***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The clinical oral examination ( COE ) is the criterion st and ard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma ( OSCC ) at an early stage when they are most treatable . The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC . METHODS The authors conducted automated search es of PubMed , Web of Knowledge , and the Cochrane Library from 1966 through 2010 for r and omized controlled trials and observational studies that included the terms " oral mucosal lesion screening " and " oral lesions . " They determined the quality ( sensitivity , specificity , positive predictive value , negative predictive value and diagnostic odds ratio ) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool . RESULTS The overall diagnostic odds ratio was 6.1 ( 95 % confidence interval , 2.1 - 17.6 ) ; therefore , the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC . CLINICAL IMPLICATION S On the basis of the available literature , the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis . The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions BACKGROUND The aim of this prospect i ve study was to evaluate the efficacy of a new form of autofluorescence imaging and tissue reflectance spectroscopy ( Identafi , DentalEZ ) in examining patients with oral mucosal lesions . METHODS The authors examined 88 patients with 231 oral mucosal lesions by conventional oral examination ( COE ) using white-light illumination and ×2.5 magnification loupes , followed by examination using Identafi . The authors noted fluorescence visualization loss , the presence of blanching , and diffuseness of vasculature . They performed incisional biopsies to provide definitive histopathologic diagnosis . RESULTS Identafi 's white light produced lesion visibility and border distinctness equivalent to COE . Identafi 's violet light displayed a sensitivity of 12.5 % and specificity of 85.4 % for detection of oral epithelial dysplasia ( OED ) . The authors noted visible vasculature using the green-amber light in 40.9 % of lesions . CONCLUSIONS Identafi 's intraoral white light provided detailed visualization of oral mucosal lesions comparable with examination using an extraoral white-light source with magnification . A high level of clinical experience is required to interpret the results of autofluorescence examination as the violet light displayed low sensitivity for detection of OED . The green-amber light provided additional clinical information in relation to underlying vasculature and inflammation of lesions . PRACTICAL IMPLICATION S Examination using Identafi can provide clinicians with more clinical data than a st and ard COE with yellow inc and escent light , but the clinical and optical findings should be interpreted as a whole and not in isolation . Clinicians should use the light features of Identafi in a sequential and differential manner The prognosis for patients with oral squamous cell carcinoma remains poor despite advances in multimodal treatment concepts . Early diagnosis and treatment is the key to improved patient survival . A device ( VELscope ) that uses autofluorescence technology , allowing direct fluorescence visualization of the oral cavity , might be a useful tool for oral cancer detection or as an adjunct to st and ard clinical examination . A total of 289 patients with oral premalignant lesions were r and omly divided into two groups for clinical examination of precancerous oral lesions . In group 1 , 166 patients were examined conventionally with white light , and in group 2 , 123 patients were examined with the autofluorescence visualization device ( VELscope ) in addition to the white light examination . Biopsies were obtained from all suspicious areas identified in both examination groups ( n=52 ) . In the first step , baseline characteristics of the two groups ( only white light vs. white light and VELscope ) were compared to exclude selection bias . In the second step , for the group examined with white light and VELscope ( 123 patients ) , the diagnostic strategies were compared with regard to sensitivity and specificity using biopsy as the gold st and ard . The results showed that using the VELscope leads to higher sensitivity ( 100 % instead of 17 % ) , but to lower specificity ( 74 % instead of 97 % ) . Thus , we can conclude that the VELscope is a useful new diagnostic device for detection of oral cancer diseases The survival of patients with oral cancer is decreased by locoregional recurrence after an initial multimodal treatment . In order to identify lesions in the oral cavity for a possible recurrence , clinical evaluation as well as MRI or CT scanning is advised . The evaluation of mucosa lesions is hampered by changes related to radio- and chemotherapy as well as reconstruction with tissue flaps . Several techniques for easier identification of tissue abnormalities in the oral cavity have been advocated as adjuncts in order to facilitate identification . Especially methods using altered tissue fluorescence have gained much interest during the last decade . The aim of our prospect i ve study was to evaluate fluorescence properties of undiagnosed mucosa lesions with the VELscope device in patients with multimodal treated oral cancer prior to histological confirmation . In total , 41 patients with a history of oral squamous cell carcinomas ( OSCC ) ( 19 females and 22 males ) with undiagnosed mucosa lesions where included in the study . After clinical evaluation , examination and documentation using the VELscope ® device were performed . Then , an incisional biopsy was performed . An autofluorescence loss indicating a malignant or dysplastic mucosa condition could be detected in six patients ( 14.6 % ) ; however , only one OSCC and one SIN revealed a complete autofluorescence loss . In four patients , OSCC was present in lesions with retained autofluorescence . Sensitivity and specificity for the VELscope ® examination to identify malignant oral lesions by autofluorescence were 33.3 and 88.6 % , respectively . The positive