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Diagnostic aids in the screening of oral cancer

By Stefano Fedele


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

Topics: Research
Publisher: BioMed Central
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Provided by: PubMed Central

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  1. (1998). Alfano RR, Huvos AG: In vivo native cellular fluorescence and histological characteristics of head and neck cancer. Clin Cancer Res
  2. (2008). Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol
  3. (2008). Bascones-Martínez A: Update on molecular pathology in oral cancer and precancer. Anticancer Res
  4. (2002). Brush biopsy 'saves lives'.
  5. (2007). C: Visualization and other emerging technologies as change makers for oral cancer prevention.
  6. (2002). Cancer Report. Edited by: Stewart BW, Kleihues P. International Agency for Research on Cancer and World Health Organization. Geneve: Suisse;
  7. (2005). CH: Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions. Int J Oral Maxillofac Surg
  8. (1997). CL: Evaluation of oral cancer screening.
  9. (2001). CM: Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
  10. (2000). Diagnosis of early oral and oropharyngeal squamous carcinoma: obstacles and their amelioration. Oral Oncol
  11. (1997). eds: SEER cancer statistics review, 1973–1994. NIH publication no.
  12. (2006). Epstein JB: Clinical evaluation of chemiluminescent lighting: an adjunct for oral mucosal examinations.
  13. (2005). Fedele S: Oral cancer screening: 5 minutes to save a life. Lancet
  14. (1998). Feine JS: The role of diagnostic delays in the prognosis of oral cancer: a review of the literature. Oral Oncol
  15. (2002). Field change and oral cancer: new evidence for widespread carcinogenesis.
  16. (1983). Final evaluation of tolonium chloride rinse for screening of high-risk patients with asymptomatic squamous carcinoma. J Am Dent Assoc
  17. (1996). Fluorescence photography as a diagnostic method for oral cancer. Cancer Lett
  18. (2005). Frist S: The relevance of the high positive predictive value of the oral brush biopsy. Oral Oncol
  19. (1999). H: Usefulness of fluorescence photography for diagnosis of oral cancer.
  20. (2004). Immune activation and chronic inflammation as the cause of malignancy in oral lichen planus: is there any evidence? Oral Oncol
  21. (1999). Improving detection of precancerous and cancerous oral lesions. Computer-assisted analysis of the oral brush biopsy.
  22. (2003). JH: Oral malignancies associated with negative transepithelial brush biopsy. J Oral Maxillofac Surg
  23. (2007). Laskin DM: Efficacy of the ViziLite system in the identification of oral lesions.
  24. (2002). Lo Muzio L: Costs and effectiveness in the care of patients with oral and pharyngeal cancer: analysis of a paradox.
  25. (2001). Lo Muzio L: Oral and pharyngeal cancer: lack of prevention and early detection by health care providers.
  26. (2004). Lo Russo L: The World Cancer Report and the burden of oral cancer.
  27. (2007). MJ: A pilot case control study on the efficacy of acetic acid wash and chemiluminescent illumination (ViziLitetrade mark) in the visualisation of oral mucosal white lesions. Oral Oncol
  28. (2007). MP: Direct fluorescence visualization of clinically occult high-risk oral premalignant disease using a simple hand-held device. Head Neck
  29. (2005). MP: Toluidine blue staining identifies high-risk primary oral premalignant lesions with poor outcome. Cancer Res
  30. (1996). NW: Sensitivity and specificity of OraScan (R) toluidine blue mouthrinse in the detection of oral cancer and precancer. J Oral Pathol Med
  31. (2003). Oral brush biopsy: the problem of false positives. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
  32. (2008). Oral cancer prevention and control – The approach of the World Health Organization. Oral Oncol
  33. (1994). Oral submucous fibrosis: etiology, pathogenesis, and future research. Bull World Health Organ
  34. (2008). PM: Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol
  35. (1999). Porphyrin-like fluorescence in oral cancer: In vivo fluorescence spectral characterization of lesions by use of a near-ultraviolet excited autofluorescence diagnosis system and separation of fluorescent extracts by capillary electrophoresis. Cancer
  36. (2005). Roodenburg JL: The status of in vivo autofluorescence spectroscopy and imaging for oral oncology. Oral Oncol
  37. (2006). SA: A cohort study of cancer incidence in systemic sclerosis.
  38. (1993). Screening for cancer of the aerodigestive tract. Cancer
  39. (2004). SR: An audit of the efficacy of the oral brush biopsy technique in a specialist Oral Medicine unit. Oral Oncol
  40. (2007). SR: Field cancerization in oral lichen planus. Eur J Surg Oncol
  41. (2003). SR: The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer. Head Neck
  42. (1998). The application of toluidine blue as a diagnostic adjunct in the detection of epithelial dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
  43. (2006). The efficacy of oral lumenoscopy (ViziLite) in visualizing oral mucosal lesions. Spec Care Dentist
  44. (2003). The oral brush biopsy: separating fact from fiction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
  45. (2004). The sensitivity and specificity of the OralCDx technique: evaluation of 103 cases. Oral Oncol
  46. (2006). Toluidine blue uptake in potentially malignant oral lesions in vivo: clinical and histological assessment. Oral Oncol
  47. (2005). Trivandrum Oral Cancer Screening Study Group: Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet
  48. (2003). World cancer rates set to double by 2020. BMJ
  49. (2002). Zunt SL: Comparison of computer-assisted brush biopsy results with follow up scalpel biopsy and histology. Gen Dent

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