DNA-image cytometry has promise for oral cancer detection.

DATA SOURCES: 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. STUDY SELECTION: Prospective and retrospective studies evaluating brush cytology were considered. Only computer-assisted methods that included histologically confirmed disease positive status were included. DATA EXTRACTION AND SYNTHESIS: 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. RESULTS: 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. CONCLUSIONS: 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.