Centre for Oral Immunobiology and Regenerative Medicine, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Newark Street, London E1 2AT.
Centre for Oral Immunobiology and Regenerative Medicine, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Newark Street, London E1 2AT.
Br J Oral Maxillofac Surg. 2021 Jan;59(1):e17-e22. doi: 10.1016/j.bjoms.2020.08.094. Epub 2020 Aug 23.
Screening for oral cancer by direct visual examination is believed to be ineffective because of the difficulty in differentiating a small number of malignancies from the much more prevalent benign oral mucosal lesions (OML) that are found in high-risk individuals. Standardised clinical diagnoses were recorded for all the OMLs identified during oral visual examination of 1111 individuals with risk factors for oral cancer, including tobacco and areca nut (paan) consumption. Suspicious lesions were referred for biopsy and definitive diagnosis. A total of 1438 OMLs with 32 different clinical diagnoses were identified in 604 participants. Analysis of referrals revealed two distinct groups: visually benign lesions (VBLs) none of which was referred, and visually complex lesions (VCLs) comprising 661 OMLs with nine different clinical diagnoses. After biopsy the VCLs included known potentially malignant disorders (PMDs) as well as benign lesions such as paan mucositis. VCLs (but not VBLs) share risk factors with oral cancer (p<0.05 for paan 5.82 (CI: 1.98 to 8.43), and smoking 3.59 (CI: 1.12 to 4.47)). They are clinically indistinguishable from, but much more prevalent than, oral cancer, and most will never undergo malignant change. They therefore can prevent dentists from accurately detecting malignancy during the clinical examination of high-risk patients. However, they can easily be differentiated from other benign lesions by visual examination alone. Further research into diagnostic technology is needed to help differentiate them from oral cancers.
通过直接目视检查筛查口腔癌被认为效果不佳，因为难以将少数恶性肿瘤与在高危人群中更为常见的良性口腔黏膜病变（OML）区分开来。对 1111 名有口腔癌风险因素（包括烟草和槟榔（paan）消费）的个体进行口腔视觉检查时，记录了所有发现的 OML 的标准化临床诊断。可疑病变被转介进行活检和明确诊断。在 604 名参与者中发现了 1438 个 OML，具有 32 种不同的临床诊断。对转诊的分析揭示了两个不同的群体：视觉良性病变（VBL）无一例被转诊，以及视觉复杂病变（VCL），包括 661 个 OML，具有 9 种不同的临床诊断。活检后，VCL 包括已知的潜在恶性疾病（PMD）以及良性病变，如槟榔黏膜炎。VCL（而非 VBL）与口腔癌具有相同的风险因素（槟榔为 5.82（CI：1.98 至 8.43），吸烟为 3.59（CI：1.12 至 4.47），p<0.05）。它们在临床上与口腔癌无法区分，但比口腔癌更为常见，而且大多数病变永远不会发生恶性变化。因此，它们会妨碍牙医在对高危患者进行临床检查时准确检测恶性肿瘤。然而，仅通过目视检查就可以很容易地将它们与其他良性病变区分开来。需要进一步研究诊断技术，以帮助区分它们与口腔癌。
