Twenty-three studies were included in the review. The figures cited below were given in online supplementary tables (see URL for Additional Data).
Vital staining with toluidine blue (14 studies, 17 data sets, 2,285 participants and 2,309 lesions): The quality scores for studies that assessed the accuracy of vital tissue staining with toluidine blue ranged from 15±5 to 77.5±2.5. Biopsy was not performed in all positive lesions in all studies. The prevalence of oral premalignant and malignant lesions ranged from 26 to 81%. Diagnostic sensitivities ranged from 38 to 100%; specificities ranged from 9 to 100%.
Visualization using ViziLite (three studies, 179 participants, 183 lesions): All studies included only patients with previously visualised mucosal lesions. The quality scores for studies that assessed the accuracy of ViziLite ranged from 32.5±2.5 to 55±5. Diagnostic sensitivity was 100% in all cases; specificity ranged from 0 to 14%. One study (n=84 participants, 97 lesions) assessed the accuracy of ViziLite in combination with toluidine blue staining. The quality score for this study was 55.5 ± 5. Diagnostic sensitivity was 100% and specificity was 55%.
Visualization using VELscope: No studies were identified that assessed the current VELscope, but two studies (three data sets) assessed the accuracy of the underlying technology. The quality scores of these studies were 42.5±2.5 and 60±0. Diagnostic sensitivity ranged from 98 to 100%; specificity ranged from 78 to 100%.
Cytopathology using the brush biopsy OralCDx: (four studies, 1,435 participants, 749 lesions): The quality scores for studies that assessed the accuracy of cytopathology using the brush biopsy OralCDx ranged from 37.5±2.5 to 50±0. The prevalence of oral premalignant and malignant lesions ranged from 19 to 38%. Diagnostic sensitivities ranged from 71 to 100%; specificities ranged from 25 to 94%.
No studies of Microlux DL (low-energy blue light system) or Orascoptic DK (hand-held LED instrument with an oral lesion screening attachment) met the inclusion criteria.