Diagnostic accuracy of optical coherence tomography for early oral cancer detection: A systematic review

Salivary sialic acid (SSA) has been detected as biomarker in several cancers and the level of salivary sialic acids has been proven to have a potential diagnostic value in early detection of cancer. This systematic review aims to assess Salivary Sialic Acid (SSA) levels as a biomarker for early detection of oral precancer and oral cancer. A comprehensive Literature search was conducted in various databases such as PubMed, Scopus, Google scholar and ProQuest. Quality assessment of articles was done by Newcastle Ottawa Quality Assessment Scale. A total of 22 studies were included in the systematic review and 14 articles were included for meta-analysis. Studies showed an increase in SSA levels in both oral precancer (SMD 1.79; 95% CI 0.41-3.18), and oral cancer (SMD 11.30; 95% CI -17.04 - 39.64). Total free and protein-bound sialic acid levels were increased in oral cancer group as compared to the healthy controls. The overall standard mean difference of FSA, PBSA, TSA among oral cancer and HC (SMD 23.83; 95% CI 9.22-38.44; p=0.02) and the data revealed statistically significant differences. The results of Meta-analysis revealed statistically significant differences between SSA levels of oral cancer and healthy group. Salivary sialic acid levels were observed to be consistently higher in oral cancer group compared to oral precancer and healthy group. However, a cut-off value of SSA levels for the early detection of oral cancer and precancer could not be established because of the limited and heterogeneous data. In order to translate the use of SSA levels into clinical practice, to utilize it as a sensitive and reliable biomarker, more standardized method of saliva processing and biochemical analysis are required with studies conducted on larger populations.

Purpose: The incidence of oral cavity and pharynx cancer is rising in the United States and South Dakota (SD) (2009-2018). In 2018, it was estimated that 396,937 of Americans were living with oral cavity and pharynx cancer. The 5-year relative survival rate for oral cancer is 66.2%, which is less than the survival rates for breast, colorectum, and prostate cancers. Tobacco and alcohol use and human papillomavirus (HPV16) exposure are some of the risk factors for oral cancer. Overall rural populations have higher cancer mortality than no rural population due to higher poverty, lower access to health services, and cigarette use. The purpose of this study is to investigate the prevalence of the oral cancer risk factors (e.g., cigarette smoking), HPV vaccination rates, and to identify the spatial distribution of social and environmental factors (e.g., social vulnerability, dental care access) in SD. Finally, this article discusses how nurses can contribute to oral cancer prevention and early detection. Methods: This descriptive study used data from multiple data sources (e.g., SD Department of Health, HRSA, County Health Rankings). Maps were created using ArcGIS. Findings: From the 66 SD counties, nearly 17% presented high-level shortage scores and were also highly socially vulnerable. HPV vaccination among youth was higher than the national average. Studies showed that improving nurse’s knowledge by training on oral cancer is needed and this may increase nurses’ practice in oral cancer prevention and control. Conclusions: Primary care professionals like nurse practitioners can assist in early detection of oral cancer and promote awareness of signs and main risk factors in rural areas. As part of the total patient care, nurses hold a vital role in prevention and early detection of oral cancer. These efforts with referral to oral cancer screening are vital for decreasing oral cancers morbidity and mortality rates primarily. Keywords: Rural health, Nurses, oral cancer, dentalcare access, Geographic Information Systems DOI: https://doi.org/10.14574/ojrnhc.v21i2.692

