Derek Richards1. 1. Centre for Evidence-based Dentistry, Dental Health Services Research Unit, University of Dundee, Dundee, Scotland, UK.
Abstract
DATA SOURCES: Medline, the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Groups Trials Register, Embase and MEDION. STUDY SELECTION: Two of the reviewers independently assessed titles abstracts and extracted data. Cross-sectional diagnostic test accuracy studies (or consecutive series) and randomised studies of diagnostic test accuracy that reported the diagnostic test accuracy of vital staining, oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis used as an adjunct to conventional oral examination in detecting PMD or oral squamous cell carcinoma of the lip or oral cavity were considered. Scalpel, punch or fine needle aspiration biopsy with histological diagnosis was the reference test. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using a modified version of QUADAS-2. Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. Meta-regressionanalysis was undertaken to explore possible sources of heterogeneity. RESULTS: Forty-one studies, recruiting 4002 patients were included. No single study could be classified as being at low risk of bias across all domains. Fourteen studies evaluated vital staining, 13 studies oral cytology and 13 studies light-based detection or oral spectroscopy, while six studies assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. CONCLUSIONS: The overall quality of the included studies was poor. None of the adjunctive tests can be recommended as a replacement for the currently used standard of a scalpel biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation.
DATA SOURCES: Medline, the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Groups Trials Register, Embase and MEDION. STUDY SELECTION: Two of the reviewers independently assessed titles abstracts and extracted data. Cross-sectional diagnostic test accuracy studies (or consecutive series) and randomised studies of diagnostic test accuracy that reported the diagnostic test accuracy of vital staining, oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis used as an adjunct to conventional oral examination in detecting PMD or oral squamous cell carcinoma of the lip or oral cavity were considered. Scalpel, punch or fine needle aspiration biopsy with histological diagnosis was the reference test. DATA EXTRACTION AND SYNTHESIS: Study quality was assessed using a modified version of QUADAS-2. Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. Meta-regressionanalysis was undertaken to explore possible sources of heterogeneity. RESULTS: Forty-one studies, recruiting 4002 patients were included. No single study could be classified as being at low risk of bias across all domains. Fourteen studies evaluated vital staining, 13 studies oral cytology and 13 studies light-based detection or oral spectroscopy, while six studies assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. CONCLUSIONS: The overall quality of the included studies was poor. None of the adjunctive tests can be recommended as a replacement for the currently used standard of a scalpel biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation.
Authors: Anne-Marie Glenny; Susan Furness; Helen V Worthington; David I Conway; Richard Oliver; Jan E Clarkson; Michaelina Macluskey; Sue Pavitt; Kelvin Kw Chan; Paul Brocklehurst Journal: Cochrane Database Syst Rev Date: 2010-12-08
Authors: David I Conway; Alex D McMahon; Katrina Smith; Roger Black; Gerry Robertson; John Devine; Patricia A McKinney Journal: Br J Oral Maxillofac Surg Date: 2009-05-28 Impact factor: 1.651
Authors: Susan Furness; Anne-Marie Glenny; Helen V Worthington; Sue Pavitt; Richard Oliver; Jan E Clarkson; Michaelina Macluskey; Kelvin Kw Chan; David I Conway Journal: Cochrane Database Syst Rev Date: 2011-04-13
Authors: Tanya Walsh; Joseph L Y Liu; Paul Brocklehurst; Anne-Marie Glenny; Mark Lingen; Alexander R Kerr; Graham Ogden; Saman Warnakulasuriya; Crispian Scully Journal: Cochrane Database Syst Rev Date: 2013-11-21
Authors: Roman C Brands; Olga Köhler; Stephan Rauthe; Stefan Hartmann; Harald Ebhardt; Axel Seher; Christian Linz; Alexander C Kübler; Urs D A Müller-Richter Journal: Clin Oral Investig Date: 2016-09-08 Impact factor: 3.573