DNA-image cytometry has promise for oral cancer detection

The Medline, Embase, PubMed, Elsevier and Web of Science databases and the reference lists of known primary and review papers were scanned for relevant citations.

Prospective and retrospective studies evaluating brush cytology were considered. Only computer-assisted methods that included histologically confirmed disease positive status were included.

Data were extracted using a standardised form. Study quality was assessed by one reviewer using the quality assessment of diagnostic accuracy studies (QUADAS) checklist. Pooled sensitivity and specificity were calculated with 95% CIs (confidence intervals) separately for each study. Likelihood and diagnostic odds ratios were also calculated along with a summary receiver-operating characteristic (SROC) curve analysis.

Thirteen studies (eight of OralCDx brush biopsy and five of DNA-image cytometry) reporting on 1981 oral mucosa lesions were included. OralCDx brush biopsy had a pooled sensitivity of 86% (95% CI; 81-90) and pooled specificity of 81% (95% CI; 78-85). The pooled sensitivity and specificity of DNA-image cytometry were 89% (95% CI; 83-94) and 99% (95% CI; 97-100). Diagnostic odds ratio estimates for OralCDx brush biopsy and DNA-image cytometry were 20.36 (95% CI; 2.72-152.67) and 446.08 (95% CI; 73.36-2712.43), respectively. Study size was found to be closely related to heterogeneity among studies and analysis suggested publication bias in relation to OralCDx brush biopsy.

The results of this meta-analysis suggest that DNA-image cytometry has a highly significant potential over OralCDx brush biopsy as an accurate and simple diagnostic tool for clinically suspected oral precancer and oral cancer.