Epstein Joel B, Güneri Pelin, Boyacioglu Hayal, Abt Elliot
City of Hope National Medical Center, Duarte, CA, USA.
Tex Dent J. 2013 May;130(5):410-24.
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% 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）是早期发现具有发育异常或口腔鳞状细胞癌（OSCC）的口腔病变的标准方法，此时这些病变最易治疗。作者进行了一项系统评价，以评估COE在预测发育异常或OSCC组织学诊断方面的有效性。
作者对1966年至2010年期间的PubMed、Web of Knowledge和Cochrane图书馆进行了自动检索，以查找包含“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所选研究的质量（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作为预测发育异常和OSCC的诊断方法，总体表现较差。
根据现有文献，作者确定黏膜病变的COE通常不能预测组织学诊断。OSCC往往在疾病晚期才被诊断出来，这一事实表明需要改进COE并开发辅助手段来帮助检测和诊断口腔黏膜病变。
