Little evidence for the effectiveness of chemiluminescence and autofluorescent imaging devices as oral cancer screening adjuncts.

DATA SOURCES: Medline/PubMed. STUDY SELECTION: Primary studies where an optical device was used for investigation, screening or as a diagnostic tool for OSCC or OPMD were considered. DATA EXTRACTION AND SYNTHESIS: Data were abstracted by two reviewers independently and the biological plausibility, technical feasibility and diagnostic performance assessed. RESULTS: Twenty-five studies were included, 13 involving the use of chemiluminescence and 12 using autofluorescence with some using both. Chemiluminescence showed sensitivity at detecting any OPMDs and oral cancer, but preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss often extends beyond the clinically visible lesion. However, in addition to OPMDs, it may detect erythematous lesions of benign inflammation resulting in false-positive test results. CONCLUSIONS: In agreement with previous reviews, there is inadequate evidence to draw valid conclusions on the effectiveness of chemiluminescence and autofluorescent imaging devices as screening adjuncts. There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.