Clinical utility of oral cytology for detecting oral epithelial dysplasia or worse: A diagnostic meta-analysis

Abstract

Background

The majority of oral cancers are diagnosed at an advanced stage. It has been demonstrated that the implementation of screening programs reduces mortality rates. Oral cytology is a technique that is used in these programs. However, the accuracy of oral cytology remains controversial. Therefore, the objective of this meta-analysis was to validate the accuracy of oral cytology.

Methods

A literature search was conducted in the PubMed, Embase, and Cochrane Library databases to identify eligible studies. The inclusion criteria were as follows: studies that evaluated the diagnostic accuracy of oral cytology for low-grade squamous intraepithelial lesion or worse. The article incorporated peer-reviewed articles. In addition, studies that provided sufficient data for conducting a meta-analysis were assessed. The meta-analysis was conducted using a bivariate random-effects model.

Results

In total, 26 articles comprising 8397 specimens were included in the study. The meta-analysis yielded a pooled sensitivity of 93.8% and a pooled specificity of 87.7% of oral cytology for identifying oral epithelia dysplasia or worse. A subgroup analysis of studies that evaluated oral cytology with Papanicolaou staining demonstrated a pooled sensitivity of 94.8%. The accuracy of oral cytology in detecting high-grade squamous intraepithelial lesion or worse was examined, resulting in a pooled sensitivity of 95.7%.

Conclusions

This meta-analysis indicated that oral cytology exhibited high sensitivity and specificity in detecting oral epithelia dysplasia or worse, with slightly higher sensitivity for high-grade squamous intraepithelial lesion or worse. A notable advantage of using oral cytology with Papanicolaou staining is the potential for enhanced sensitivity.