Efficacy of toluidine blue in the diagnosis and screening of oral cancer and pre-cancer: A systematic review and meta-analysis.

AIMS: The accuracy of toluidine blue (TB) and chemiluminescence for diagnosing oral cancer and pre-cancer was evaluated. METHODS: Two authors (working independently) comprehensively reviewed six databases (PubMed, Cochrane database, Embase, Web of Science, SCOPUS and Google Scholar) from their dates of inception until March 2020. Oral mucosal disorder, as detected by TB, was compared with that detected by chemiluminescence. True-positive, true-negative, false-positive and false-negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). The extent of interrater agreement was also assessed. RESULTS: Twenty-nine prospective and retrospective studies were included. The diagnostic odds ratio (DOR) of TB was 7.017 (95% confidence interval [CI], 4.544; 10.836). The area under the summary receiver operating characteristic curve was 0.766. The correlation between the sensitivity and the false-positive rate was 0.196, indicating the absence of heterogeneity. TB exhibited moderate interrater reliability (0.6777; 95% CI, 0.43; 0.7455). Compared with chemiluminescence, as used in nine studies, TB had a lower sensitivity (0.659 vs 0.841), but a higher specificity (0.809 vs 0.345), negative predictive value (0.766 vs 0.690) and DOR (10.565 vs 5.203). Compared with clinical examination, as used in four studies, TB method had a higher sensitivity (0.891 vs 0.891), specificity (0.739 vs 0.634), negative predictive value (0.920 vs 0.714) and DOR (28.491 vs 8.526). Subgroup analysis showed that screening for severe dysplasia or more severe disease was significantly more sensitive, but less specific, than screening for all dysplasias. CONCLUSIONS: Although the diagnostic accuracy of TB in the diagnostic work-up of oral cancer and pre-cancer was higher than that of clinical examination, it was not high enough for TB to reliably be used alone. Instead, it should be combined with chemiluminescence or other diagnostic tools.

Multi-Target Stool DNA Testing for Colorectal Cancer Screening: Emerging Learning on Real-world Performance.

PURPOSE OF REVIEW: Multi-target stool DNA (MT-sDNA) was approved in 2014 for use in screening average-risk patients for colorectal cancer (CRC). Here, we highlight recent literature from post-market studies to provide an update on clinical use and utility not possible from pre-approval studies. RECENT FINDINGS: MT-sDNA has been included in major society guidelines as an option for colorectal cancer screening, and has seen exponentially increasing use in clinical practice. MT-sDNA appears to be attracting new patients to CRC screening, and patient adherence to diagnostic colonoscopy after a positive MT-sDNA test is high. Approximately two-thirds of these patients are found to have colorectal neoplasia (CRN), 80% of whom have at least one right-sided lesion; 1 in 3 will have advanced CRN. High yield of CRN is due not only to post-screening increase in probability but also likely improved endoscopist attention. In those with a negative high-quality colonoscopy after positive MT-sDNA test ("false positive MT-sDNA"), further interventions do not appear to be necessary. SUMMARY: MT-sDNA is a promising tool to improve rates and quality of CRC screening. Further investigation should examine MT-sDNA performance in populations at increased risk for CRC, and as an interval test after colonoscopy to detect potentially missed lesions.

Lesiones cancerígenas y precancerosas bucales. Factores de riesgos asociados. Policlínico Bernardo Posse. Año 2017 / Cancerous and pre-cancerous buccal lesions. Associated risk factors. Policlínico Bernardo Posse Years 2017

RESUMEN Introducción: el cáncer bucal constituye uno de los mayores problemas de salud al cual se enfrenta la humanidad, no solo en el ámbito de salud pública sino también en la ciencia en general, que afecta un grupo significativo de personas en todo el mundo. Objetivo: describir el comportamiento de las lesiones precancerígenas y cancerígenas de la cavidad bucal y los factores de riesgos asociados en individuos pertenecientes al Policlínico Bernardo Posse, municipio San Miguel del Padrón, La Habana, 2017. Materiales y métodos: se realizó un estudio analítico retrospectivo en pacientes de más de 15 años de edad entre enero y noviembre del 2017 sobre los factores de riesgo asociados con la aparición de lesiones premalignas y malignas del complejo bucal con un universo de 631 pacientes. Se operacionalizaron las variables en estudio. Resultados: se mostró un predominio del sexo masculino en un 52,9 %, siendo el grupo de edad más frecuente el comprendido entre 35 a 59 años para un 53.2%. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos mayor de 60 años para un 1,42 %. De los pacientes examinados, el 53.2% consumen bebidas alcohólicas de forma habitual. Conclusiones: en el estudio predominaron las personas del sexo masculino y los mayores de 35 años de edad. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos de mayor de 60 años. Se constató relación entre los factores de riesgo estudiados y la presencia de lesiones malignas y premalignas (AU).

