Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: A cross-sectional study
BACKGROUND ViziLite Plus with TBlue system (Zila Pharmaceuticals; now Zila, a division of Tolmar, Fort Collins, Colo.) and VELscope (LED Dental, White Rock, British Columbia, Canada) are oral cancer screening aids that have been developed to assist dentists in identifying precancerous and cancerous oral lesions. METHODS The authors screened patients with an overhead examination light and then with VELscope or ViziLite. Patients with a clinically innocuous lesion underwent a biopsy, and the authors compared the results of tissue pathological analysis with findings from the screening aid tests to determine the sensitivity and specificity of each device. The authors tested these devices to determine their ability to aid in the decision-making process regarding whether further evaluation of a clinically innocuous lesion was required. RESULTS The authors examined 102 lesions with ViziLite and then biopsied them [corrected]. They found three dysplasias and one malignancy, none of which were detected with the ViziLite (sensitivity = 0 percent, confidence interval [CI] = 0-60.2 percent; specificity = 75.5 percent, CI = 66.7-82.8 percent). The authors examined another 156 lesions with VELscope and then biopsied them [corrected].They found 11 dysplasias and one malignancy, six of which were detected with VELscope (sensitivity = 50 percent, CI = 21.1-78.9 percent; specificity = 38.9 percent, CI = 30.8-46.9 percent). CONCLUSIONS The study results indicate that use of ViziLite or VELscope along with a conventional screening examination for lesions deemed clinically innocuous was not beneficial in identifying dysplasia or cancer. Additional clinical studies are needed before these devices can be recommended. CLINICAL IMPLICATIONS Clinicians and patients could have a false sense of security after obtaining a negative ViziLite or VELscope examination result because potentially large numbers of precancerous and cancerous lesions will be missed by both devices.