May VelScope Be Deemed an Opportunistic Oral Cancer Screening by General Dentists? A Pilot Study.

Anna Turkina,Noemi Coppola,Gianrico Spagnuolo,Maria Eleonora Bizzoca,Stefania Leuci,Gianfranco Favia,Michele Davide Mignogna

doi:10.3390/jcm9061754

Abstract

Early diagnosis of oral cancer through visual inspection followed by histopathological confirmation is a pivotal step for reducing rates of morbidity and mortality. There are several auxiliary devices used to improve oral examination. The purpose of this cross-sectional pilot study is to evaluate the sensitivity and specificity of the Visually Enhance Lesion Scope (VelScope) system when it is used by the general dentist after a yearly oral medicine training. Thirty-five patients with oral lesions were evaluated with clinical and VelScope examination by two general dentists, one of which trained with a specific course. A comparison of the histopathological results, clinical examination, and VelScope made by both dentists was performed through statistical analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting oral potentially malignant disorders (OPMDs) are 53.3%, 65%, 53.3%, 76.5% for unskilled dentist, 73.3%, 65%, 61.1%, 76.5% for skilled clinician. When both examiners use VelScope the values are 53.3%, 70%, 57.1%, 66.7% for unskilled general dentist (u-GD), 86.7%, 90%, 86.7%, 90% for skilled general dentist (s-GD). Improvement of a skilled general dentist for detecting malignancies is higher than inexperienced examiner when using VelScope. VelScope alone is unable to improve the general dentist’s ability to detect malignancies, but it could be a useful adjunctive device for clinicians when a focused training program is performed.

Highlights

Cancer is one of the most common causes of morbidity and mortality, with over 10 million new cases and over six million deaths each year in the world, and it is responsible for 20% of all deaths in high-income countries and 10% in low-income ones [1]
The VelScope examination (Vel-E) was interpreted by unskilled general dentist (u-general dentists (GDs)) as positive in 14 patients (40%) and negative in 21 patients
The high values of sensitivity and specificity reported have not been tested in the general dentistry field; for this reason, VelScope is not supported by robust evidence for its use in primary care, but only in selected specialist clinics where trained physicians may discriminate among oral potentially malignant disorders (OPMDs) [21]

Summary

Introduction

Cancer is one of the most common causes of morbidity and mortality, with over 10 million new cases and over six million deaths each year in the world, and it is responsible for 20% of all deaths in high-income countries and 10% in low-income ones [1]. In the presence of LAF, the Vel-E is defined positive; it is due to several alterations, : (i) break-up of the collagen cross-links, (ii) increase in blood supply due to micro-vascularization and inflammation, and (iii) reduction in flavine–adenine–dinucleotide (FAD) and nicotinamide-adenine-dinucleotide (NADH) (fluorochromes). These alterations could be present both in tissues with dysplasia and in tissues with ongoing inflammatory phenomena, thereby reducing the reliability of the test [7]

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