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. 2023 Mar;29(2):380-389.
doi: 10.1111/odi.13892. Epub 2021 May 11.

High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine

Nabihah Haron  1 , Senthilmani Rajendran  1 , Thomas George Kallarakkal  2   3 , Rosnah Binti Zain  2   3   4 , Anand Ramanathan  2   3 , Mannil Thomas Abraham  5   6 , Shin Hin Lau  7 , Lai Choo Cheng  6 , Sherrie Mei Yee Chong  5   6 , Farah Aliya Mohamed Azahar  6   8 , Zuraiza Mohamad Zaini  2 , Siew Wui Chan  2 , Yet Ching Goh  2 , Daniel Lim  2 , Juliana Khairi  5   6 , Marzuki Zainal Abidin  6   8 , Zainal Ariff Abdul Rahman  2 , Chee Sun Liew  9   10   11 , Siew Chinn Fong  1 , Yi-Hsin Yang  12 , Siti Mazlipah Ismail  2 , Sok Ching Cheong  1   2
Affiliations

High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine

Nabihah Haron et al. Oral Dis. 2023 Mar.

Abstract

Objective: To evaluate the accuracy of MeMoSA®, a mobile phone application to review images of oral lesions in identifying oral cancers and oral potentially malignant disorders requiring referral.

Subjects and methods: A prospective study of 355 participants, including 280 with oral lesions/variants was conducted. Adults aged ≥18 treated at tertiary referral centres were included. Images of the oral cavity were taken using MeMoSA®. The identification of the presence of lesion/variant and referral decision made using MeMoSA® were compared to clinical oral examination, using kappa statistics for intra-rater agreement. Sensitivity, specificity, concordance and F1 score were computed. Images were reviewed by an off-site specialist and inter-rater agreement was evaluated. Images from sequential clinical visits were compared to evaluate observable changes in the lesions.

Results: Kappa values comparing MeMoSA® with clinical oral examination in detecting a lesion and referral decision was 0.604 and 0.892, respectively. Sensitivity and specificity for referral decision were 94.0% and 95.5%. Concordance and F1 score were 94.9% and 93.3%, respectively. Inter-rater agreement for a referral decision was 0.825. Progression or regression of lesions were systematically documented using MeMoSA®.

Conclusion: Referral decisions made through MeMoSA® is highly comparable to clinical examination demonstrating it is a reliable telemedicine tool to facilitate the identification of high-risk lesions for early management.

Keywords: clinical oral examination; early detection; oral cancer; oral medicine; oral potentially malignant disorders; telemedicine.

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