Beyond Visual Inspection: A Systematic Review of Adjunctive Aids for the Early Detection of Oral Squamous Cell Carcinoma

TL;DR

This systematic review evaluates tools that help detect early signs of oral cancer, finding that narrow band imaging is the most promising for experts, but none are ideal for general dentists.

Contribution

The study systematically evaluates the diagnostic accuracy of various visual aids for early detection of oral cancer compared to standard methods.

Findings

Narrow band imaging (NBI) showed the highest sensitivity and specificity among the tested visual aids.

Visual aids like VELscope and ViziLite had lower specificity, limiting their use for general screening.

Study heterogeneity and lack of randomized trials hindered stronger conclusions.

Abstract

Background/Objectives: The early detection of oral squamous cell carcinoma (OSCC), especially when in the presence of oral potentially malignant disorders (OPMDs), may be challenging and would assist in improving poor OSCC survival rates reported in the literature. We conducted a systematic review to evaluate the utility of adjunctive aids that could assist during clinical examination of the oral cavity to identify suspicious mucosal lesions. Methods: Three databases (CENTRAL, PubMed/MEDLINE, Embase) were screened, limiting results from 2015 to November 2025. Inclusion criteria were: articles written in English; investigating the diagnostic accuracy of diagnostic visual aids compared to conventional oral examination under white light in the assessment of oral mucosal lesions. Extracted data were analysed narratively. Studies not reporting diagnostic accuracy using biopsy results as the gold standard were excluded. Results: The search produced 137 articles; after removing duplicates, 105 were screened through inclusion/exclusion criteria, leading to 17 papers included in the review. Eight articles investigated diagnostic accuracy of narrow band imaging (NBI), seven visually enhanced lesion scopes (VELscopes), one Glasses for Oral Cancer Curing Light Exposed Screening (GOCCLES), one ViziLite chemiluminescence system, and two toluidine blue (TB). Conclusions: High study heterogeneity and lack of randomized clinical trials limit the conclusions of this review. In this context, among the investigated visual aids for expert use, NBI (sensitivity 85–100%, specificity 75–98%) emerges as the most promising tool (VELscope sensitivity 76–87.1%, specificity 21.4–90%; GOCCLES 66%, 48%; ViziLite 77.3%, 27.8%, TB 56.8–91%, 65.3–68%), due to its ability to highlight sub epithelial vascular abnormalities, considered as early indicators of dysplastic or neoplastic progression even. None of the investigated visual aids seem suited for screening purposes/use by the general dentist.

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