TY - JOUR
T1 - Adjuncts for the evaluation of potentially malignant disorders in the oral cavity
T2 - Diagnostic test accuracy systematic review and meta-analysis—a report of the American Dental Association
AU - Lingen, Mark W.
AU - Tampi, Malavika P.
AU - Urquhart, Olivia
AU - Abt, Elliot
AU - Agrawal, Nishant
AU - Chaturvedi, Anil K.
AU - Cohen, Ezra
AU - D'Souza, Gypsyamber
AU - Gurenlian, Jo Ann
AU - Kalmar, John R.
AU - Kerr, Alexander R.
AU - Lambert, Paul M.
AU - Patton, Lauren L.
AU - Sollecito, Thomas P.
AU - Truelove, Edmond
AU - Banfield, Laura
AU - Carrasco-Labra, Alonso
N1 - Funding Information:
Disclosures. Dr. Lingen has received research funding from the National Institute of Dental and Craniofacial Research (NIDCR) and the National Cancer Institute (NCI). In addition, he is the editor-in-chief of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and the vice president of the American Academy of Oral and Maxillofacial Pathology. Dr. Agrawal has received funds from the National Institutes of Health (NIH) to conduct research focused on head and neck cancer genetics and tumor DNA in the saliva and plasma of patients with head and neck cancer. He is also on the editorial board of Scientific Reports. Dr. Chaturvedi has received funds from the Intramural Program of the NCI to conduct research focused on the natural history of oral cancer precursor lesions. He is an employee at the NCI NIH, and authorship in this guideline is considered his opinion and not that of the NCI NIH. Dr. Cohen is a consultant to AstraZeneca, Bristol-Myers Squibb, Human Longevity, Merck, Merck Serono, and Pfizer. Dr. D'Souza has received funds from the NIDCR. Dr. Kalmar has received funds from The Ohio State University to conduct research on determining surgical margins by using VELscope (LED Medical Diagnostics). Dr. Kerr has received funds from the NIDCR to conduct research focused on increasing oral cancer screening by dentists. Dr. Patton is a coeditor of the second edition of The ADA Practical Guide to Patients With Medical Conditions. She also has received funds from the NIDCR to conduct research focused on a clinical registry of dental outcomes in patients with head and neck cancer. In addition, she is the oral medicine section editor of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and she is vice president of the American Academy of Oral Medicine. Dr. Sollecito is the director and treasurer of the American Board of Oral Medicine, a site visitor for the Commission on Dental Accreditation, and a regional director for the Royal College of Surgeons Edinburgh. He also has received funds from the NIDCR to conduct research focused on a clinical registry of dental outcomes in patients with head and neck cancer. Ms. Tampi, Mrs. Urquhart, and Dr. Carrasco-Labra have no disclosures to report.
Publisher Copyright:
© 2017 American Dental Association
PY - 2017/11
Y1 - 2017/11
N2 - Background: Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients’ values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity. Types of Studies Reviewed: The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence). Conclusions and Practical Implications: Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.
AB - Background: Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients’ values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity. Types of Studies Reviewed: The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence). Conclusions and Practical Implications: Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.
KW - Oral squamous cell carcinoma
KW - diagnostic test accuracy
KW - patients’ values and preferences
KW - potentially malignant disorders
UR - http://www.scopus.com/inward/record.url?scp=85032005294&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032005294&partnerID=8YFLogxK
U2 - 10.1016/j.adaj.2017.08.045
DO - 10.1016/j.adaj.2017.08.045
M3 - Review article
C2 - 29080605
AN - SCOPUS:85032005294
VL - 148
SP - 797-813.e52
JO - Journal of the American Dental Association
JF - Journal of the American Dental Association
SN - 0002-8177
IS - 11
ER -