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Adjuncts for the evaluation of potentially malignant disorders in the oral cavity Diagnostic test accuracy systematic review and meta-analysis—a report of the American Dental Association
- Lingen, Mark W;
- Tampi, Malavika P;
- Urquhart, Olivia;
- Abt, Elliot;
- Agrawal, Nishant;
- Chaturvedi, Anil K;
- Cohen, Ezra;
- D'Souza, Gypsyamber;
- Gurenlian, JoAnn;
- Kalmar, John R;
- Kerr, Alexander R;
- Lambert, Paul M;
- Patton, Lauren L;
- Sollecito, Thomas P;
- Truelove, Edmond;
- Banfield, Laura;
- Carrasco-Labra, Alonso
- et al.
Published Web Location
https://doi.org/10.1016/j.adaj.2017.08.045Abstract
Background
Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.Types of studies reviewed
The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach.Results
The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence).Conclusions and practical implications
Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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