and negative predictive values were 33.3 and 88.6 % , respectively . No statistical correlation between gender and lesion appearance versus autofluorescence loss could be detected . In contrast to mucosa lesions in patients with no prior treatment , the autofluorescence evaluation with the VELscope reveals no additional information in our analysis . Accordingly , invasive biopsies as gold st and ard are still needed to get sufficient evidence regarding potential malignancy in patients after multimodal treatment for oral cancer BACKGROUND An expert panel convened by the American Dental Association ( ADA ) Council on Scientific Affairs and the Center for Evidence -Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions , including potentially malignant disorders ( PMDs ) , in the oral cavity . TYPES OF STUDIES REVIEW ED This is an up date of the ADA 's 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma . The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify r and omized controlled trials and diagnostic test accuracy studies . The authors used the Grading of Recommendations Assessment , Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions . RESULTS The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity . For patients seeking care for suspicious lesions , immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice . In exceptional cases , when patients decline a biopsy or live in rural areas with limited access to care , the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed ( conditional recommendation , low- quality evidence ) . CONCLUSIONS AND PRACTICAL IMPLICATION S The authors urge clinicians to remain alert and take diligent action when they identify a PMD . The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial OBJECTIVE AND STUDY DESIGN Several noninvasive adjunctive methods have been proposed for identification of potentially malignant mucosa lesions . The VELscope is an optical device for detecting spatial changes in mucosa autofluorescence caused by premalignant lesions in conjunction with an intraoral exam . The aim of our prospect i ve study was to correlate loss of autofluorescence from undiagnosed mucosa lesions with histology . RESULTS In total 64 patients considered at risk for squamous cell carcinoma ( 20 had previous OSCC ) were included in the study . Regions with fluorescence visualization loss were considered as malignant or dysplastic . All patients underwent  biopsy  after VELscope examination . In 22 patients ( 34.4 % ) a loss of autofluorescence indicating a squamous intraepithelial neoplasia ( SIN ) or malignant mucosal lesion was detected . The sensitivity of identification of malignant and dysplastic areas with the VELscope was 100 % and the specificity was 80.8 % , respectively , compared with histology as gold st and ard . The positive predictive value was 54.5 % and the negative predictive value was 100 % respectively . CONCLUSION Evaluation of autofluorescence imaging with VELscope can assist in the identification of malignant and potentially malignant oral lesions from normal mucosa in high-risk patients but does not help discriminating benign lesions from malignant or premalignant mucosal conditions BACKGROUND To analyze the efficacy of fluorescence visualization in early detection of oral early neoplastic processes when used by an inexperienced and an adept oral examiner . METHODS A dental student and an expert professional in oral diagnosis examined 15 r and omly selected patients using conventional oral examination and fluorescence visualization search ing for early signs of epithelial dysplasia and oral potentially malignant disorders . Patients detected with oral lesions in any of examinations were su bmi tted to incisional biopsy for definitive diagnosis . RESULTS Taking histopathologic analysis as Gold St and ard , sensitivity , specificity , positive and negative predictive values and accuracy of inexperienced examiner for detecting both epithelium dysplasia and oral potentially malignant disorders increased when using fluorescence visualization compared to conventional white light examination , matching the same values found for expert professional in oral diagnosis . Furthermore , it was possible to observe discrete increase in the efficacy of expert professional 's examination when using fluorescence visualization . CONCLUSION This study indicates fluorescence visualization is capable of improve inexperienced professionals ' efficacy for early detecting oral lesions more prone to be dysplastic and oral potentially malignant disorders Objective . Although approved by the US Food and Drug Administration for clinical use , the utility of h and held 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 st and ard examination . Study Design . Prospect i ve , cross-sectional analysis . Setting . Tertiary care medical center . Subjects and 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 ( st and ard 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  st and ard 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 . Conclusion . St and ard 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 OBJECTIVE To determine the usefulness of the VELscope in detecting  malignant and premalignant oral cavity lesions .  STUDY DESIGN Prospect i ve clinical study . SETTING Head and neck oncology clinic at an academic tertiary care centre . SUBJECTS AND METHODS Eighty-five patients with a history of smoking , alcohol use , and /or head and neck cancer were recruited into the study . The VELscope was used to examine patients ' oral cavities after a clinical examination . Biopsies were then taken from suspicious areas . RESULTS Of the 85 patients included in the study , 33 underwent biopsies prompted by a clinical examination , the VELscope 
    Output:
    
Optical fluorescence imaging demonstrated positive results , with higher sensitivity scores , increased lesion detection and visualisation than comprehensive oral examination alone in the clinical evaluation of oral squamous cell carcinoma and oral potentially malignant disorders .