title: Assessment of tissue autofluorescence and reflectance for oral cavity cancer screening.
abstract: OBJECTIVE
  Although approved by the US Food and Drug Administration for clinical use, the utility of handheld tissue reflectance and autofluorescence devices for screening head and neck cancer patients is poorly defined. There is limited published evidence regarding the efficacy of these devices. The authors investigated the sensitivity and specificity of these modalities compared with standard examination.
  
  
  METHODS
  Prospective, cross-sectional analysis.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  Patients who were treated previously for head and neck cancer (n = 88) between 2009 and 2010 were included. Patients were screened using white light visualization (standard of care) and compared with tissue reflectance and autofluorescence visualization. Screening results were compared with biopsy or long-term follow-up.
  
  
  RESULTS
  Autofluorescence visualization had a specificity of 81% and a sensitivity of 50% for detecting oral cavity cancer, whereas white light visualization had a specificity of 98% and a sensitivity of 50%. Tissue reflectance visualization had low sensitivity (0%) and good specificity (86%). The power of this study was insufficient to compare the positive and negative predictive values of standard white light examination (50% and 98%, respectively) to tissue autofluorescence (11% and 97%) or reflectance (0% and 95%). In addition, stratification by previous radiation therapy found no statistically significant difference in screening results.
  
  
  CONCLUSIONS
  Standard clinical lighting has a higher specificity than tissue reflectance and autofluorescence visualization for detection of disease in patients with a history of head and neck cancer. This study does not support the added costs associated with these devices.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Sweeny
authors.forename: Nichole R
authors.initials: NR
authors.lastname: Dean
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: Lisa
authors.initials: L
authors.lastname: Clemons
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005453:Fluorescence; D006258:Head and Neck Neoplasms / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008857:Microscopy, Interference; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity