Assessment of oral mucosa in normal, precancer and cancer using chemiluminescent illumination, toluidine blue supravital staining and oral exfoliative cytology

Light-Based Non-Invasive Techniques as Diagnostic Tools in Cancer Detection: A Systematic Review

Oral squamous cell carcinomas (OSCCs) fall between the sixth and eighth most common cancers. The prevention of cancer and the treatment of the disease depends on early diagnosis. To encourage dental professionals to use light-based detection techniques in clinical practice, this systematic review aims to evaluate the literature on the effectiveness of chemiluminescence and autofluorescent imaging equipment in the detection of OSCC and OPMDs. PUBMED [MEDLINE] and SCIENCE DIRECT were the electronic databases and retrieval systems used to look for pertinent articles. Search terms like"oral cancer,""early diagnosis,""potentially malignant disorders,"chemiluminescence," autofluorescence," and "VELscope" were used to search the database of indexed journals. 26 articles in total have been chosen for this review. The majority of the research was cross-sectional. Chemiluminescence and Autofluorescence can help a skilled doctor spot oral premalignant lesions with the autofluorescence technique being superior and the way for biopsies within the altered mucosa.

Efficacy of optical coherence tomography in the diagnosing of oral cancerous lesion: systematic review and meta-analysis

Non-invasive diagnostic tools that facilitate visualization of potentially malignant oral lesions and cancers have been introduced. Oral lesions detected by optical coherence tomography (OCT) were compared to reference results based on histological findings. The diagnostic odds ratio (DOR), along with summary receiver operating characteristic curve (SROC), area under SROC, sensitivity, specificity, and negative predictive values, were the outcomes. The DOR of OCT was 86.9190 (95% confidence interval [CI]: 38.7435, 194.9985), and the area under SROC was 0.951. OCT showed good sensitivity (0.9138; 95% CI: 0.8758, 0.9409) and specificity (0.9110; 95% CI: 0.8568, 0.9460), and a high negative predictive value (0.9225; 95% CI: 0.8863, 0.9478). Diagnostic sensitivity was higher when using artificial intelligence and automated algorithms compared to diagnoses made by clinicians. OCT is non-invasive, provides rapid results without radiation exposure, and can aid in the diagnosis and follow-up of oral cancer and oral precancerous lesions.

Current advances in noninvasive methods for the diagnosis of oral squamous cell carcinoma: a review

Oral squamous cell carcinoma (OSCC), one of the most common types of cancers worldwide, is diagnosed mainly through tissue biopsy. However, owing to the tumor heterogeneity and other drawbacks, such as the invasiveness of the biopsy procedure and high cost and limited usefulness of longitudinal surveillance, there has been a focus on adopting more rapid, economical, and noninvasive screening methods. Examples of these include liquid biopsy, optical detection systems, oral brush cytology, microfluidic detection, and artificial intelligence auxiliary diagnosis, which have their own strengths and weaknesses. Extensive research is being performed on various liquid biopsy biomarkers, including novel microbiome components, noncoding RNAs, extracellular vesicles, and circulating tumor DNA. The majority of these elements have demonstrated encouraging clinical outcomes in early OSCC detection. This review summarizes the screening methods for OSCC with a focus on providing new guiding strategies for the diagnosis of the disease.

How effective is toluidine blue for screening and diagnosis of oral cancer and premalignant lesions?

