ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title VELscope Is Not Able To Identify Pre-Cancerous And Cancerous Oral Lesions
Clinical Question Will using the VELscope improve the general dentist’s ability to identify benign, precancerous and cancerous lesions?
Clinical Bottom Line The VELscope does not find occult lesions and cannot determine if a lesion is a dysplasia or cancer.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20123872Mehrota/2010156 (biopsied lesions)Cross-sectional comparison to tissue biopsy
Key resultsThis study compared Velscope screening results with histopathologic findings in lesions deemed to be clinically innocuous according to conventional light examination. The results were; Sensitivity: 50%, Specificity: 38.9%, PPV: 6.4%, NPV: 90.3%. The high false-negative rates could potentially result in large numbers of precancerous and cancerous lesions being missed. High false-negative rates will lead to delayed diagnosis and a potentially greater number of oral cancers diagnosed at an advanced stage.
#2) 19639920Huber/2009130 (smoked 1PPD)Observational Study
Key resultsThe clinical findings derived from a conventional examination protocol were compared to the findings observed with the VELscope. Ten suspicious lesions were identified by conventional examination. No occult lesions were found using the VELscope. No Sensitivity or Specificity values were determined in this study.
#3) 20714910Koch/201078 patients with previously identified lesionsClinical Trial (Blinded)
Key results78 patients with suspicious oral mucosal lesions previously identified using conventional light were examined using the VELscope. The researcher wanted to find out if the malignant lesions could be distinguished from the benign. The results are as follow; Sensitivity: 93%, Specificity: 13-17%, PPV: 41%, NPV: 75-80%. Use of the VELscope could not reliably distinguish benign oral lesions from dysplasia or SSC.
#4) 20123872Awan/2011126 patients with oral lesions lesionsClinical Trial (Blinded)
Key resultsAll the patients had oral red and white patches which were potentially malignant. The objective of this study was to evaluate the accuracy of auto-fluorescence against conventional oral examination and surgical biopsy. With a Sensitivity: 84.1%, Specificity: 15% the VELscope was unable to discriminate between high and low-risk lesions.
Evidence Search VELscope[All Fields] AND "mouth neoplasms"[MeSH Terms]
Comments on
The Evidence
The VELscope added no benefit to a screening exam. It was not able to identify any occult lesions or lesions that had not been previously found using a conventional light source. The VELscope could not distinguish between benign, dysplastic or cancerous oral lesions.
Applicability Further well designed clinical studies are needed to evaluate the effectiveness of VELscope before it can be recommended for use by the general practitioner in a general practice.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords Autoflouresence, VELscope, oral cancer
ID# 2134
Date of submission: 09/30/2011spacer
E-mail robinsfam@aol.com
Author Miriam Robins, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Michaell A. Huber, DDS
Faculty mentor/Co-author e-mail HuberM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Michaell Huber, DDS (San Antonio, TX) on 12/03/2015
The limited data does appear to support the option of using the Velscope as an adjunctive case assessment aid to assist the surgeon in delineating the surgical margins of a suspected lesion. However, the original clinical question assessed the value of the Velscope as an adjunctive screening aid to be used in the performance of the routine patient examination.
by Prashant Amin, DDS (San Antonio, TX) on 11/16/2015
I conducted a PubMed search on this topic in October of 2015, and found 2 more recent publications by Rashid/2015 (PubMed ID: 25183259) and Hanken/2015 (PubMed ID: 23967796). These 2 articles suggest that VELscope may not be useful as a diagnostic tool in detection of oral cancer, or differentiation between pre-cancerous and cancerous lesions. However, in the hands of an experienced clinician, it can be utilized as an adjunct to biopsy when determining borders of lesions.
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