Background/Objectives:Effective screening for oral cancer (OC) remains challenging. Inaccuracies contribute to delayed diagnosis and poor outcomes. Tobacco-related changes in oral mucosa may compromise the accuracy of oral screening approaches, and, in emerging “smart” screening modalities, they may overshadow the influence of other predictive variables. The objective of this study was to evaluate the screening accuracy of an imaging- and risk factor-based OC screening platform in individuals practicing different types of tobacco usage.Methods:318 subjects who had previously screened positive for increased OC risk were recruited and sorted into “tobacco smoker”, “tobacco vaper”, “tobacco chewer”, “hookah user”, “multiple tobacco usage”, or “tobacco non-user” groups. Next, demographic information, risk factors, outcome of clinical examination, as well as AFI and pWLI were recorded using a prototype OC screening platform. The OC risk assessment outcome from the OC screening platform was compared to that from an oral medicine specialist.Results:The screening platform demonstrated high sensitivity in tobacco chewers and hookah users, and it also exceeded 90% in smokers, vapers, and multi-product users. In tobacco non-users, 80% screening sensitivity was recorded. Screening specificity was considerably better in tobacco non-users than in the tobacco-user groups, and low in tobacco chewers (33.3%), vapers (55.6%), and smokers (62.5%). Across all groups, agreement between the screening platform outcome and specialist evaluation exceeded 80%. Significant differences in probe accuracy were noted between tobacco non-users and users (p< 0.05), except for tobacco vapers.Conclusions:These findings highlight the need to consider the effects of type of tobacco use on the OC screening approach, and to integrate these variables into imaging-and risk-factor-based algorithms for OC screening.
背景/目的：口腔癌（OC）的有效筛查仍具挑战性。筛查不准确会导致诊断延迟和预后不良。烟草相关口腔黏膜变化可能影响口腔筛查方法的准确性，并在新兴的“智能”筛查模式中可能掩盖其他预测变量的影响。本研究旨在评估一种基于影像和风险因素的口腔癌筛查平台在不同烟草使用类型个体中的筛查准确性。 方法：招募了318名先前筛查为口腔癌风险增加的受试者，并将其分为“吸烟者”、“电子烟使用者”、“咀嚼烟草者”、“水烟使用者”、“多种烟草使用者”或“非烟草使用者”组。随后，使用原型口腔癌筛查平台记录人口统计学信息、风险因素、临床检查结果以及自体荧光成像（AFI）和偏振白光成像（pWLI）结果。将筛查平台的口腔癌风险评估结果与口腔医学专家的评估结果进行比较。 结果：筛查平台在咀嚼烟草者和水烟使用者中表现出高敏感性，在吸烟者、电子烟使用者和多产品使用者中也超过90%。在非烟草使用者中，筛查敏感性为80%。非烟草使用者的筛查特异性显著优于烟草使用组，而在咀嚼烟草者（33.3%）、电子烟使用者（55.6%）和吸烟者（62.5%）中较低。在所有组别中，筛查平台结果与专家评估的一致性超过80%。除电子烟使用者外，非烟草使用者与烟草使用者的探针准确性存在显著差异（p < 0.05）。 结论：这些发现强调需要考虑烟草使用类型对口腔癌筛查方法的影响，并将这些变量整合到基于影像和风险因素的口腔癌筛查算法中。
Effects of Tobacco Use on Oral Cancer Screening Algorithm Performance
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