Abstract
Screening for oral potentially malignant disorders (OPMDs) with dysplasia in high-risk groups is suggested in countries with a high prevalence of the disorders. This study aimed to compare the accuracy of diagnoses of OPMDs with dysplasia made by a primary examiner (general dental clinician) and a specialist (oral and maxillofacial surgeon) using the current Taiwanese Nationwide Oral Mucosal Screening Program (TNOMSP). A total of 134 high-risk participants were enrolled for oral mucosal screening via the TNOMSP. A primary examiner and a specialist examined each participant. Mucosal biopsies were obtained and subjected to histopathological analysis. The OPMD most frequently diagnosed by the primary examiner was thin homogeneous leukoplakia (48/134; 35.8%), and in 39/134 participants (29.1%) the diagnosis was uncertain, but abnormalities were suggested. The OPMDs most frequently diagnosed by the specialist were erythroleukoplakia (23/134; 17.2%) and thin homogeneous leukoplakia (21/134; 15.7%), and 51/134 participants (38.1%) were diagnosed with other diseases. Via histopathology, 70/134 participants (52.3%) were diagnosed with dysplasia, and 58/134 (43.3%) were diagnosed with benign conditions. The specialist's diagnoses exhibited a higher specificity, positive predictive value, and accuracy than the primary examiners. A specialist using the current TNOMSP for high-risk participants diagnosed OPMDs with dysplasia more accurately than a primary examiner. Early diagnosis of high-risk OPMDs is crucial in countries with a high prevalence of the disorders. Proficient examination via the current TNOMSP by trained clinician is effective for the management of OPMDs with dysplasia.
Highlights
Several terms have been used to refer to the mucosal pathology that develops prior to oral cancer, such as “pre-cancerous”, “precancerous/premalignant lesions”, and “intraepithelial neoplasia” [1,2,3]
Warnakulasuriya et al [4] proposed the more precise term–oral potentially malignant disorders (OPMDs)–to refer to conditions such as leukoplakia, erythroplakia, and submucous fibrosis, and stated that they are a family of morphological alterations with the potential for malignant transformation
An oral mucosal screening program checklist developed by the Health Promotion Administration at the Ministry of Health and Welfare is commonly used for oral cancer screening as well as screening for OPMDs in Taiwan
Summary
Several terms have been used to refer to the mucosal pathology that develops prior to oral cancer, such as “pre-cancerous”, “precancerous/premalignant lesions”, and “intraepithelial neoplasia” [1,2,3]. Warnakulasuriya et al [4] proposed the more precise term–oral potentially malignant disorders (OPMDs)–to refer to conditions such as leukoplakia, erythroplakia, and submucous fibrosis, and stated that they are a family of morphological alterations with the potential for malignant transformation. The spectrum of OPMDs includes oral leukoplakia, erythroplakia, erythroleukoplakia, oral submucous fibrosis, palatal lesions in reverse smokers, oral lichen planus, oral lichenoid reactions, and other disorders involving systemic disease or hereditary conditions [5]. The histopathological diagnosis of OPMDs varies and can include hyperplasia, hyperkeratosis, and oral epithelial dysplasia (OED) [6]. The OED grade has predictive value with regard to the potential for malignancy in individuals with oral mucosal lesions or OPMDs [8]; reported associated rates of malignant transformation range from 2.2% to 38.1% [9,10]
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