Efficacy of non-invasive diagnostic methods in the diagnosis and screening of oral cancer and precancer

Abstract Introduction: Traditional meta-analyses on the diagnostic accuracy of oral lesions have been conducted, but they were inherently limited to direct pairwise comparisons between a single method and a single alternative, while multiple diagnostic options and the ranking thereof were methodologically not possible. Objective: To evaluate the diagnostic values of various methods in patients with oral potential malignant disease by performing a network meta-analysis. Methods: Two authors independently searched the databases (MEDLINE, SCOPUS, the Cochrane Register of Controlled Trials, and Google scholar) up to June 2020 for studies comparing the diagnostic accuracy of various tools (autofluorescence, chemiluminescence, cytology, narrow band imaging, and toluidine blue) with visual examination or other tools. The outcomes of interest for this analysis were sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results: Treatment networks consisting of six interventions were defined for the network metaanalysis. The results of traditional meta-analysis showed that, among six methods, narrow band imaging showed higher sensitivity, specificity, negative predictive value, positive predictive value, and accuracy compared to visual examination. The results of network meta-analysis showed that autofluorescence, chemiluminescence, and narrow band imaging had higher sensitivity compared with visual examination, and that chemiluminescence and narrow band imaging had higher negative predictive value compared with visual examination. However, autofluorescence and chemiluminescence had lower specificity compared with visual examination. There were no significant differences in positive predictive value and accuracy among the six interventions. Conclusion: This study demonstrated that narrow banding imaging has superiority in terms of sensitivity and negative predictive value compared with the other five tested agents.

摘要 引言：既往已有针对口腔病变诊断准确性的传统荟萃分析，但此类研究固有局限于单一方法与单一对照方法间的直接两两比较，无法从方法学层面实现多诊断方案的比较及其排名。
研究目的：本研究通过开展网络荟萃分析（network meta-analysis），评估各类诊断方法在口腔潜在恶性疾患患者中的诊断价值。
研究方法：两名研究者独立检索截至2020年6月的数据库（MEDLINE、SCOPUS、考克兰对照试验注册库（Cochrane Register of Controlled Trials）、谷歌学术（Google scholar）），筛选对比各类工具（自体荧光（autofluorescence）、化学发光（chemiluminescence）、细胞学检查（cytology）、窄带成像（narrow band imaging）、甲苯胺蓝（toluidine blue））与视诊或其他工具诊断准确性的相关研究。本分析关注的结局指标包括灵敏度、特异度、阴性预测值、阳性预测值及诊断准确度。研究同时开展了标准两两荟萃分析与网络荟萃分析。
研究结果：网络荟萃分析共纳入包含6种干预措施的治疗网络。传统荟萃分析结果显示，在6种方法中，窄带成像的灵敏度、特异度、阴性预测值、阳性预测值及诊断准确度均优于视诊。网络荟萃分析结果显示，自体荧光、化学发光及窄带成像的灵敏度优于视诊，化学发光与窄带成像的阴性预测值优于视诊；但自体荧光与化学发光的特异度低于视诊。6种干预措施的阳性预测值与诊断准确度无显著差异。
研究结论：本研究表明，相较于其余5种受试诊断工具，窄带成像在灵敏度与阴性预测值方面具有优势。