Influence of fluorescence on screening decisions for oral mucosal lesions in community dental practices
Influence of fluorescence on screening decisions for oral mucosal lesions in community dental practices
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DOI：
10.1111/jop.12090
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发表时间：
2014-01-01
影响因子：
3.3
通讯作者：
Rosin, Miriam P.
中科院分区：
文献类型：
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作者：
Laronde, Denise M.;Williams, P. M.;Rosin, Miriam P.
背景口腔筛查检查的质量取决于临床医生的经验，并且差异很大。对于全科医生来说，决定何时需要转诊患者是一个关键且困难的决定。帮助做出这一决定的设备将是有益的。本研究的目的是检验牙医使用直接荧光可视化 (FV) 的实用性，以帮助其在癌症和其他口腔病变筛查过程中做出决策。方法牙医接受培训，使用逐步方案评估口腔粘膜：病史、头部、颈部和口腔检查以及荧光可视化检查。他们被要求使用临床特征将病变分类为低（LR）、中（IR）或高（HR）风险，然后确定这些病变的 FV 状态。临床医生在 3 周内决定重新评估哪些病变，并根据重新评估结果转介。结果 在 11 个月的筛查中，2404 名患者中，357 名患者最初出现病变，其中 325 名 (15%) 被确定为 LR，16 名 (4.5%) 为 IR，16 名 (4.5%) HR。最初评估为 IR 和 HR 的病变与 LR 病变相比，持续到重新评估预约时 FV 丢失的风险增加了 2.7 倍。病变持续性最具预测性的模型包括 FV 状态和病变风险评估。结论 建议采用筛查方案（评估风险、重新评估和转诊）来筛查异常口腔内病变。将 FV 整合到评估和重新评估病变的过程中显着改进了该模型。
BackgroundQuality of oral screening examinations is dependent upon the experience of the clinician and can vary widely. Deciding when a patient needs to be referred is a critical and difficult decision for general practice clinicians. A device to aid in this decision would be beneficial. The objective of this study was to to examine the utility of direct fluorescence visualization (FV) by dental practitioners as an aid in decision-making during screening for cancer and other oral lesions.MethodsDentists were trained to use a stepwise protocol for evaluation of the oral mucosa: medical history, head, neck and oral exam, and fluorescent visualization exam. They were asked to use clinical features to categorize lesions as low (LR), intermediate (IR), or high (HR) risk and then to determine FV status of these lesions. Clinicians made the decision of which lesions to reassess in 3 weeks and based on this reassessment, to refer forward.ResultsOf 2404 patients screened over 11months, 357 initially had lesions with 325 (15%) identified as LR, 16 (4.5%) IR, and 16 (4.5%) HR. Lesions assessed initially as IR and HR had a 2.7-fold increased risk of FV loss persisting to the reassessment appointment versus the LR lesions. The most predictive model for lesion persistence included both FV status and lesion risk assessment.ConclusionA protocol for screening (assess risk, reassess, and refer) is recommended for the screening of abnormal intraoral lesions. Integrating FV into a process of assessing and reassessing lesions significantly improved this model.