic test accuracy of any of the aforementioned tests in detecting PMD or cancer of the lip or oral cavity. Diagnosis of PMD or cancer was made by specialist clinicians or pathologists, or alternatively through follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors independently and in duplicate. Studies were assessed for methodological quality using QUADAS-2. We reported the sensitivity and specificity of the included studies. MAIN RESULTS Thirteen studies, recruiting 68,362 participants, were included. These studies evaluated the diagnostic accuracy of COE (10 studies), MSE (two studies). One randomised controlled of test accuracy trial directly evaluated COE and vital rinsing. There were no eligible diagnostic accuracy studies evaluating light-based detection or blood or salivary sample analysis (which tests for the presence of bio-markers of PMD and oral cancer). Given the clinical heterogeneity of the included studies in terms of the participants recruited, setting, prevalence of target condition, the application of the index test and reference standard and the flow and timing of the process, the data could not be pooled. For COE (10 studies, 25,568 participants), prevalence in the diagnostic test accuracy sample ranged from 1% to 51%. For the eight studies with prevalence of 10% or lower, the sensitivity estimates were highly variable, and ranged from 0.50 (95% confidence interval (CI) 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00) with uniform specificity estimates around 0.98 (95% CI 0.97 to 1.00). Estimates of sensitivity and specificity were 0.95 (95% CI 0.92 to 0.97) and 0.81 (95% CI 0.79 to 0.83) for one study with prevalence of 22% and 0.97 (95% CI 0.96 to 0.98) and 0.75 (95% CI 0.73 to 0.77) for one study with prevalence of 51%. Three studies were judged to be at low risk of bias overall; two were judged to be at high risk of bias resulting from the flow and timing domain; and for five studies the overall risk of bias was judged as unclear resulting from insufficient information to form a judgement for at least one of the four quality assessment domains. Applicability was of low concern overall for two studies; high concern overall for three studies due to high risk population, and unclear overall applicability for five studies. Estimates of sensitivity for MSE (two studies, 34,819 participants) were 0.18 (95% CI 0.13 to 0.24) and 0.33 (95% CI 0.10 to 0.65); specificity for MSE was 1.00 (95% CI 1.00 to 1.00) and 0.54 (95% CI 0.37 to 0.69). One study (7975 participants) directly compared COE with COE plus vital rinsing in a randomised controlled trial. This study found a higher detection rate for oral cavity cancer in the conventional oral examination plus vital rinsing adjunct trial arm. AUTHORS' CONCLUSIONS The prevalence of the target condition both between and within index tests varied considerably. For COE estimates of sensitivity over the range of prevalence levels varied widely. Observed estimates of specificity were more homogeneous. Index tests at a prevalence reported in the population (between 1% and 5%) were better at correctly classifying the absence of PMD or oral cavity cancer in disease-free individuals that classifying the presence in diseased individuals. Incorrectly classifying disease-free individuals as having the disease would have clinical and financial implications following inappropriate referral; incorrectly classifying individuals with the disease as disease-free will mean PMD or oral cavity cancer will only be diagnosed later when the disease will be more severe. General dental practitioners and dental care professionals should remain vigilant for signs of PMD and oral cancer whilst performing routine oral examinations in practice.
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Affiliation(s)
- Tanya Walsh
- School of Dentistry, The University of ManchesterCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Joseph LY Liu
- Scottish Dental Clinical Effectiveness Programme, NHS Education for ScotlandUniversity of Dundee, Dental Health Services Research UnitFrankland Building, Small's WyndDundeeUKDD1 4HN
| | - Paul Brocklehurst
- School of Dentistry, The University of ManchesterCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Anne‐Marie Glenny
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Mark Lingen
- University of ChicagoPritzker School of Medicine, Division of Biological Sciences, Department of Pathology5841 South Maryland AvenueChicagoIllinoisUSA60637‐1470
| | - Alexander R Kerr
- New York University College of DentistryDepartment of Oral and Maxillofacial Pathology, Radiology and Medicine345 East 24th StreetSchwartz BuildingNew YorkUSA10010
| | - Graham Ogden
- University of DundeeDivision of Oral and Maxillofacial Clinical Sciences, School of DentistryPark PlaceDundeeScotlandUKDD1 4HR
| | - Saman Warnakulasuriya
- King's College LondonClinical and Diagnostic SciencesBessemer RoadDenmark Hill CampusLondonUKSE5 9RW
| | - Crispian Scully
- University College London256 Gray's Inn RoadLondonUKWC1X 8LD