Design A systematic review and bivariate meta-analysis was designed to determine the efficacy of toluidine blue (TB) in the screening and diagnosis of oral cancer and premalignant lesions. Six databases were reviewed independently by two authors to identify relevant studies.Case selection Inclusion criteria comprised prospective or retrospective studies comparing TB with chemiluminescence or clinical examination, which incorporated sensitivity and specificity analyses. Studies regarding diagnosis of non-oral tumours were excluded, as well as case reports and review articles.Data analysis Diagnostic accuracy was analysed using diagnostic odds ratio (DOR) with 95% confidence intervals (CI). Summary receiver operating characteristic (SROC) curves and the inter-rater agreement were also analysed. Cohen's kappa coefficient and Fisher z-values were used to estimate reliability and stabilise variance. Homogeneity analyses were performed using the Q statistic. Forest plots were drawn for the sensitivity, specificity, negative predictive values, and SROC curves.Results Twenty-nine studies comprising 1,921 participants were included in the meta-analysis. The DOR of TB was 7.017 (95% CI, 4.544; 10.836). Nine studies compared TB with chemiluminescence; TB had a lower sensitivity but a higher specificity. Compared with clinical examination in four studies, TB had a higher sensitivity and specificity. TB has a sensitivity of 73% and specificity of 69%, and was found to be more sensitive in severe dysplasia but more specific in benign lesions.Conclusions The diagnostic accuracy of TB for oral cancer or premalignant lesions is greater than clinical examination alone; however, it is not reliable enough for TB to be used as a screening method in isolation. TB is a diagnostic aid that can be recommended in adjunct with chemiluminescence or other techniques.

Electrochemical immunoplatform to assist in the diagnosis of oral cancer through the determination of CYFRA 21.1 biomarker in human saliva samples: Preparation of a novel portable biosensor toward non-invasive diagnosis of oral cancer

In this study, a novel, low-cost, and flexible paper-based electrochemical immunosensor was developed for the bioanalysis of Cyfra 21.1 biomarker in human saliva samples by using stabilization of synthesis Ag nano-ink on the surface of paper using pen-on-paper technology. The employed electrochemical techniques for the evaluation of immunoplatform performance were differential pulse voltammetry and chronoamperometry. Also, the prepared immunosensor showed great ability in the determination of Cyfra21.1 in human saliva specimens. Under the optimized conditions, the obtained linear range was from 0.0025 to 10 ng/mL, and the obtained LLOQ was 0.0025 ng/mL. The developed immunosensor is easy to prepare, sensitive, cost-effective, portable, and simple. So proposed immunoplatform can be an accomplished biodevice in clinical laboratories. The proposed paper-based immunosensor could be a hopefully new and cheap tool for the diagnosis of other biomarkers. Also, the prepared immunosensor showed great ability in the determination of Cyfra21.1 biomarker in human saliva specimens.

Accuracy of autofluorescence and chemiluminescence in the diagnosis of oral Dysplasia and Carcinoma: A systematic review and Meta-analysis

OBJECTIVES

To define the accuracy of autofluorescence-based (AF) and chemiluminescence-based (CL) systems in the diagnosis of oral dysplastic and malignant lesions in addition to the Conventional Oral Examination (COE).

MATERIALS AND METHODS

The study was performed according to the PRISMA-DTA guidelines.

RESULTS

A total of 2631 oral cavity lesions (AF, n = 2076; CL, n = 555) from 26 studies (AF = 17; CL = 9) was used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity of the AF were 81.3% (95% CI: 74.3% - 87.5%) and 52.1% (95% CI: 36.9% - 67.1%), respectively. Cumulative diagnostic odds ratio (DOR) was 5.44 (95% CI: 2.29 - 10.56) with a significant heterogeneity between studies (I² = 80.7%, 95% CI: 70.0% - 86.7%; p < .05). The overall pooled sensitivity and specificity for the CL were 84.9% (95% CI: 66.7% - 96.7%) and 51.8% (95% CI: 37.3% - 65.9%), respectively. The overall pooled DOR was 8.59 (95% CI: 2.11 - 22.38) with a significant heterogeneity between studies (I² = 65.4%, 95% CI: 29.6% - 83.0%; p < .05).

CONCLUSIONS

AF and CL present a high sensitivity in the diagnosis of dysplastic and malignant oral cavity lesions, demonstrating that diagnostic biopsies may be avoided in case of a negative test result. Both tests have a low specificity, and the reduction of the false positive rate compared to the COE alone remains poor.

