1
What about new ways
of detecting potentially
malignant lesions
earlier?
Critical Evaluation of Diagnostic Aids for
the Detection of Oral Cancer*
M Lingen, J Kalmar, T Karrison & P Speight
Oral Oncology 2008 Jan;44(1):10-22
University of Chicago, Ohio State University, University of Sheffield
* A position paper of the
American Academy of Oral and Maxillofacial Pathology
True Positive and True
Negative Requires a
“GOLD STANDARD”
GOLD STANDARD for
tissue diagnosis is a
scalpel biopsy
Screening vs. Case-Finding
•Case-finding - a diagnostic test for
a patient who has abnormal signs or
symptoms (Class I)
•Screening - checking for a disease in a
person who is symptom free (Class II)
Evidence of
chemiluminescence
enhancing intraoral
examinations?
Let’s look at the scientific
literature
2
Evidence of chemiluminescence
enhancing intraoral
examinations?
Literature was only for
gynecological
examinations until 2004
Acetic Acid Wash and Chemiluminescent Illumination as
an Adjunct to Conventional Oral Soft Tissue Examination
for the Detection of Dysplasia: A Pilot Study
Huber MA, Bsoul SA, Terezhalmy GT
Quintessence International 2004: 35(5):378-84
•150 consecutive patients
• Examined linea alba, leukoedema, hairy tongue, leukoplakia, traumatic
ulcer, fibroma, amalgam tattoo, tori and frictional keratosis
• All 32 cases of leukoedema were positive (aceto-white) - False Positives
• 2 of 14 frictional keratoses were positive; No biopsies performed on
“frictional keratoses”
• 3 Leukoplakias
1 biopsied = hyperkeratosis
2 brushed, 1 “atypical” biopsied = ulcer
• One lesion aceto-white lesion identified not clinically apparent
Strengths of this study
• Large sample size
• Consecutive patients
• One lesion detected by ViziLite (not stated what diagnosis was)
Weaknesses of this study
• Few cases with histologic correlation
• Can’t assess sensitivity, specificity or predictive value
• High false positives - suggests that sensitivity may be
high but specificity and PPV are low
Chemiluminescence as a diagnostic aid in the detec