Faculty of Medicine, University of British Columbia, #306 – 805 West Broadway, Vancouver, BC, Canada.
Community Dent Oral Epidemiol. 2011 Apr;39(2):171-6. doi: 10.1111/j.1600-0528.2010.00579.x. Epub 2010 Oct 5.
Visually distinguishing oral cancer from noncancerous oral lesions is problematic. Currently, commercial diagnostic devices are being marketed to dentists as effective screening devices to use in general practice. The purpose of this study is to evaluate the probabilistic performance of VELscope®, Oral CDx® and toluidine blue staining as clinical adjunctive diagnostic procedures in routine screening for oral cancer in dental practice.
Sensitivity and specificity information for each device was taken from the literature. The positive predictive value (PPV) and false positive rate, based on three clinical screening scenario, were calculated using Bayes' Theorem.
Under three clinical scenarios (screening the general population, screening only adults (≥40 years) and screening adults (≥40 years) that present with intra-oral visible lesions), VELscope produced the highest PPV's of 1.27%, 2.53% and 8.11%, respectively. This indicates a false positive rate of between 91.89% and 98.73%.
VELscope, OralCDx and toluidine blue staining have high false positive rates when they are used to screen routinely for oral cancer. It would be inefficient to allocate scarce healthcare resources to the routine use of these devices for oral cancer screening. These devices may be beneficial in opportunistic screening programmes or in cancer referral clinics when the pretest probability of oral cancer is likely to be above 10%. Further research is needed to determine at which pretest probabilities these adjunctive diagnostic devices would be cost-beneficial for the screening of oral cancer.
肉眼区分口腔癌与非癌性口腔病变存在一定困难。目前，已有商业化的诊断设备被推向市场，供牙医在常规临床实践中用作有效筛查设备。本研究旨在评估 VELscope®、Oral CDx® 和甲苯胺蓝染色作为临床辅助诊断程序，在常规口腔癌筛查中的概率性能。
从文献中获取了每种设备的敏感性和特异性信息。基于三种临床筛查情况，使用贝叶斯定理计算阳性预测值（PPV）和假阳性率。
在三种临床场景下（筛查普通人群、仅筛查成人（≥40 岁）以及筛查出现口腔内可见病变的成年患者（≥40 岁）），VELscope 分别产生了最高的 1.27%、2.53%和 8.11%的 PPV。这表明假阳性率在 91.89%至 98.73%之间。
当用于常规口腔癌筛查时，VELscope、OralCDx 和甲苯胺蓝染色的假阳性率较高。将有限的医疗资源分配给这些设备进行常规口腔癌筛查效率低下。这些设备可能在机会性筛查计划或癌症转诊诊所中受益，当口腔癌的术前概率预计高于 10%时。需要进一步研究以确定在何种术前概率下，这些辅助诊断设备对口腔癌筛查具有成本效益。