Efficacy of non-invasive diagnostic methods in the diagnosis and screening of oral cancer and precancer

INTRODUCTION

Traditional meta-analyses on the diagnostic accuracy of oral lesions have been conducted, but they were inherently limited to direct pairwise comparisons between a single method and a single alternative, while multiple diagnostic options and the ranking thereof were methodologically not possible.

OBJECTIVE

To evaluate the diagnostic values of various methods in patients with oral potential malignant disease by performing a network meta-analysis.

METHODS

Two authors independently searched the databases (MEDLINE, SCOPUS, the Cochrane Register of Controlled Trials, and Google scholar) up to June 2020 for studies comparing the diagnostic accuracy of various tools (autofluorescence, chemiluminescence, cytology, narrow band imaging, and toluidine blue) with visual examination or other tools. The outcomes of interest for this analysis were sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Both a standard pairwise meta-analysis and network meta-analysis were conducted.

RESULTS

Treatment networks consisting of six interventions were defined for the network meta-analysis. The results of traditional meta-analysis showed that, among six methods, narrow band imaging showed higher sensitivity, specificity, negative predictive value, positive predictive value, and accuracy compared to visual examination. The results of network meta-analysis showed that autofluorescence, chemiluminescence, and narrow band imaging had higher sensitivity compared with visual examination, and that chemiluminescence and narrow band imaging had higher negative predictive value compared with visual examination. However, autofluorescence and chemiluminescence had lower specificity compared with visual examination. There were no significant differences in positive predictive value and accuracy among the six interventions.

CONCLUSION

This study demonstrated that narrow banding imaging has superiority in terms of sensitivity and negative predictive value compared with the other five tested agents.

Narrow-band imaging for screening of oral premalignant or cancerous lesions: A systematic review and meta-analysis

BACKGROUND

It remains unclear whether the use of adjunctive diagnostic screening methods improves the diagnostic efficacies of oral premalignant and cancerous lesions.

OBJECTIVE OF REVIEW

We evaluated the diagnostic accuracy of narrow-band imaging used to detect oral cancer and precancerous lesions defined employing different narrow-band imaging criteria.

TYPE OF REVIEW

Systematic review and meta-analyses.

SEARCH STRATEGY

We searched PubMed, Scopus, the Web of Science, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials to May 2020.

EVALUATION METHODS

Three different criteria for oral mucosal vascular changes using narrow-band imaging were compared: class I: well-demarcated brownish areas with thick dark spots and/or winding vessels; class II: intraepithelial papillary capillary looping of grades 2, 3 and 4; and class III: intraepithelial papillary capillary looping of grades 3 and 4. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (ver. 2) tool. We compared narrow-band imaging to conventional white-light imaging.

RESULTS

We included 10 prospective or retrospective studies (1374 patients). To detect all dysplastic and cancerous lesions, the class I criteria afforded the optimal specificity and sensitivity; the area under the summary receiver operating characteristic curve was 0.918. To detect highly dysplastic and advanced cancerous lesions, the class III criteria afforded appropriate specificity and sensitivity. The summary receiver operating characteristic curve was 0.905. When using the class III criteria, narrow-band imaging afforded better specificity (0.941 [range 0.920, 0.9572], P < .0001) compared to white-light imaging (0.520 [range 0.409, 0.629]). However, the white-light imaging data were inconsistent and the ranges were broad; narrow-band imaging may be considerably more accurate than white-light imaging when using the class III criteria.

CONCLUSION

Narrow-band imaging diagnosed oral premalignant or cancerous lesions much more reliably than white-light imaging.

Diagnostic accuracy of clinical visualization and light-based tests in precancerous and cancerous lesions of the oral cavity and oropharynx: a systematic review and meta-analysis

OBJECTIVE

Evaluate and compare the performance of autofluorescence, chemiluminescence, and clinical visual examination in the detection of oral potentially malignant disorders (OPMD), oral cancer (OC), and oropharyngeal cancer (OPC).

