TABLE 1.
COE versus biopsy or excision: Study characteristics
| Author, year country study design | Population | History of oral cancer/lesions | Sample size (no. of lesions) | Mean age (years) | No. of males (%) | Index test | Reference standard | Dental professional performing index test | Prevalence: dysplasia or malignant lesions | Prevalence: malignant lesions |
|---|---|---|---|---|---|---|---|---|---|---|
|
Allegra 2009 20 Italy NR |
Oral mucosa lesions | NR | 32 (45) | 59 | 19/32 (59%) | COE | Punch biopsy | Experienced otolaryngologist | 30/45 (67%) | 7/45 (16%) |
|
Bhoopathi 2011 21 USA Retrospective a |
Atypical lesions or positive by brush biopsy | NR | 148 (148) | 55 | 80/148 (54%) | COE | Scalpel biopsy | Oral surgeons | 12/148 (8%) | NR |
|
Brocklehurst 2015 18 UK Retrospective |
Standardized clinical photographs of mouth cancer, PMDs and benign lesions of the oral mucosa | NR | 90 (90) | NR | NR | COE | Histological confirmation | Primary care dentists (N = 96) | 35/90 (39%) | NR |
| Hygienists/therapists (N = 63) | 35/90 (39%) | NR | ||||||||
| Hospital based dentists (N = 9) | 35/90 (39%) | NR | ||||||||
| Dental nurses (N = 24) | 35/90 (39%) | NR | ||||||||
|
Chainani‐Wu 2015 26 USA Cross‐sectional, consecutive |
Oral LP, ELP, or EP on clinical examination with no current history of oral cancer | No | 43 (77) | 61 | 23/43 (54%) | COE | Punch or scalpel biopsy | NR | 17/77 (22%) b | 6/77 (8%) |
|
Epstein 2003 27 USA Prospective |
Treated within past 2 years for upper aerodigestive tract or pulmonary carcinoma but no current treatment for oral cancer | Y (history of cancer) | 81 (96) | 61 | 61/81 (75%) | COE | Punch or wedge biopsy | NR | 30/96 (31%) c | NR |
|
Farah 2012 22 Australia Prospective |
Clinically suspicious oral mucosal white or mixed red/white lesion; no known oral epithelial dysplasia or SCC | No | 112 (118) | 59 | 46/112 (41%) | COE | Scalpel biopsy | Oral medicine specialists | 28/118 (24%) | NR |
|
Forman 2015 30 USA Retrospective |
Oral lesion with biopsy and pathology report with unequivocal clinical impression and histologic diagnosis | Y: 12.9% had a history of cancer | 1003 (1003) | 45 | 491/1003 (49%) | COE | Biopsy | Surgeons (25–30 years experience) or residents (< 5 years experience) | 74/1003 (7.4%) | NR |
|
Gillenwater 1998 19 USA NR |
Known or suspected premalignant or malignant oral cavity lesions and normal tissue from same patients | NR | 10 (28) | NR | NR | COE | Surgical biopsy | Experienced neck and head surgeon or dental oncologist | 17/28 (61%) | NR |
|
Hanken 2013 28 Germany Prospective |
Suspicious oral premalignant lesions but with no current advanced SCC | NR | 60 (60) | NR (range 38–82) | 20/60 (33%) | COE | Surgical biopsy | Experienced oral and maxillofacial surgeon | 54/60 (90%) | 3% (2/60) |
|
Jayaprakash 2013 (abst) 31 USA NR |
Potentially malignant white or white‐red oral mucosal lesions | NR | 146 (255) | NR | NR | COE | Biopsy | NR | 184/255 (72%) | NR |
|
Jayaprakash 2009 32 USA NR |
Clinically suspicious oral lesions or recently diagnosed untreated premalignant lesions or cancer, history of previously treated oral cancer but no evidence of cancer recurrence and no active malignancy treatment | Y: 47% previous head and neck cancer | 60 (249) | 60 | 41/60 (68%) | COE | Biopsy | Specialist dental oncologist | 170/249 (68%) | 15/249 (6%) d |
|
Kammerer 2015 29 Germany Prospective |
Potentially malignant oral disorders | NR | 44 (50) | 60 | 25/44 (57%) | COE | Scalpel/surgical biopsy | NR | 10/50 (20%) | 7/50 (14%) |
|
Koch 2011 23 Germany NR |
Clinically suspicious epithelial lesions or diagnosed oral mucosal lesion as SCC | NR | 78 (78) | 62 | 46/78 (59%) | COE | Scalpel biopsy | Specialist dental oncologist | 33/78 (42%) | 30/78 (38%) |
|
Marzouki 2012 34 Canada Prospective |
Strong history of smoking, alcohol and suspicious lesion referred by GP, or previous history of cancer but cancer free and having regular follow‐ups | Y: 68% previous head and neck cancer | 33 (33) | 62 | 49/85 (58%) | COE | Biopsy | Head and neck oncology staff person | 13/33 (40%) | NR |
|
Australia NR |
Clinically suspicious oral mucosal white lesion | NR | 50 (50) | 57 | 23/50 (46%) | COE | Scalpel biopsy | NR | 9/50 (18%) | NR |
|
McNamara 2012 25 USA NR |
Undergoing initial oral evaluation and routine dental care | NR | NR (34) | 45 | 67/130 (52%) | COE | Scalpel biopsy | Resident, oral and maxillofacial pathology | 3/34 (9%) | NR |
|
Patel 2011 33 New Zealand Retrospective |
All lesions involving soft tissues of mouth: tongue, gingiva, unattached mucosa, and the lips to the vermillion‐skin junction | NR | 3067 (3127) | 49 | 1308/3067 (43%) | COE | Biopsy | All clinicians combined | 391/2517 (16%) | 66/2517 (2.6%) |
| General dental practitioner | 32/404 (8%) | 3/404 (0.7%) | ||||||||
| Specialist dentist with postgraduate qualifications | 350/2079 (17%) | 58/2079 (2.8%) | ||||||||
|
Piazza 2016 17 Italy Prospective |
Not treated for OC/OP with LPs and EPs and not been biopsied | No | 128 (128) | 65 | 54/128 (42%) | COE | Excisional biopsy f | NR | 87/128 (68%) | NR |
Abbreviations: Abst, conference abstract; CIS, carcinoma in situ; COE, conventional oral examination; ELP, erythroleukoplakia; EPs, erythroplakias; LPs, leukoplakias; NR, not reported; OC, oral cavity; OP, oropharyngeal; PMDs, premalignant diseases; SCC, squamous cell carcinoma.
Consecutive cohort but retrospective analyses.
For severe dysplasia and cancer only.
For cancer or CIS only, not dysplasia.
Calculated for invasive SCC and other carcinomas (one salivary gland carcinoma and two verrucous carcinomas with SSC component).
Data reported for Microlux/DL examination but was same as clinical provisional diagnosis.
Excisional biopsy of the entire lesion under local or general anesthesia regardless of the appearance at COE.