Diagnostic Performance of Autofluorescence for Oral Lesions: A Comparison Between a Postgraduate and an Expert Clinician

TL;DR

This study compares how a postgraduate dentist and an expert clinician use autofluorescence to detect oral lesions, finding that it improves sensitivity but lowers specificity, especially for less experienced users.

Contribution

The study evaluates the impact of autofluorescence on diagnostic performance differences between a novice and an expert in oral lesion detection.

Findings

Autofluorescence increased sensitivity for both clinicians, with postgraduate dentists showing a larger improvement.

Specificity and positive predictive value decreased when using autofluorescence, particularly for the postgraduate dentist.

Autofluorescence should be used as a complementary tool alongside clinical expertise and histopathological confirmation.

Abstract

Background/Objectives: Autofluorescence (AF) is a widely used adjunctive tool in the detection of oral potentially malignant disorders (OPMDs) and malignant lesions, but its performance can be influenced by clinicians’ experiences. This study aimed to examine how AF influences diagnostic decision-making and performances of a novice clinician compared with those of an experienced examiner. Methods: A total of 80 patients with oral lesions participated in this cross-sectional study. Each underwent a standard oral examination (OE) followed by an assessment with the VELscope® System Vx (LED Medical Diagnostics Inc., Burnaby, BC, Canada), independently conducted by an expert clinician (E) and a postgraduate dentist (PD), both blinded to each other’s results. Biopsy and histopathological analysis provided the reference diagnosis. After every examination, lesions were categorized as either “Risk of Malignancy” (RM) or “No Risk of Malignancy” (NRM). Results: Based on OE, PD identified 39 RM lesions, while E 29. AF with VELscope® identified an additional 12 RM lesions for the PD and 7 for the E that were not suspected on OE alone. Combining OE with VELscope® improved sensitivity (PD: 90.9%; E: 95.4%) and negative predictive value (PD: 91.7%; E: 97.6%), while decreasing specificity (PD: 37.9%; E: 70.7%) and positive predictive value (PD: 35.7%; E: 55.3%) compared with OE alone. Conclusions: AF increases diagnostic sensitivity, particularly for less experienced clinicians, while offering moderate advantages for experts. Nevertheless, the corresponding decline in specificity emphasizes the need for cautious interpretation. AF should be incorporated as a complementary tool within structured diagnostic pathways, accompanied by adequate training, and cannot replace histopathological confirmation or clinical expertise.

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