Abstract
BackgroundEarly detection holds the key to an effective control of cancers in general and of oral cancers in particular. However, screening procedures for oral cancer are not straightforward due to procedural requirements as well as feasibility issues, especially in resource-limited countries.MethodsWe conducted a cross-sectional study to compare the performance of chemiluminescence, toluidine blue and histopathology for detection of high-risk precancerous oral lesions. We evaluated 99 lesions from 55 patients who underwent chemiluminescence and toluidine blue tests along with biopsy and histopathological examination. We studied inter-as well as intra-rater agreement in the histopathological evaluation and then using latent class modeling, we estimated the operating characteristics of these tests in the absence of a reference standard test.ResultsThere was a weak inter-rater agreement (kappa < 0.15) as well as a weak intra-rater reproducibility (Pearson's r = 0.28, intra-class correlation rho = 0.03) in the histopathological evaluation of potentially high-risk precancerous lesions. When compared to histopathology, chemiluminescence and toluidine blue retention had a sensitivity of 1.00 and 0.59, respectively and a specificity of 0.01 and 0.79, respectively. However, latent class analysis indicated a low sensitivity (0.37) and high specificity (0.90) of histopathological evaluation. Toluidine blue had a near perfect high sensitivity and specificity for detection of high-risk lesions.ConclusionIn our study, there was variability in the histopathological evaluation of oral precancerous lesions. Our results indicate that toluidine blue retention test may be better suited than chemiluminescence to detect high-risk oral precancerous lesions in a high-prevalence and low-resource setting like India.
Highlights
Detection holds the key to an effective control of cancers in general and of oral cancers in particular
Histopathology continues to be used as the reference standard test [10]
The total score ranged from 0 to 75 and, based on this total score, the histopathological grading was given as follows: no dysplasia, mild dysplasia, moderate dysplasia and severe dysplasia. We further reduced these evaluations to a binary classification scheme as high risk/low risk in accordance with the criteria set by the World Health Organization (WHO) classification [18]
Summary
Suspicious lesions were first identified with conventional visual examination under incandescent projected light and data including lesion characteristics like the location of the lesion, the type of lesion, the size, and the presence or absence of any adjacent satellite lesions were obtained This was followed by an oral rinse with 1% acetic acid solution which was given to the patient to hold in the mouth for 30-60 seconds before expectorating. To estimate the diagnostic performance of histopathological evaluations along with the three test protocols (CHEM, TBLU and CHTB) we did not make any a priori assumption about the reference standard. Such a representation of the data is amenable to latent class analysis (LCA) [19,20,21,22]. Statistical significance was assessed at a type I error rate of 0.05
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