J Am Dent Assoc. 2017 Oct;148(10):712-727.e10. doi: 10.1016/j.adaj.2017.07.032.
An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity.
This is an update of the ADA's 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma. The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and diagnostic test accuracy studies. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions.
The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity. For patients seeking care for suspicious lesions, immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice. In exceptional cases, when patients decline a biopsy or live in rural areas with limited access to care, the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed (conditional recommendation, low-quality evidence).
The authors urge clinicians to remain alert and take diligent action when they identify a PMD. The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial.
美国牙科协会（ADA）科学事务理事会和循证牙科中心召集的一个专家小组进行了系统评价，并制定了临床建议，以便向初级保健临床医生提供有关辅助工具作为口腔病变（包括可能恶性疾病[PMD]）评估的分诊工具的潜在用途的信息。
这是 ADA 关于 PMD 和口腔鳞状细胞癌早期诊断的 2010 年建议的更新。作者通过 Ovid 对 MEDLINE 和 Embase 中的文献进行了系统搜索，并对 Cochrane 中央对照试验注册中心进行了搜索，以确定随机对照试验和诊断试验准确性研究。作者使用推荐评估、制定和评估方法来评估证据的确定性，并从证据转移到决策。
专家组制定了 1 项良好实践声明和 6 项临床建议，结论是没有可用的辅助工具表现出足够的诊断测试准确性，无法支持它们在口腔病变评估期间作为分诊工具的常规使用。对于因可疑病变寻求治疗的患者，立即进行活检或转诊给专家仍然是临床实践中最重要的建议。在特殊情况下，如果患者拒绝进行活检或居住在农村地区，获得护理的机会有限，专家组建议可以使用细胞学检查来启动诊断过程，直到可以进行活检（有条件建议，低质量证据）。
作者敦促临床医生在识别出 PMD 时保持警惕并采取积极行动。作者强调需要进行咨询，因为患者可能会因为焦虑和否认而延迟诊断。
