Abstract
BackgroundOral squamous cell carcinoma (OSCC) has a remarkably high incidence worldwide, and a fairly serious prognosis, encouraging further research into advanced technologies for noninvasive methods of making early diagnoses, ideally in primary care settings.ObjectivesOur purpose was to examine the validity of using advanced noninvasive technologies in diagnosis of OSCC by identifying and evaluating relevant published reports.Data sourceMEDLINE, EMBASE, and CINAHL were searched to identify clinical trials and other information published between 1990 and 10 June 2014; the searches of MEDLINE and EMBASE were updated to November 2014. Study selection: Studies of noninvasive methods of diagnosing OSCC, including oral brush biopsy, optical biopsy, saliva-based oral cancer diagnosis, and others were included.Data extractionData were abstracted and evaluated in duplicate for possible relevance on two occasions at an interval of 2 months before being included or excluded.Data synthesisThis study identified 163 studies of noninvasive methods for diagnosing OSCC that met the inclusion criteria. These included six studies of oral brush biopsy, 42 of saliva-based oral diagnosis, and 115 of optical biopsy. Sixty nine of these studies were assessed by the modified version of the QUADAS instrument. Saliva-based oral cancer diagnosis and optical biopsy were found to be promising noninvasive methods for diagnosing OSCC.LimitationThe strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.ConclusionsIt is clear that screening for and early detection of cancer and pre-cancerous lesions have the potential to reduce the morbidity and mortality of this disease. Advances in technologies for saliva-based oral diagnosis and optical biopsy are promising pathways for the future development of more effective noninvasive methods for diagnosing OSCC that are easy to perform clinically in primary care settings.
Highlights
Oral cancer is the eighth most common cancer worldwide and represents a significant disease burden
A modified version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument developed by Whiting et al was used to assess the internal validity of each of the included studies because we considered the original form of QUADAS adequate (List 3) [19]
The modifications made to this instrument included the following: (i) were the patients assessed by the gold standard?; (ii) were the patients assessed by a reference standard regardless of the biopsy results?; (iii) was funding for this study provided by a source with no obvious financial interest in the findings?; (iv) was the design prospective?; (v) were complete data reported?; (vi) were all patients assessed by the reference standard?; (vii) were interreader differences accounted for?; and (viii) were readers and outcome assessors blinded? List 4 provides the full list of items modified
Summary
Oral cancer is the eighth most common cancer worldwide and represents a significant disease burden. If detected at an early stage, survival from oral cancer is better than 90% at 5 years, whereas survival of patients presenting with late stage disease is only 30%. The 5year survival rate for oral cancer has remained less than. 50% over the last 50 years for the following reasons [1,2]: (i) most oral cancers (60%) are diagnosed at advanced stages (III and IV); and (ii)) oral cancer is subject to the “field cancerisation phenomenon”, having the highest risk of development of second primary tumours of any cancer. Oral squamous cell carcinoma (OSCC) has a remarkably high incidence worldwide, and a fairly serious prognosis, encouraging further research into advanced technologies for noninvasive methods of making early diagnoses, ideally in primary care settings
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