The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma

Background. The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC. Methods. The authors conducted automated searches of PubMed, Web of Knowledge and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. Results. The overall diagnostic odds ratio was 6.1 (95 percent confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC. Clinical Implications. On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.