MATERIALS AND METHODS

A systematic review with meta-analysis based on diagnostic test studies. A literature search was carried out in the MEDLINE and EMBASE databases through August 30, 2020. For this review, the quality assessment tool of diagnostic precision studies (QUADAS-2) was used. Hierarchical regression models were used to estimate pooled diagnostic precision values in a random effects model.

RESULTS

A total of 40 studies were identified for this review according to each test evaluated: 5.562 samples for autofluorescence, 1.353 samples for chemiluminescence, and 1.892 samples for clinical examination. The summary measures sensitivity and specificity of the clinical examination were 63% and 78%, respectively, AUC = 0.78 95% CI (0.74-0.81). In the autofluorescence test, these were 86% and 72%, respectively, AUC = 0.86 95% CI (0.83-0.89); and the chemiluminescent test were 67% and 48%, respectively, AUC = 0.59 95% CI (0.54-0.63) CONCLUSIONS: Autofluorescence devices displayed superior accuracy levels in the identification of premalignant lesions and early neoplastic changes compared to clinical examination and chemiluminescent test. Overall, biopsy remains the gold standard for the definitive diagnosis of OPMD, OC, and OPC.

CLINICAL RELEVANCE

Light-based clinical methods such as autofluorescence and chemiluminescence techniques have been used in clinical diagnosis for the differentiation of OPMD and malignant and benign lesions; although detailed visual examination appears to be effective in identifying, previous systematic reviews have not evaluated a relevant number of studies and they did not evaluate the accuracy of the clinical examination.

Non-Invasive Diagnostic System Based on Light for Detecting Early-Stage Oral Cancer and High-Risk Precancerous Lesions-Potential for Dentistry

Simple Summary

The early detection of oral cancer and oral potentially malignant disorders can facilitate minimum intervention and subsequent improvements in prognosis and quality of life after treatment. Recently, several non-invasive adjunctive fluorescence-based detection systems have improved the accuracy of detection and diagnosis of oral cancer and oral potentially malignant disorders. This article summarizes current knowledge about fluorescence-based diagnostic methods and discusses their benefits and drawbacks from a clinical viewpoint.

Abstract

Oral health promotion and examinations have contributed to the early detection of oral cancer and oral potentially malignant disorders, leading to the adaptation of minimally invasive therapies and subsequent improvements in the prognosis/maintenance of the quality of life after treatments. However, the accurate detection of early-stage oral cancer and oral epithelial dysplasia is particularly difficult for conventional oral examinations because these lesions sometimes resemble benign lesions or healthy oral mucosa tissues. Although oral biopsy has been considered the gold standard for accurate diagnosis, it is deemed invasive for patients. For this reason, most clinicians are looking forward to the development of non-invasive diagnostic technologies to detect and distinguish between cancerous and benign lesions. To date, several non-invasive adjunctive fluorescence-based detection systems have improved the accuracy of the detection and diagnosis of oral mucosal lesions. Autofluorescence-based systems can detect lesions as a loss of autofluorescence through irradiation with blue-violet lights. Photodynamic diagnosis using 5-aminolevulinic acid (ALA-PDD) shows the presence of very early oral cancers and oral epithelial dysplasia as a red fluorescent area. In this article, currently used fluorescence-based diagnostic methods are introduced and discussed from a clinical point of view.

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis

Introduction

Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy.

Objective

This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions.

Methods

Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2).

Results

Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692–0.917), 0.429 (95% CI 0.217–0.672), 0.747 (95% CI 0.607–0.849), and 4.061 (95% CI 1.528–10.796; I² = 9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91).

Conclusion

Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.

