City of Hope National Medical Center, Duarte, CA, USA.
J Am Dent Assoc. 2012 Dec;143(12):1332-42. doi: 10.14219/jada.archive.2012.0096.
The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC.
The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool.
The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC.
On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.
临床口腔检查（COE）是早期发现具有异型增生或口腔鳞状细胞癌（OSCC）的口腔病变的标准方法，此时病变最易治疗。作者进行了一项系统评价，以评估 COE 在预测异型增生或 OSCC 的组织学诊断方面的有效性。
作者从 1966 年至 2010 年，通过自动搜索 PubMed、Web of Knowledge 和 Cochrane Library，检索了包括“口腔黏膜病变筛查”和“口腔病变”等术语的随机对照试验和观察性研究。他们使用诊断准确性研究质量评估工具确定了选定研究的质量（敏感性、特异性、阳性预测值、阴性预测值和诊断比值比）。
总体诊断比值比为 6.1（95%置信区间，2.1-17.6）；因此，COE 被认为作为预测异型增生和 OSCC 的诊断方法整体性能不佳。
根据现有文献，作者确定 COE 对黏膜病变的一般预测价值不大。OSCC 通常在疾病的晚期诊断，这表明需要改进 COE，并开发辅助方法来帮助检测和诊断口腔黏膜病变。
