Autofluorescence imaging to identify oral malignant or premalignant lesions: Systematic review and meta-analysis

The aim is to evaluate the accuracy of autofluorescence for screening oral cancer in comparison with toluidine blue staining and clinical examination. Oral mucosal disorders detected by autofluorescence were compared with those detected using toluidine blue staining. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic odds ratio (DOR) for autofluorescence was 8.197 (95% confidence interval, 4.018-16.723). The area under the summary receiver operating characteristic curve (AUC) was 0.815. Compared with toluidine blue, autofluorescence had a similar sensitivity, negative predictive value, and AUC but a lower specificity and DOR. Compared with clinical examination, the autofluorescence had a higher sensitivity but lower specificity, DOR, and AUC. Although the diagnostic accuracy of autofluorescence in the screening work-up of oral cancer and precancer was more sensitive than those of clinical examination and toluidine blue staining, it was not accurate enough to be used alone reliably.