Research On The Application Of VELscope In The Diagnosis Of Oral Potentially Malignant Disorders And The Correlation Of VELscope And Histopathological Factors

Background and Objective:Oral potentially malignant disorders(OPMDs)occur in the oral mucosa and have the potential to cause cancer.OPMDs have a high prevalence(approximately 4.47%),with the rate of cancer development being approximately 7.9%.Therefore,early and effective screening and management of OPMDs is important to prevent carcinogenesis and to improve patient survival rates.OPMDs include a wide range of oral mucosal lesions with various manifestations,and early diagnosis is difficult.Therefore,accurate early diagnosis of OPMDs is challenging for dentists.The VELscope is a tool which uses tissue autofluorescence to distinguish oral mucosal abnormalities from oral cancer,with the advantages of non-invasive,real-time,and convenient operation for the early detection of OPMDs.However,the specificity and sensitivity values vary significantly,and the application range and diagnostic efficacy of the VELscope in the diagnosis of OPMDs requires further study.In addition,VELscope examination results may be biased due to different diagnostic criteria.The potential to objectively evaluate autofluorescence images and to improve diagnostic effectiveness is still a research focus and warrants further research.When VELscope is used to detect OPMDs,it displays a wide range of autofluorescence patterns,varying from loss to increase.The correlation between fluorescence patterns and histopathological features remains to be determined.This study comprehensively evaluated the diagnostic efficacy of VELscope for OPMDs through systematic review of previous relevant diagnostic studies.By analyzing the diagnostic results of 59 oral lesions,this study compared the subjective and objective methods to interpret the results of VELscope autofluorescence and discussed the clinical application range and diagnostic efficacy of VELscope.Through analysis of histopathological factors in the objective interpretation of VELscope results,histopathological factors that may affect diagnostic efficacy were screened to provide a theoretical basis for clinical decision-making.Methods:1.This study was designed according to the principles of PICOS(Population,Intervention,Comparison,Outcome,Study design),and the relevant literature related to VELscope which was published before May 1st 2022 was included.A systematic evaluation and Metaanalysis were performed to determine the sensitivity and specificity of VELscope.2.Fifty-four OPMDs patients who visited Shandong Stomatological Hospital between May 2017 and May 2021 were subjected to conventional oral and VELscope autofluorescence examinations.A kappa test was performed to compare the results of fluorescence detection and histopathological diagnosis.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of VELscope autofluorescence were evaluated by histopathological diagnosis and classification of different lesion sites.3.Samples were randomly selected from the four groups of true positive,false positive,true negative and false negative cases in the objective VELscope autofluorescence examination.Paraffin sections were prepared,and Hematoxylin-Eosion(HE)staining was performed.The keratinized layer thickness,squamous epithelium depth,degree of inflammatory cell infiltration degree,microvessel density and mean vessel area were measured and recorded using OLYMPUS cellSens Entry 3.1 software.Immunohistochemical staining was used to detect the expression of the tumor markers p53 and Ki-67.Logistic regression analysis and other methods were used to analyze the correlation between objective VELscope autofluorescence and the above histopathological features.Results:1.A total of 1468 articles were obtained from the databases,and 17 articles were included in this study,1832 autofluorescence specimens were included and evaluated.All studies were included in the Meta-analysis.The sensitivity of the included studies ranged from 30%to 100%and the specificity ranged from 12%to 100%.The sensitivity of OPMDs detection using the VELscope method was 0.84,with a 95%confidence interval(CI)of 0.76-0.91,and the specificity was 0.48 with a 95%CI of 0.32-0.64.2.The sensitivities of the subjective and objective VELscope autofluorescence methods in distinguishing OPMDs from oral cancer were 76.9%and 65.4%,respectively,and the consistency of objective autofluorescence and histopathological examination was higher than that of subjective autofluorescence(P<0.05).The specificity of the subjective and objective VELscope autofluorescence methods in distinguishing high-risk and low-risk lesions in OPMDs was 50.0%and 82.1%,respectively,and the consistency of objective autofluorescence and histopathological examination was higher than that of subjective autofluorescence(P<0.05).The sensitivity of the subjective VELscope autofluorescence method for distinguishing OPMDs from oral cancer was 81.0%,which was higher than that for the masticatory mucosa.3.The fluorescence pattern of the objective VELscope examination was statistically correlated with the degree of inflammatory cell infiltration(P<0.05),but not with keratinized layer thickness,squamous epithelium depth,microvessel density or mean vessel area(P>0.05).There was no significant correlation between the fluorescence pattern of the objective VELscope examination and the positive expression of p53 and Ki67(P>0.05).Conclusion:1.The results of the Meta-analysis suggest that VELscope has a high sensitivity for screening OPMDs,but low specificity.2.The objective VELscope autofluorescence examination is highly capable of identifying low-risk lesions.The sensitivity of subjective VELscope autofluorescence screening for OPMDs in the covered mucosa was higher than that in the masticatory mucosa.3.The objective VELscope autofluorescence pattern was significantly correlated with the degree of inflammatory cell infiltration.