Background: This systematic review investigates techniques for determining adequate mucosal margins during the resection of oral squamous cell carcinoma (SCC). The primary treatment involves surgical removal with ≥5 mm margins, highlighting the importance of accurate differentiation between SCC and dysplasia during surgery. Methods: A comprehensive Embase and PubMed literature search was performed. Studies underwent quality assessment using QUADAS-2. Results: After the full-text screening and exclusion of studies exhibiting high bias, eight studies were included, focusing on three margin visualization techniques: autofluorescence, iodine staining, and narrow-band imaging (NBI). Negative predictive value (NPV) was calculable across the studies, though reference standards varied. Results indicated NPVs for autofluorescence, iodine, and NBI ranging from 61% to 100%, 92% to 99%, and 86% to 100%, respectively. Autofluorescence did not significantly enhance margins compared to white light-guided surgery, while iodine staining demonstrated improvement for mild or moderate dysplasia. NBI lacked comparison with a white light-guided surgery cohort. Conclusions: We recommend studying and comparing the diagnostic accuracy of iodine staining and NBI in larger cohorts of patients with oral SCC, focusing on discriminating between SCC and (severe) dysplasia. Furthermore, we advise reporting the diagnostic accuracy alongside the treatment effects to improve the assessment of these techniques.
背景：本系统性综述探讨了在口腔鳞状细胞癌（SCC）切除术中确定足够黏膜切缘的技术。主要治疗手段为手术切除，要求切缘≥5毫米，这凸显了术中准确区分SCC与异型增生的重要性。方法：对Embase和PubMed数据库进行了全面的文献检索。研究质量采用QUADAS-2工具进行评估。结果：经过全文筛选并排除高偏倚风险的研究后，共纳入八项研究，重点关注三种切缘可视化技术：自体荧光、碘染色和窄带成像（NBI）。尽管各项研究的参考标准不同，但均可计算阴性预测值（NPV）。结果显示，自体荧光、碘染色和NBI的NPV范围分别为61%至100%、92%至99%以及86%至100%。与白光引导手术相比，自体荧光并未显著改善切缘评估；碘染色则在轻度或中度异型增生的识别中显示出优势。NBI技术缺乏与白光引导手术队列的直接比较。结论：我们建议在更大规模的口腔SCC患者队列中研究和比较碘染色与NBI的诊断准确性，重点关注其对SCC与（重度）异型增生的鉴别能力。此外，我们建议在报告诊断准确性的同时评估治疗效果，以提升对这些技术的综合评价。
肿瘤(癌症)患者之家