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Meta-Analysis
. 2015 May 29;2015(5):CD010276.
doi: 10.1002/14651858.CD010276.pub2.

Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions

Richard Macey  1 , Tanya Walsh, Paul Brocklehurst, Alexander R Kerr, Joseph L Y Liu, Mark W Lingen, Graham R Ogden, Saman Warnakulasuriya, Crispian Scully
Affiliations
Meta-Analysis

Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions

Richard Macey et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Oral squamous cell carcinoma is the most common form of malignancy of the lip and oral cavity, often being proceeded by potentially malignant disorders (PMD). Early detection can reduce the malignant transformation of PMD and can improve the survival rate for oral cancer. The current standard of scalpel biopsy with histology is painful for patients and involves a delay whilst histology is completed; other tests are available that are unobtrusive and provide immediate results.

Primary objective: To estimate the diagnostic accuracy of index tests for the detection of oral cancer and PMD of the lip and oral cavity, in people presenting with clinically evident lesions.

Secondary objective: To estimate the relative accuracy of the different index tests.

Search methods: The electronic databases were searched on 30 April 2013. 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 (Ovid)). 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 the following index tests when used as an adjunct to conventional oral examination in detecting PMD or oral squamous cell carcinoma of the lip or oral cavity: vital staining, oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis (which test for the presence of biomarkers in blood or saliva).

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. Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity.

Main results: We included 41 studies, recruiting 4002 participants, in this review. These studies evaluated the diagnostic accuracy of conventional oral examination with: vital staining (14 studies), oral cytology (13 studies), light-based detection or oral spectroscopy (13 studies). Six studies assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis.The summary estimates for vital staining obtained from the meta-analysis were sensitivity of 0.84 (95% CI 0.74 to 0.90) with specificity of 0.70 (0.59 to 0.79), with 14 studies were included in the meta-analysis. For cytology, sensitivity was 0.91 (0.81 to 0.96) and specificity was 0.91 (0.81 to 0.95) with 12 studies included in the meta-analysis. For light-based detection, sensitivity was 0.91 (0.77 to 0.97) and specificity was 0.58 (0.22 to 0.87) with 11 studies included in the meta-analysis. The relative test accuracy was assessed by adding covariates to the bivariate analysis, no difference in model fit was observed.

Authors' conclusions: The overall quality of the included studies was poor. None of the adjunctive tests can be recommended as a replacement for the currently used standard of a scalpel biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation.

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Conflict of interest statement

Richard Macey: none known Tanya Walsh: none known Paul Brocklehurst: none known Alexander R Kerr: none known Joseph LY Liu: none known Mark Lingen: none known Graham Ogden: none known Saman Warnakulasuriya: none known. I was a co‐author on three of the included studies but was not involved in selecting or assessing them. Crispian Scully: none known

Figures

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Study flow diagram
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Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
3
3
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
4
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Forest plot of Vital staining
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5
Summary ROC Plot of Vital staining
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Forest plot of Cytology
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7
Summary ROC Plot of Cytology
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Forest plot of Light‐based
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Summary ROC Plot of Light‐based
1
1. Test
Vital staining.
2
2. Test
Cytology.
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3. Test
Light‐based.
4
4. Test
Vital staining plus adjunct (Light).
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5. Test
Vital staining plus adjunct (Cytology).
See this image and copyright information in PMC

References

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