title: Assessment of a decision making protocol to improve the efficacy of VELscope™ in general dental practice: a prospective evaluation.
abstract: BACKGROUND
  VELscope™ is a device designed to help detect potentially malignant disorders of the oral mucosa at an early stage using direct tissue autofluorescence. Previous research indicates a high rate of false positives using this device. This study assesses a decision making protocol for the detection of oral mucosal lesions using conventional oral examination and VELscope™ in a general dental practice setting.
  
  
  METHODS
  305 patients presenting for general dental treatment were screened by a general dental practitioner (GDP) for oral mucosal lesions using incandescent light (conventional oral examination - COE), followed by VELscope™ and then by correlating the findings from these two examinations. A decision making protocol was followed. Patients were either reviewed or referred to an Oral Medicine specialist (OMS) for consultation, and biopsy was undertaken as required for definitive diagnosis.
  
  
  RESULTS
  146 patients presented with at least one oral mucosal lesion, and a total of 222 lesions were detected. COE detected 161 oral mucosal lesions and an additional 61 lesions were detected with VELscope™. COE alone showed a sensitivity of 44.0% and specificity of 99.0% while VELscope™ alone showed a sensitivity of 64.0% and specificity of 54.3%. Using the decision making protocol, the sensitivity and specificity were 73.9% and 97.9% respectively.
  
  
  CONCLUSIONS
  Using the decision making protocol proposed in this study allows for the detection of additional oral mucosal lesions requiring specialist referral by incorporating VELscope™ into routine general dental practice, without compromising patient care.
authors.affiliation: The Australian Centre for Oral Oncology Research & Education, Brisbane, QLD 4000, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, QLD 4029, Australia.
authors.forename: Nirav
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: The Australian Centre for Oral Oncology Research & Education, Brisbane, QLD 4000, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, QLD 4029, Australia.
authors.forename: Marie Anne T
authors.initials: MA
authors.lastname: Matias
authors.affiliation: The Australian Centre for Oral Oncology Research & Education, Brisbane, QLD 4000, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, QLD 4029, Australia. Electronic address: camile@oralmedpath.com.au.
authors.forename: Camile S
authors.initials: CS
authors.lastname: Farah
mesh_terms: D003657:Decision Making; D003752:Dental Health Services / Q000458:organization & administration*; D006801:Humans; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies
keywords: Early detection of cancer; Fluorescence imaging; Oral cancer; Precancerous conditions; Sensitivity and specificity