The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma
The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma
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DOI：
10.14219/jada.archive.2012.0096
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发表时间：
2012-12-01
影响因子：
3.9
通讯作者：
Abt, Elliot
中科院分区：
文献类型：
--
作者：
Epstein, Joel B.;Guneri, Pelin;Abt, Elliot
背景临床口腔检查（COE）是在最可治疗的早期阶段初步检测口腔病变的标准。作者进行了一项系统回顾，以评估COE在预测异型增生或OSCC的组织学诊断中的有效性。作者从1966年到2010年对PubMed、Web of Knowledge和科克伦图书馆进行了自动搜索，以寻找随机对照试验和观察性研究，其中包括术语“口腔粘膜病变筛查”和“口腔病变”。“他们通过使用诊断准确性研究质量评估工具来确定所选研究的质量（敏感性，特异性，阳性预测值，阴性预测值和诊断比值比）。总体诊断优势比为6.1（95%置信区间为2.1-17.6）;因此，COE作为预测异型增生和口腔鳞癌的诊断方法，总体表现不佳。临床意义根据现有文献，作者确定粘膜病变的COE通常不能预测组织学诊断。OSCC通常在疾病的晚期被诊断的事实表明，需要改善COE和开发用于帮助检测和诊断口腔粘膜病变的抗体。
Background. The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC.Methods. The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool.Results. The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC.Clinical Implications. On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.