Background: Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer. The gold standard for diagnosing OSCC is the use of scalpel biopsy with histologic assessment, but there are many adjunctive tests for diagnosing OSCC that are less invasive. So, the authors conducted a systematic review to determine whether adjunctive oral cancer tests have a diagnostic accuracy comparable to scalpel biopsy and histologic assessment.
Clinical question: What is the diagnostic accuracy of oral cancer screening tests for the detection of oral cancer and potentially malignant disorders of the lip and oral cavity in individuals with clinically evident lesions?
Summary of methods and results: A systematic literature search was conducted of the following adjunctive oral cancer tests: vital staining, oral cytology, light-based detection, and blood and saliva analysis. A total of 37 studies were included in the meta-analysis; separate analyses were conducted to calculate the sensitivity and specificity of each diagnostic test. For vital staining, sensitivity was 0.84 (95% confidence interval [CI] = 0.74 to 0.90) and specificity was 0.70 (95% CI = 0.59 to 0.79); for cytology, sensitivity was 0.91 (95% CI = 0.81 to 0.96) and specificity was 0.91 (95% CI = 0.81 to 0.95); for light-based detection, sensitivity was 0.91 (95% CI = 0.77 to 0.97) and specificity was 0.58 (95% CI = 0.22 to 0.87). No studies were found evaluating blood and saliva analysis.
Critical appraisal: This systematic review met most of the AMSTAR criteria for assessing systematic reviews. However, the body of evidence was judged to be at high risk of bias and potentially suffered from selection bias. Because of this, the results should be interpreted with caution.
Practical applications: Scalpel biopsy with histologic assessment remains the gold standard for diagnosing lesions suspected to be OSCC or potentially malignant disorders (PMD). Patients with lesions should be referred to clinicians that have specialty training in oral and maxillofacial pathology/surgery for further evaluation and scalpel biopsy, if needed.