Diagnostic Accuracy of Chemiluminescence for Oral Potentially Malignant Disorders: A Systematic Review and Meta-analysis

Introduction: Biopsy is the gold standard for Oral Potentially Malignant Disorders (OPMD) diagnosis. Chemiluminescence provides promising complementary alternative diagnostic adjunct for its simple non invasive collection and technique and to screen large populations. Aim: To summarise and compare the existing evidence on diagnostic accuracy of chemiluminescence in detecting OPMD. Materials and Methods: The systematic review and meta-analysis protocol was registered at the international prospective register of systematic reviews (PROSPERO- CRD42022306061) and performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy (PRISMA-DTA) checklist. PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2021 to identify the screening potential of chemiluminescence for OPMD. True positive, false positive, true negative, false negative, sensitivity, and specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the sensitivity and specificity and summary points. Summary Receiver Operating Curve (SROC), confidence region, and prediction region were calculated. Results: Twenty-four studies were included for qualitative synthesis and out of that, 14 were included for meta-analysis. Sufficient data for meta-analysis was available only for leukoplakia, oral lichen planus (OLP) and oral submucous fibrosis (OSMF). Sensitivity and specificity were calculated with Area Under Curve (AUC). For leukoplakia, chemiluminescence had sensitivity and specificity of 75% and 98% with 0.74 AUC. For OLP, it was 78% and 60% with 0.70 AUC. For oral submucous fibrosis it was 89% and 76% with 0.69 AUC. Conclusion: Chemiluminescence overall had good sensitivity and specificity values along with good AUC. This strongly supports the fact that it can be used as an alternative diagnostic adjunct to biopsy for various OPMD.