Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Sneha Sethi; Xiangqun Ju; Richard M Logan; Paul Sambrook; Robert A McLaughlin; Lisa M Jamieson

doi:10.3390/ijerph182312390

Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2021 Nov 25;18(23):12390. doi: 10.3390/ijerph182312390.

Authors

Sneha Sethi¹, Xiangqun Ju¹, Richard M Logan², Paul Sambrook^{2

3}, Robert A McLaughlin^{4

5

6}, Lisa M Jamieson¹

Affiliations

¹ Australian Research Centre for Population Oral Health, Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
² Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
³ Oral and Maxillofacial Surgery Unit, SA Dental Service, Adelaide, SA 5005, Australia.
⁴ School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
⁵ Australian Research Council Centre of Excellence for Nanoscale Biophotonics, The University of Adelaide, Adelaide, SA 5005, Australia.
⁶ Institute of Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA 5005, Australia.

Abstract

Background: Advances in treatment approaches for patients with oral squamous cell carcinoma (OSCC) have been unsuccessful in preventing frequent recurrences and distant metastases, leading to a poor prognosis. Early detection and prevention enable an improved 5-year survival and better prognosis. Confocal Laser Endomicroscopy (CLE) is a non-invasive imaging instrument that could enable an earlier diagnosis and possibly help in reducing unnecessary invasive surgical procedures.

Objective: To present an up to date systematic review and meta-analysis assessing the diagnostic accuracy of CLE in diagnosing OSCC.

Materials and methods: PubMed, Scopus, and Web of Science databases were explored up to 30 June 2021, to collect articles concerning the diagnosis of OSCC through CLE. Screening: data extraction and appraisal was done by two reviewers. The quality of the methodology followed by the studies included in this review was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random effects model was used for the meta-analysis.

Results: Six studies were included, leading to a total number of 361 lesions in 213 patients. The pooled sensitivity and specificity were 95% (95% CI, 92-97%; I² = 77.5%) and 93% (95% CI, 90-95%; I² = 68.6%); the pooled positive likelihood ratios and negative likelihood ratios were 10.85 (95% CI, 5.4-21.7; I² = 55.9%) and 0.08 (95% CI, 0.03-0.2; I² = 83.5%); and the pooled diagnostic odds ratio was 174.45 (95% CI, 34.51-881.69; I² = 73.6%). Although risk of bias and heterogeneity is observed, this study validates that CLE may have a noteworthy clinical influence on the diagnosis of OSCC, through its high sensitivity and specificity.

Conclusions: This review indicates an exceptionally high sensitivity and specificity of CLE for diagnosing OSCC. Whilst it is a promising diagnostic instrument, the limited number of existing studies and potential risk of bias of included studies does not allow us to draw firm conclusions. A conclusive inference can be drawn when more studies, possibly with homogeneous methodological approach, are performed.

Keywords: confocal laser endomicroscopy; diagnostic test accuracy; meta-analysis; oral squamous cell carcinoma; systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Carcinoma, Squamous Cell* / diagnostic imaging
Head and Neck Neoplasms*
Humans
Lasers
Microscopy, Confocal
Mouth Neoplasms* / diagnostic imaging
Sensitivity and Specificity
Squamous Cell Carcinoma of Head and Neck