Despite the fact that the oral cavity is easily accessible, only ~30% of oral cancers are diagnosed at an early stage, which is the main factor attributed to the low 5-year survival rate (63%) of oral cancer patients. Several screening tools for oral cancer have been commercially available; however, none of them have been demonstrated to have sufficient sensitivity and specificity for early detection of oral cancer and dysplasia. We hypothesized that an array of biochemical and metabolic biomarkers for oral cancer and dysplasia can be quantified by endogenous fluorescence lifetime imaging (FLIM), thus enabling levels of sensitivity and specificity adequate for early detection of oral cancer and dysplasia. Our group has recently developed multispectral FLIM endoscopes to image the oral cavity with unprecedented imaging speed (>2fps). We have also performed an in vivo pilot study, in which endogenous multispectral FLIM images were acquired from clinically suspicious oral lesions of 70 patients undergoing tissue biopsy. The results from this pilot study indicated that mild-dysplasia and early stage oral cancer could be detected from benign lesions using a computed aided diagnosis (CAD) system developed based on biochemical and metabolic biomarkers that could be quantified from endogenous multispectral FLIM images. The diagnostic performance of this novel FLIM based clinical tool was estimated using a cross-validation approach, showing levels of sensitivity >90%, specificity >80%, and Area Under the Receiving Operating Curve (RO- AUC) >0.9. Future efforts are focused on developing cost-effective FLIM endoscopes and validating this novel clinical tool in prospective multi-center clinical studies.

Despite the fact that the oral cavity is easily accessible, only ~30% of oral cancers are diagnosed at an early stage, which is the main factor attributed to the low 5-year survival rate (63%) of oral cancer patients. Several screening tools for oral cancer have been commercially available; however, none of them have been demonstrated to have sufficient sensitivity and specificity for early detection of oral cancer and dysplasia. We hypothesized that an array of biochemical and metabolic biomarkers for oral cancer and dysplasia can be quantified by endogenous fluorescence lifetime imaging (FLIM), thus enabling levels of sensitivity and specificity adequate for early detection of oral cancer and dysplasia. Our group has recently developed multispectral FLIM endoscopes to image the oral cavity with unprecedented imaging speed (>2fps). We have also performed an in vivo pilot study, in which endogenous multispectral FLIM images were acquired from clinically suspicious oral lesions of 52 patients undergoing tissue biopsy. The results from this pilot study indicated that mild-dysplasia and early stage oral cancer could be detected from benign lesions using a computed aided diagnosis (CAD) system developed based on biochemical and metabolic biomarkers that could be quantified from endogenous multispectral FLIM images. The diagnostic performance of this novel FLIM clinical tool was estimated using a cross-validation approach, showing levels of sensitivity and specificity >80%, and Area Under the Receiving Operating Curve (RO- AUC) >0.9. Future efforts are focused on developing cost-effective FLIM endoscopes and validating this novel clinical tool in prospective multi-center clinical studies.

Oral cancer is due to over expression of growth of abnormal cells which rapidly multiply and divide. oral cancer is the sixth most common tumour in the world and the highest mortality and morbidity rate amongst all the human malignancies. Betal nut, chewing pan and smokeless tobacco, intake of alcohol and chronic viral infections like human papilloma virus are some of the etiological factors of oral cancer. The pathogenies of oral cancers depend upon the interaction between the genetic, epigenetic and carcinogenetic factors and their association with tumour growth and the progression of cancer. Genetic alteration changes give rise to a multiplex of oral mucosal changes like cellular and architectural and dysplastic changes which help in grading of tumour (well-differentiated, moderately differentiated and poorly differentiated) oral cancer. K-67 and cyclin D1 are strong genetic changes taking place in oral malignancies. Diagnostic biomarkers are an essential tool for the early detection and better prognosis of oral cancer. There are invasive and non-invasive procedures for the diagnosis of oral cancer which include invasive procedures like biopsy and the non-invasive or minimally invasive procedures are blood, plasma, serum and saliva. The oral cancer biomarkers can be detected by taking the samples from cancer patients and running the molecular laboratory techniques like real time PCR for liquid biopsy, DNA sequencing, hybridization technique, single nucleotide polymorphism analysis and immunofluorescence for FFPS.
 Methylation includes hypermethylation and hypomethylation in which there is a defect in the promotor region of CPG island. The methylation process takes place in the early phase of the initiation of cancer so it is an important biomarker for the early detection of oral cancer. HOXA9, NID2, P16 AND PTEN are the genes of interest for hypermethylation in early cancer detection.
 Viral infection load like Epstein bar virus (EBV)and human papilloma virus (HPV) DNA load have specific biomarkers which can help in the early detection of oral cancer when combines with hypermethylation. Interferon and microRNA related gene are also upregulated in tumour and a biomarker for early detection of oral cancer.

