The Catholic University of Korea, College of Medicine, Seoul St. Mary's Hospital, Department of Otolaryngology-Head and Neck Surgery, Seoul, Korea.
The Catholic University of Korea, College of Medicine, Bucheon St. Mary's Hospital, Department of Otolaryngology-Head and Neck Surgery, Seoul, Korea.
Braz J Otorhinolaryngol. 2022 May-Jun;88(3):358-364. doi: 10.1016/j.bjorl.2020.06.011. Epub 2020 Jul 29.
Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy.
This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions.
Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2).
Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I=9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91).
Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.
早期发现可能恶性的口腔疾病对于获得良好的预后至关重要，目前尚不清楚使用化学发光作为辅助诊断筛查方法是否能提高诊断准确性。
本系统评价和荟萃分析旨在评估化学发光在诊断口腔癌和癌前病变中的准确性。
检索了 PubMed、Cochrane 数据库、SCOPUS、Web of Science、Embase 和 Google Scholar 中的 16 项前瞻性和回顾性研究。通过化学发光检测到的口腔黏膜病变与甲苯胺蓝或视觉检查检测到的口腔黏膜病变进行比较。从每项研究中提取真阳性、真阴性、假阳性和假阴性率。使用诊断准确性研究质量评估工具（版本 2）评估方法学质量。
甲苯胺蓝的使用灵敏度、特异度、阴性预测值和诊断比值比（DOR）分别为 0.832（95%置信区间[CI] 0.692-0.917）、0.429（95% CI 0.217-0.672）、0.747（95% CI 0.607-0.849）和 4.061（95% CI 1.528-10.796；I=9.128%）。汇总受试者工作特征（SROC）曲线下面积为 0.743。与甲苯胺蓝（12 项研究）相比，化学发光的灵敏度更高（0.831 比 0.694）；特异性更低（0.415 比 0.734），阴性预测值更低（0.674 比 0.729），DOR 更低（3.891 比 7.705）。与临床检查（3 项研究）相比，化学发光的 DOR 较低（4.576 比 5.499），曲线下面积较小（0.818 比 0.91）。
虽然化学发光本身对口腔癌和癌前病变的诊断性检查具有良好的敏感性，但化学发光的诊断准确性与甲苯胺蓝和临床检查相当或更差。因此，单独使用化学发光的诊断准确性不足，无法可靠使用。