Minimally invasive procedures for the recognition and diagnosis of oral precancer and cancer

Oral cancer represents a blend of genetic and epigenetic instability. Many a times, oral cancer occurs in the background of oral potentially malignant disorders (OPMDs), which could be easily detected and diagnosed. Various diagnostic aids have been explored for early detection of oral cancer. Some of the minimally invasive (chair-side diagnostic) procedures such as vital staining and light-based systems are used widely in the clinical practice as well as in the hospital setting owing to their simple and easy operability. In addition, these chair-side diagnostic procedures offer relatively good sensitivity and specificity despite some of their limitations. These diagnostic tools could complement good clinical history and thorough examination of patients for early detection of oral precancer and cancer.

Utilisation of Toluidine blue O pH 4.0 and histochemical inferences in plant sections obtained by free-hand

For the observation of plant material under a light microscope, free-hand sectioning is usually the fastest and most practical procedure. The staining of the obtained cuts is a crucial step and the action mechanism of the dye is variable. Toluidine blue O is a cationic dye whose metachromatic potential for free-hand sections has long been known. Thus, this work aimed at analysing the performance of Toluidine blue O for this type of sectioning with a systematic and comparative approach. The action of Toluidine blue O pH 4.0 was tested for both fresh and previously clarified free-hand sections from leaves of different species of plant. These sections were compared with sections embedded in glycol-methacrylate resin stained with the same dye or submitted to different histochemical tests. The fresh sections obtained by free-hand and stained with Toluidine blue O permitted the accomplishment of histochemical inferences, with the advantage of maintaining the natural colours from the tissues. The previously clarified sections presented the advantage of having a clearer image, allowing a better cellular delimitation. We concluded that Toluidine blue O is very informative for sections of plant material obtained by free-hand, being, therefore, a procedure that is fast, inexpensive and with excellent results.

An Overview on Current Non-invasive Diagnostic Devices in Oral Oncology

Oral squamous cell carcinoma (OSCC) is the most common head and neck malignancy, and despite advances in cancer therapies, the overall 5-year survival rate has remained below 50% over the past decades. OSCC is typically preceded by potentially malignant disorders (PMD), but distinguishing high-risk from low-risk PMD is challenging. In the last years, several diagnostic methods as light-based detection systems (LBDS) have been proposed to facilitate the detection of OSCC and PMD. Furthermore, the recent evolution of nanotechnology may provide new opportunities to detect PMD and OSCC at an early stage. Indeed, several preclinical studies showed the potential of nanotechnology to enhance diagnostic accuracy. For these reasons, it is fundamental to conduct studies to evaluate the efficacy of nanotechnology implementation in LBDS. The aim of this article is to review the current literature on LBDS and to provide a summary of the sensitivity and specificity of each technique, and possible future applications of nanotechnologies. The LBDS showed great potential for screening and monitoring oral lesions, but there are several factors that hinder an extensive use of these devices. These devices seem to be useful in assessing lesion margins that must be biopsied. However, to date, conventional oral examination, and tissue biopsy remain the gold standard for OSCC diagnosis. The use of nanotechnologies could be the next step in the evolution of LBDS, thus providing devices that can help clinicians to detect and better monitor oral lesions.

Role of Toluidine Blue Staining in Suspicious Lesions of Oral Cavity and Oropharynx

Oral cancer; the sixth most common malignancy in the world has one of the lowest 5 year survival rates. This can be attributed mainly to the delay in diagnosis. The purpose of this study was to evaluate the efficacy of vital staining with toluidine blue dye as an adjunct to standard clinical examination to facilitate early detection of malignant lesions of oral cavity and oropharynx. A hospital based diagnostic test accuracy study was carried out on 55 subjects with oral mucosal disorders that included clinically suspicious premalignant or malignant lesions, in the Department of ENT, Academy of Medical Sciences, Pariyaram, Kannur, Kerala over a period of 2 years. All lesions were subjected to detailed clinical examination and toluidine blue staining; and dye retention was recorded with photographs. The results of staining were compared with findings on histopathological examination. The Sensitivity and specificity of toluidine blue test for the detection of malignancy was 92.6 and 67.9% respectively; and the overall diagnostic accuracy was 80%. The result was highly significant with a 'p value' <0.001. The results indicate that toluidine blue staining is a simple, non-invasive technique which can be a valuable adjunct in the diagnostic process of oral and oropharyngeal cancers.

