Awan K H, Morgan P R, Warnakulasuriya S
Department of Clinical and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Head and Neck Pathology, Dental Institute, King's College London, London, UK.
Clin Oral Investig. 2015 Dec;19(9):2267-72. doi: 10.1007/s00784-015-1457-9. Epub 2015 Mar 26.
Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders.
A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia.
Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively.
While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity.
These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.
早期发现口腔癌及其癌前病变是降低口腔癌所致高死亡率的关键。目前有多种新型椅旁诊断工具，可增强口腔黏膜检查并有助于检测良性和恶性疾病。本研究的目的是调查自体荧光、化学发光和甲苯胺蓝（TBlue）联合使用时相对于传统口腔检查和手术活检在检测和评估口腔潜在恶性疾病风险状态方面的准确性。
共纳入126例有白色、红色及红白相间斑块的患者。在进行全面口腔检查后，所有患者均接受了自体荧光、化学发光和TBlue检查的标准方案。进行手术活检以评估口腔上皮发育异常情况。
70例患者有白斑/红斑，44例有上皮发育异常。对于白斑/红斑，自体荧光、化学发光和TBlue的敏感性分别为87.1%、77.1%和52.9%，特异性分别为21.4%、26.8%和67.9%。对于发育异常病例，自体荧光、化学发光和TBlue的敏感性和特异性分别为84.1%、77.3%和56.8%以及15.3%、27.8%和65.8%。
虽然这三种检测方法在检测口腔黏膜变化方面均有用，但它们在识别口腔潜在恶性疾病（OPMD）方面的准确性值得怀疑。然而，联合使用时，检测结果更好，特异性有所提高。
这些研究工具在专科诊所中很有帮助，但需要进一步研究以考察它们在初级保健机构筛查中的作用。