Early diagnosis of oral cancer results in less aggressive treatment and improves the quality of life and overall 5-year survival rate. Well-trained dental professionals can play a crucial role in the early detection of oral cancers. The present study aims to determine the effectiveness of the training program "OralDETECT", a spaced repetitive, test-enhanced learning tool with a corrective feedback mechanism for early detection of oral cancer. Thirty-two dentists and 259 dental students from three Malaysian dental schools were involved in this study. All participants were trained and calibrated to recognize oral potentially malignant disorders (OPMD) and oral cancer using "OralDETECT", which is comprised of a series of pre-test, lecture, post-tests and review sessions. The percentage of correct answers (scores) for each test given by the participants was calculated and analysed using a paired t test. It was found that the overall percentage of diagnostic accuracy for both dental professionals and student groups increased to above 80% from the pre-tests to the final post-tests. There was a significant improvement in overall scores between the pre-tests and all three post-tests for the dental professional groups and the student groups. The diagnostic accuracy for individual OPMD and lesions suspicious of oral cancer also increased to above 80% for both groups. The results of our study demonstrate that the "OralDETECT" is an efficient and effective competency tool which can be used to train dental professionals and students for the early detection of OPMD and oral cancer.

Oral cancer early detection: What will it take?

BackgroundThe challenges associated with ensuring widespread system changes to enable early diagnosis and prevention of oral cancer could benefit from interprofessional practice. A needs assessment study was conducted to inform the Interprofessional Education and Collaborative Practice (IPECP) course related to oral cancer. The primary objectives of this study were 1) to establish a tool assess the knowledge attitude and practice (KAP) related to prevention and early detection of oral cancer of health professional students, and 2) to assess the same KAP of pre-licensure dental students. Additional objectives were to consider the possibility that dental students would demonstrate good scores related to early detection and prevention of oral cancer thus indicating their readiness for interprofessional learning and collaborative practice.MethodsTwo questionnaires were utilized for this study which included 1) Readiness for interprofessional learning was assessed using the pre- validated tool of Readiness for Interprofessional Learning Scale (RIPLS) 2) A questionnaire to assess the KAP related to early diagnosis and prevention of oral cancer which was developed, validated, and evaluated. Statistical analysis includes, descriptive statistics, Mann–Whitney U test, Ordered logistic regression and Probit analysis. p value was set at < 0.05.ResultsA total of 130 dental students (74.6% female) were included in the study. Mean scores related to KAP were 15.96 ± 1.394, 4.70 + 1.146, 7.02 ± 1.019 respectively. The mean score of RIPLS was 73.15 ± 15.961. The probability of overall samples to have good RIPLS scores was around 0.68 to 0.76 (Male 0.68—0.82 & Female 0.68 -0.74). The percentage of students having good knowledge score was 93.8%, good attitude score was around 54.6% and good practice score was around 90%.ConclusionKnowledge and practice related to prevention and early detection of oral cancer were scored highly. Attitude scores were lower in a relatively higher proportion of participants and needed to be addressed in the curriculum. RIPLS score indicates a positive attitude towards interprofessional learning.

