Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults

Tanya Walsh (Lead / Corresponding author), Joseph L. Y. Liu, Paul Brocklehurst, Anne-Marie Glenny, Mark Lingen, Alexander R. Kerr, Graham Ogden, Saman Warnakulasuriya, Crispian Scully

Research output: Contribution to journalReview article

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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.
Original languageEnglish
Article numberCD010173
Pages (from-to)1-70
Number of pages70
JournalCochrane Database of Systematic Reviews
Volume2013
Issue number11
DOIs
Publication statusPublished - 21 Nov 2013

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Mouth Neoplasms
Oral Diagnosis
Mouth
Confidence Intervals
Self-Examination
Lip Neoplasms
Routine Diagnostic Tests
Cross-Sectional Studies
Databases
Biomarkers
Sensitivity and Specificity
Neoplasms
Dental Care
Oral Health
Lip
MEDLINE
General Practitioners
Patient Selection
Population
Tooth

Cite this

Walsh, Tanya ; Liu, Joseph L. Y. ; Brocklehurst, Paul ; Glenny, Anne-Marie ; Lingen, Mark ; Kerr, Alexander R. ; Ogden, Graham ; Warnakulasuriya, Saman ; Scully, Crispian. / Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. In: Cochrane Database of Systematic Reviews. 2013 ; Vol. 2013, No. 11. pp. 1-70.
@article{08278e6451b3446eb03e626b010e6a77,
title = "Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults",
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.",
author = "Tanya Walsh and Liu, {Joseph L. Y.} and Paul Brocklehurst and Anne-Marie Glenny and Mark Lingen and Kerr, {Alexander R.} and Graham Ogden and Saman Warnakulasuriya and Crispian Scully",
year = "2013",
month = "11",
day = "21",
doi = "10.1002/14651858.CD010173.pub2",
language = "English",
volume = "2013",
pages = "1--70",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
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}

Walsh, T, Liu, JLY, Brocklehurst, P, Glenny, A-M, Lingen, M, Kerr, AR, Ogden, G, Warnakulasuriya, S & Scully, C 2013, 'Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults', Cochrane Database of Systematic Reviews, vol. 2013, no. 11, CD010173, pp. 1-70. https://doi.org/10.1002/14651858.CD010173.pub2

Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. / Walsh, Tanya (Lead / Corresponding author); Liu, Joseph L. Y.; Brocklehurst, Paul; Glenny, Anne-Marie; Lingen, Mark; Kerr, Alexander R.; Ogden, Graham; Warnakulasuriya, Saman; Scully, Crispian.

In: Cochrane Database of Systematic Reviews, Vol. 2013, No. 11, CD010173, 21.11.2013, p. 1-70.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults

AU - Walsh, Tanya

AU - Liu, Joseph L. Y.

AU - Brocklehurst, Paul

AU - Glenny, Anne-Marie

AU - Lingen, Mark

AU - Kerr, Alexander R.

AU - Ogden, Graham

AU - Warnakulasuriya, Saman

AU - Scully, Crispian

PY - 2013/11/21

Y1 - 2013/11/21

N2 - 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.

AB - 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.

U2 - 10.1002/14651858.CD010173.pub2

DO - 10.1002/14651858.CD010173.pub2

M3 - Review article

VL - 2013

SP - 1

EP - 70

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 11

M1 - CD010173

ER -