ABSTRACT Introduction: cancer is one the major health problems in humanity, not only in the field of public health, but also in science in general.It affects a significant group of persons in the world. Objetive: to describe the behavior of the cancerous and pre-cancerous lesions in the buccal cavity and risk factors associated with patients assisted in Bernardo Posse Clinic, located in San Miguel del Padrón municipality, Havana, 2017. Materials and methods: an analytic and retrospective study about risk factors associated with cancerous and pre-cancerous lesions in the buccal cavity in patients aged 15 and over, between January and November, 2017. There is a universe of 631 patients. Some variable were analyzed in the study. Results: the male sex predominated prove a predominance of sex masculine with a 52, 9 %. The 35 and 59 age group was the most affected, with a 53,2%. The age group older than 60 was the most affected with pre-cancerous lesions in the buccal cavity, with a 1, 42 %. From the patients examined throughout the research, the 53, 2% consumed alcohol in a regular way. Conclusions: in the study predominated the persons of male sex and the older than 35 years. The pre-cancerous lesions were more frequent in the age group older than 60 years .If was proved the relation between the risk factors and the cancerous and pre-cancerous lesions (AU).

Lesiones cancerígenas y precancerosas bucales. Factores de riesgos asociados. Policlínico Bernardo Posse. Año 2017 / Cancerous and pre-cancerous buccal lesions. Associated risk factors. Policlínico Bernardo Posse Years 2017

RESUMEN Introducción: el cáncer bucal constituye uno de los mayores problemas de salud al cual se enfrenta la humanidad, no solo en el ámbito de salud pública sino también en la ciencia en general, que afecta un grupo significativo de personas en todo el mundo. Objetivo: describir el comportamiento de las lesiones precancerígenas y cancerígenas de la cavidad bucal y los factores de riesgos asociados en individuos pertenecientes al Policlínico Bernardo Posse, municipio San Miguel del Padrón, La Habana, 2017. Materiales y métodos: se realizó un estudio analítico retrospectivo en pacientes de más de 15 años de edad entre enero y noviembre del 2017 sobre los factores de riesgo asociados con la aparición de lesiones premalignas y malignas del complejo bucal con un universo de 631 pacientes. Se operacionalizaron las variables en estudio. Resultados: se mostró un predominio del sexo masculino en un 52,9 %, siendo el grupo de edad más frecuente el comprendido entre 35 a 59 años para un 53.2%. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos mayor de 60 años para un 1,42 %. De los pacientes examinados, el 53.2% consumen bebidas alcohólicas de forma habitual. Conclusiones: en el estudio predominaron las personas del sexo masculino y los mayores de 35 años de edad. Las lesiones precancerígenas de la cavidad bucal fueron más frecuentes en los grupos etáreos de mayor de 60 años. Se constató relación entre los factores de riesgo estudiados y la presencia de lesiones malignas y premalignas.

ABSTRACT Introduction: cancer is one the major health problems in humanity, not only in the field of public health, but also in science in general.It affects a significant group of persons in the world. Objetive: to describe the behavior of the cancerous and pre-cancerous lesions in the buccal cavity and risk factors associated with patients assisted in Bernardo Posse Clinic, located in San Miguel del Padrón municipality, Havana, 2017. Materials and methods: an analytic and retrospective study about risk factors associated with cancerous and pre-cancerous lesions in the buccal cavity in patients aged 15 and over, between January and November, 2017. There is a universe of 631 patients. Some variable were analyzed in the study. Results: the male sex predominated prove a predominance of sex masculine with a 52, 9 %. The 35 and 59 age group was the most affected, with a 53,2%. The age group older than 60 was the most affected with pre-cancerous lesions in the buccal cavity, with a 1, 42 %. From the patients examined throughout the research, the 53, 2% consumed alcohol in a regular way. Conclusions: in the study predominated the persons of male sex and the older than 35 years. The pre-cancerous lesions were more frequent in the age group older than 60 years .If was proved the relation between the risk factors and the cancerous and pre-cancerous lesions.

Influence of fluorescence on screening decisions for oral mucosal lesions in community dental practices.

BACKGROUND: Quality of oral screening examinations is dependent upon the experience of the clinician and can vary widely. Deciding when a patient needs to be referred is a critical and difficult decision for general practice clinicians. A device to aid in this decision would be beneficial. The objective of this study was to to examine the utility of direct fluorescence visualization (FV) by dental practitioners as an aid in decision-making during screening for cancer and other oral lesions. METHODS: Dentists were trained to use a stepwise protocol for evaluation of the oral mucosa: medical history, head, neck and oral exam, and fluorescent visualization exam. They were asked to use clinical features to categorize lesions as low (LR), intermediate (IR), or high (HR) risk and then to determine FV status of these lesions. Clinicians made the decision of which lesions to reassess in 3 weeks and based on this reassessment, to refer forward. RESULTS: Of 2404 patients screened over 11 months, 357 initially had lesions with 325 (15%) identified as LR, 16 (4.5%) IR, and 16 (4.5%) HR. Lesions assessed initially as IR and HR had a 2.7-fold increased risk of FV loss persisting to the reassessment appointment versus the LR lesions. The most predictive model for lesion persistence included both FV status and lesion risk assessment. CONCLUSION: A protocol for screening (assess risk, reassess, and refer) is recommended for the screening of abnormal intraoral lesions. Integrating FV into a process of assessing and reassessing lesions significantly improved this model.