Objective Oral cancer is one of the most common types of cancer with dreadful consequences. But it can be detected early without much expensive equipment. Screening and early detection of oral cancer using Mobile health (mHealth) technology are reported due to the availability of the extensive network of mobile phones across populations. Therefore, we aimed to explore the existing literature regarding mHealth feasibility in the early detection of oral cancer. Materials and Method. An extensive search was conducted to explore the literature on the feasibility of mobile health for early oral cancer. Clinical studies reporting kappa agreement between on-site dentists and offsite health care workers/dentists in the early detection of oral cancer were included in this review. Studies describing the development of a diagnostic device, app development, and qualitative interviews among practitioners trained in using mobile health were also included in this review for a broader perspective on mHealth. Results While most of the studies described various diagnostic accuracies using mHealth for oral cancer early detection, few studies reported the development of mobile applications, novel device designs for mHealth applications, and the feasibility of a few mHealth programs for early oral cancer detection. Community health workers equipped with a mobile phone-based app could identify “abnormal” oral lesions. Overall, many studies reported high sensitivity, specificity, and Kappa value of agreement. Effectiveness, advantages, and barriers in oral cancer screening using mHealth are also described. Conclusion The overall results show that remote diagnosis for early detection of oral cancer using mHealth was found useful in remote settings.

Background: Head and neck cancer is the sixth most common cancer worldwide. It is generally acknowledged that the early diagnosis of oral cancer may result in higher 5-year survival rates, less need for aggressive treatment and improved quality-of-life. There is therefore a need for a quantifiable, reliable and competency-based educational tool which can be used to train dentists and other health care providers in the early detection of oral cancers. Aim: To assess the effectiveness of “OralDETECT” spaced repetitive learning method for training dental professionals to become competent in the early detection of oral cancer. Methods: The current study involved training three dental professional groups: Oral Pathology/Oral Medicine/Oral Surgery specialists (x), Periodontists/Restorative dentists (y), General Dental Practitioners (z) and four undergraduate cohorts comprising 259 dental students from 3 different Malaysian dental schools. A structured one-day training program “OralDETECT” was conducted, consisting of a well-planned series of lectures, tests and discussions of the test answers. During the spaced discussions participants were trained on how to ask appropriate questions and look for clinical clues to arrive at the correct diagnosis of target [oral potentially malignant disorders/oral cancer (OPMD/OC)] and other nontarget lesions. The tests comprised one pretest and 4 posttests for the dental professional group, and one pretest and 3 posttests for the student groups. The overall and group mean scores were analyzed for all the tests conducted. The statistical evaluation was based on the percentage of correct answers (scores) for each test given by the participants. Repeated-measure ANOVA and post hoc Bonferroni´s test were carried out to examine the differences between test scores overall and for each group. All statistical analysis was carried out using SPSS software, where P values &lt; 0.005 were considered significant. Results: The overall percentage of correct responses for both the dental professional and student groups increased from a minimum of 30% to above 80% from the pretest to the final posttest. There were significant differences in overall scores between all 4 posttests and the pretest for dental professional groups, and between all 3 posttests and the pretest for all student groups. The percentage of accuracy of diagnosis for the individual lesions (leukoplakia, lichen planus, erythroplakia, oral submucous fibrosis and suspicious of oral cancer) increased to &gt; 80% for the Dental Professional groups. The percentage of diagnostic accuracy for the individual lesions also increased to &gt; 80% (except for erythroplakia) for the student groups. Conclusion: Based on the results of our study the “OralDETECT” spaced repetitive learning method is an efficient and effective competency-based learning tool for teaching the early detection of OPMD and oral cancer among dental professionals and dental students.

AimTo discuss the broad evidence base on which strategies to enhance the early detection and diagnosis of oral cancer and potentially malignant disorders (PMD) should be designed. MethodsWe reviewed the evidence for current oral mucosal screening approaches and used a theoretical model to explore behavioural influences on the early detection of oral cancer, and to outline strategies for future interventions and research. ResultsWhile considerable advances are being made in techniques to detect oral cancer, there has been less attention paid to the patient and health care provider factors which may influence delays in detection of oral cancer. This review proposes that unless future theory based studies target these aspects of oral cancer, then efforts to improve its timely detection will have limited effectiveness. ConclusionsA primary tenet of screening programs, whether opportunistic, targeted or population based is that at-risk people present for screening. They must also present early enough in the disease process for detection to lead to a better outcome. This is particularly relevant for oral cancer. Five-year survival rates have not improved over past decades and this has mainly been attributed to delays in detection. Early detection, diagnosis and treatment significantly enhance survival rates and reduce morbidity.