Efficacy of light based detection systems for early detection of oral cancer and oral potentially malignant disorders: Systematic review

Background

Earlier detection of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) is essential for dental professionals to improve patient survival rates. The aim of this systematic review is to to evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of OSCC and OPMD.

Material and Methods

The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE] and Science direct. The search was for limited articles published in English or with an English abstract and articles published during the period from January 2005 to April 2014. Clinical trials utilized ViziLite, Microlux TM/DL and Visual Enhanced Light scope (VELscope) for early detection of OPMD and OSCC.

Results

Twenty primary studies published satisfied our criteria for selection - 10 utilised chemiluminescence and 10 tissue autofluorescence. Senstivity of Vizilite for detecting OSCC nad OPMD ranged from 77.1 % to 100% and specificity was low that ranged from 0% to 27.8%.Most have shown that chemiluminescence increases the brightness and margins of oral mucosal white lesions and thus assist in identification of mucosal lesions not considered under Conventional visual examination. However, it preferentially detects leukoplakia and may fail to spot red patches. Clinical trials demonstrated that sensitivity of VELscope in detecting malignancy and OPMD ranged from 22 % to 100 % and specificity ranged from 16 % to 100%. Most studies concluded that VELscope can help the experienced clinician to find oral precursor malignant lesions. But it couldnot differentiate between dysplasia and benign inflammatory conditions.

Conclusions

Both devices are simple, non-invasive test of the oral mucosa but are suited for clinicians with sufficient experience and training. More clinical trials in future should be conducted to establish optical imaging as an efficacious adjunct tool in early diagnosis of OSCC and OPMD.

Key words:Oral cancer, early diagnosis, potentially malignant disorders, chemiluminescence, tissue autofluorescence, VELscope, ViziLite plus.

Late stage diagnosis of oral cancer: components and possible solutions

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.

The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review

INTRODUCTION

In 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.

PURPOSE

To 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).

METHODS

A 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.

RESULTS

Twenty-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.

A chemiluminescent light system in combination with toluidine blue to assess suspicious oral lesions-clinical evaluation and review of the literature

OBJECTIVES

The aim of the study was an evaluation of an acetic acid wash and chemiluminescent light system in combination with toluidine blue in order to detect visual identified, potentially malignant lesions.

MATERIALS AND METHODS

Forty-four patients with 50 oral lesions of primary uncertain visible dignity were included. Next to a clinical examination, a screening with ViziLite® (VL) as well as toluidine blue (TB; together ViziLite® Plus (VLP)) was conducted. Histopathology served as gold standard and sensitivity (SE), specificity (SP), positive as well as negative predictive value (PPV, NPV) was calculated descriptively. Additionally, a PubMed literature search using the key words "ViziLite" and "chemiluminescence oral cancer" was conducted.

RESULTS

Histological diagnosis showed 40 lesions of reactive/inflammatory nature, moderate dysplasia (n = 3) and oral squamous cell carcinoma (OSCC n = 7). All OSCCs and one dysplasia were identified correct via clinical diagnosis (SE 90 %, SP 100 %, PPV 100 %, NPV 97.5 %). VL examination could show all malignancies with low specificity (SE 100 %, SP 30 %, PPV 26 %, NPV 100 %). TB and VLP were positive in all cases of cancer and in one case of inflammation (SE 80 %, SP 97.5 %, PPV 89 %, NPV 95 %). In the review, eight clinical trials with similar results were included.

CONCLUSIONS

The adjunct of TB to VL reduces the number of false positives without increasing the rate of false negatives.

CLINICAL RELEVANCE

Clinical evidence to justify the additional cost of the system for diagnosis of suspicious lesions is weak. However, for the potential role of VLP in detection of lesions not otherwise identified in the visual exam in general dental practice further studies are required.