Abstract
The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required.
Highlights
Cancer of the head and neck (H&N cancer), including all oral, laryngeal and pharyngeal sites, is the sixth most common cancer, accounting for about 643 000 new cases annually [1]
The aim of this paper is to review current evidence regarding available diagnostic aids of early detection of oral cancer and provide a critical analysis of their effectiveness
Prevention and early detection of oral squamous cell carcinomas (OSCCs) and its pre-invasive intra-epithelial stages is still largely based on visual examination of the mouth, a variety of molecular techniques have been tested and are likely to represent the ultimate goal of oral cancer research [51]
Summary
Cancer of the head and neck (H&N cancer), including all oral, laryngeal and pharyngeal sites, is the sixth most common cancer, accounting for about 643 000 new cases annually [1]. Further to visual oral examination with the support normal (incandescent) light, a variety of commercial diagnostic aids and adjunctive techniques have been introduced [18,19] These supposedly can assist in the detection of early cancerous mucosal changes that can be occult to visual inspection and/or to assess the biologic potential of clinically abnormal mucosal lesions [18,19]. Current data show that OralCDx's cytologic test is highly sensitive and specific in detecting dysplastic changes in high-risk mucosal lesions (due to clinical findings suggestive of malignancy), but when used in a lowrisk population with benign-appearing oral epithelial lesions, the accuracy is reduced and the rate of false-positive findings increases [18]. Further research is needed to support this clinical application of autofluorescence spectroscopy
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