Minimally invasive procedures for the recognition and diagnosis of oral precancer and cancer

Oral cancer is the most common cancer in Indian male, it accounts for 50-70 % of total cancer mortality. Oral cancer is cancer of mouth or throat. Oral cancer is as twice as common in men as in women; the incidence is nearly 11% in male and 5% in female. Lack of awareness among the health care providers is the most significant factor in delaying diagnosis and treatment of oral cancer. Early detection of oral cancers makes patients more amenable to treatment and allows the greatest chance of cure. Methods: pre-experimental research design was used for conducting study in selected educational institute of Bhopal. Subject comprising of 60 adolescents selected by non-probability convenient sampling technique, who fulfilled inclusive criteria. Result: Mean±SD of post-test knowledge score (14.5±2.42) was higher than the Mean±SD of pre-test knowledge score (6.5±1.99). The computed ‘t’ value (14.0*) was found significant at 0.05 level and 0.01 level of significance. There was significant association found of demographic variable in terms of educational level and previous exposure to the topic. Conclusion: It was concluded that informational booklet was effective in enhancing knowledge of adolescents regarding prevention of oral cancer. Health professionals therefore have an important role and responsibility in the prevention and early detection of oral cancer. The nurse has a significant role in early detection and treatment of oral cancer. This type of studies can help in creating awareness among general population regarding preventive strategies and modifying health behaviours.

BackgroundLip and oral cavity cancer is leading cause of cancer mortality among Indian men. This study evaluated diagnostic accuracy of mobile health (mHealth) enabled screening for early detection of oral premalignant lesions or oral cancer (OPML/OC). It also described epidemiology of tobacco and other substance use and associated oral lesions in rural northern India.MethodsA prospective study enrolled 10,101 high‐risk individuals from rural settings of Varanasi district, India, between February 2021 and June 2023. Trained field workers captured habits information and oral cavity images and provided screening as suspicious or nonsuspicious on mHealth. Onsite experts and remote specialists provided clinical diagnoses. Diagnostic accuracy of mHealth‐enabled screening was evaluated. A subset of 252 participants was followed to assess changes in oral lesions.ResultsPrevalence of substance use was 55.7%, with 21.4% having OPML/OC. Sensitivity of field workers and remote diagnosis for detecting OPML/OC was moderate when compared with onsite expert. Overall, interobserver agreement was substantial. During follow‐up, the remote specialists identified 30 new and 13 progressive lesions with a significant decline in the red mean parameter of red, green, and blue colour ratios.ConclusionAlthough mHealth‐enabled screening demonstrated lower sensitivity in detecting OPML/OC, their high specificity and expanded access to screening positions mHealth as a valuable tool for improving oral cancer screening coverage in Varanasi. This is particularly crucial given the high burden of oral cancer driven by prevalent smokeless tobacco and areca nut use and the current lack of effective population‐based screening programs in this region.

The aim of this pilot research was to improve understanding of individuals at risk of oral cancer, to determine their attitudes towards and responses to early detection interventions. In-depth interviews with the target group (n = 25) were used to determine their views, attitudes and requirements for an intervention to encourage early detection of oral cancer. This data was used in combination with theory-based constructs to develop written material that aimed to increase awareness of oral cancer, encourage mouth self-examination (MSE) and early presentation. A second pilot study used a think-aloud protocol to assess the target groups’ (n = 14) reactions to the written information. In both studies the tape-recorded responses were analysed using framework analysis. The target group had limited knowledge about oral cancer, particularly the signs and symptoms. Participants saw benefits in performing MSE but noted the main barriers were not knowing what signs to look for or where to look. The written information was generally well-received but required some modifications. In particular, the target group required further persuasion that their lifestyle contributed to an increased risk of oral cancer. The results of these pilot studies have informed the development of a theory-based intervention for the early detection of oral cancer.