de Koning Klijs J, Adriaansens Carleen M E M, Noorlag Rob, de Bree Remco, van Es Robert J J
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Cancers (Basel). 2024 Mar 14;16(6):1148. doi: 10.3390/cancers16061148.
This systematic review investigates techniques for determining adequate mucosal margins during the resection of oral squamous cell carcinoma (SCC). The primary treatment involves surgical removal with ≥5 mm margins, highlighting the importance of accurate differentiation between SCC and dysplasia during surgery.
A comprehensive Embase and PubMed literature search was performed. Studies underwent quality assessment using QUADAS-2.
After the full-text screening and exclusion of studies exhibiting high bias, eight studies were included, focusing on three margin visualization techniques: autofluorescence, iodine staining, and narrow-band imaging (NBI). Negative predictive value (NPV) was calculable across the studies, though reference standards varied. Results indicated NPVs for autofluorescence, iodine, and NBI ranging from 61% to 100%, 92% to 99%, and 86% to 100%, respectively. Autofluorescence did not significantly enhance margins compared to white light-guided surgery, while iodine staining demonstrated improvement for mild or moderate dysplasia. NBI lacked comparison with a white light-guided surgery cohort.
We recommend studying and comparing the diagnostic accuracy of iodine staining and NBI in larger cohorts of patients with oral SCC, focusing on discriminating between SCC and (severe) dysplasia. Furthermore, we advise reporting the diagnostic accuracy alongside the treatment effects to improve the assessment of these techniques.
本系统评价研究了口腔鳞状细胞癌（SCC）切除术中确定足够黏膜切缘的技术。主要治疗方法是手术切除，切缘≥5mm，这凸显了手术过程中准确区分SCC和发育异常的重要性。
对Embase和PubMed进行了全面的文献检索。使用QUADAS-2对研究进行质量评估。
在全文筛选并排除显示高偏倚的研究后，纳入了八项研究，重点关注三种切缘可视化技术：自体荧光、碘染色和窄带成像（NBI）。尽管参考标准各不相同，但各项研究中均可计算出阴性预测值（NPV）。结果表明，自体荧光、碘染色和NBI的NPV分别为61%至100%、92%至99%和86%至100%。与白光引导手术相比，自体荧光并未显著改善切缘，而碘染色对轻度或中度发育异常有改善作用。NBI缺乏与白光引导手术队列的比较。
我们建议在更大规模的口腔SCC患者队列中研究和比较碘染色和NBI的诊断准确性，重点是区分SCC和（重度）发育异常。此外，我们建议在报告治疗效果的同时报告诊断准确性，以改进对这些技术的评估。