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Brocklehurst P, Kujan O, O'Malley LA, Ogden G, Shepherd S, Glenny AM. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev 2013; 2013:CD004150. [PMID: 24254989 PMCID: PMC8078625 DOI: 10.1002/14651858.cd004150.pub4] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with oral cancer, there is a need to determine the effectiveness of a screening programme for this disease, either as a targeted, opportunistic or population-based measure. Evidence exists from modelled data that a visual oral examination of high-risk individuals may be a cost-effective screening strategy and the development and use of adjunctive aids and biomarkers is becoming increasingly common. OBJECTIVES To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 22 July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 22 July 2013), EMBASE via OVID (1980 to 22 July 2013) and CANCERLIT via PubMed (1950 to 22 July 2013). There were no restrictions on language in the search of the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) of screening for oral cancer or potentially malignant disorders using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We used mean differences (MDs) and 95% confidence intervals (CIs) for continuous data and risk ratios (RRs) with 95% CIs for dichotomous data. Meta-analyses would have been undertaken using a random-effects model if the number of studies had exceeded a minimum of three. Study authors were contacted where possible and where deemed necessary for missing information. MAIN RESULTS A total of 3239 citations were identified through the searches. Only one RCT, with 15-year follow-up met the inclusion criteria (n = 13 clusters: 191,873 participants). There was no statistically significant difference in the oral cancer mortality rates for the screened group (15.4/100,000 person-years) and the control group (17.1/100,000 person-years), with a RR of 0.88 (95% CI 0.69 to 1.12). A 24% reduction in mortality was reported between the screening group (30/100,000 person-years) and the control group (39.0/100,000) for high-risk individuals who used tobacco or alcohol or both, which was statistically significant (RR 0.76; 95% CI 0.60 to 0.97). No statistically significant differences were found for incidence rates. A statistically significant reduction in the number of individuals diagnosed with stage III or worse oral cancer was found for those in the screening group (RR 0.81; 95% CI 0.70 to 0.93). No harms were reported. The study was assessed as at high risk of bias. AUTHORS' CONCLUSIONS There is evidence that a visual examination as part of a population-based screening programme reduces the mortality rate of oral cancer in high-risk individuals. In addition, there is a stage shift and improvement in survival rates across the population as a whole. However, the evidence is limited to one study, which has a high risk of bias and did not account for the effect of cluster randomisation in the analysis. There was no evidence to support the use of adjunctive technologies like toluidine blue, brush biopsy or fluorescence imaging as a screening tool to reduce oral cancer mortality. Further RCTs are recommended to assess the efficacy and cost-effectiveness of a visual examination as part of a population-based screening programme in low, middle and high-income countries.
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Affiliation(s)
- Paul Brocklehurst
- School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, UK, M13 9PL
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18
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Balasundaram I, Payne KFB, Al-Hadad I, Alibhai M, Thomas S, Bhandari R. Is there any benefit in surgery for potentially malignant disorders of the oral cavity? J Oral Pathol Med 2013; 43:239-44. [DOI: 10.1111/jop.12088] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- I. Balasundaram
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - K. F. B. Payne
- Department of Oral and Maxillofacial Surgery; Kings College Hospital; London UK
| | - I. Al-Hadad
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - M. Alibhai
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - S. Thomas
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
| | - R. Bhandari
- Department of Oral and Maxillofacial Surgery; Royal London Hospital; London UK
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Gambino A, Carbone M, Arduino P. Displasia sul bordo della lingua in paziente con follow-up di 15 anni: caso clinico. DENTAL CADMOS 2012. [DOI: 10.1016/j.cadmos.2011.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Resende RG, Correia-Silva JDF, Galvão CF, Gomes CC, Carneiro MA, Gomez RS. Oral leukoplakia in a patient with Fanconi anemia: recurrence or a new primary lesion? J Oral Maxillofac Surg 2011; 69:1940-3. [PMID: 21549482 DOI: 10.1016/j.joms.2011.02.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/04/2011] [Accepted: 02/04/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Renata Gonçalves Resende
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Thode C, Bilde A, Von Buchwald C, Dabelsteen E. TP53 mutations in clinically normal mucosa adjacent to oral carcinomas. J Oral Pathol Med 2010; 39:662-6. [DOI: 10.1111/j.1600-0714.2010.00916.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brocklehurst PR, Baker SR, Speight PM. Oral cancer screening: what have we learnt and what is there still to achieve? Future Oncol 2010; 6:299-304. [PMID: 20146588 DOI: 10.2217/fon.09.163] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oral cancer is an important global healthcare problem. In the UK, the incidence is increasing and late-stage presentation is common. Determining the feasibility of a national screening program for oral cancer is therefore an important step in the prevention of the disease. Evidence exists to suggest that an oral examination of high-risk individuals may be a cost-effective screening strategy. However, questions remain over which primary care environment would be the most suitable and the criteria for a positive screen and referral. Further research is needed in the form of clinical trials or demonstration studies in primary care. The impact on secondary care, the role of auxiliaries and training needs also need to be determined. In addition, the assessment of adjunctive aids and evaluation of potential biomarkers are considered important.
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