Oral and General Health Том 3, №4, 2022
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Клінічні настанови з оцінки потенційно злоякісних захворювань ротової порожнини. Звіт Американської стоматологічної асоціації
Авторы: Mark W. Lingen, DDS, PhD, FRCPath; Elliot Abt, DDS, MS, MSc; Nishant Agrawal, MD; Anil K. Chaturvedi, PhD; Ezra Cohen, MD, FRCPSC; Gypsyamber DʼSouza, PhD; JoAnn Gurenlian, RDH, PhD; John R. Kalmar, DMD, PhD; Alexander R. Kerr, DDS, MSD; Paul M. Lambert, DDS; Lauren L. Patton, DDS; Thomas P. Sollecito, DMD, FDS, RCS; Edmond Truelove, DDS, MSD; Malavika P. Tampi, MPH; Olivia Urquhart, MPH; Laura Banfield, MLIS, MHS; Alonso Carrasco-Labra, DDS, MSc
Рубрики: Стоматология
Разделы: Справочник специалиста
Версия для печати
Резюме
Група експертів, скликана Радою з наукових питань Американської стоматологічної асоціації (ADA) та Центром доказової стоматології, провела систематичний огляд і сформулювала клінічні рекомендації для інформування лікарів первинної ланки про потенційне використання допоміжних засобів як інструментів сортування для оцінки уражень, у тому числі потенційно злоякісних, ротової порожнини. Типи розглянутих досліджень. Це оновлення рекомендацій ADA 2010 року щодо ранньої діагностики OPSCC та плоскоклітинного раку порожнини рота. Автори провели систематичний пошук літератури в MEDLINE та Embase через Ovid та Кокранівський центральний реєстр контрольованих випробувань для виявлення рандомізованих контрольованих випробувань та досліджень точності діагностичних тестів. Автори використовували підхід «оцінка, розробка та оцінка рекомендацій» для оцінки впевненості у доказах та переходу від доказів до рішень. Результати. Група експертів сформулювала 1 заяву про передову практику та 6 клінічних рекомендацій, у яких дійшла висновку про те, що жоден з доступних допоміжних засобів не продемонстрував достатню точність діагностичних тестів, щоб підтримувати їх рутинне використання як інструментів сортування при оцінці уражень у порожнині рота. Щодо пацієнтів, які звертаються по допомогу з приводу підозрілих уражень, негайне виконання біопсії або направлення до фахівця залишається єдиною найважливішою рекомендацією для клінічної практики. У виняткових випадках, коли пацієнти відмовляються від біопсії або мешкають у сільській місцевості з обмеженим доступом до медичної допомоги, група експертів запропонувала використовувати цитологічне дослідження для ініціації діагностичного процесу до проведення біопсії (умовна рекомендація, докази низької якості). Висновки та практичні рекомендації. Автори закликають клініцистів зберігати пильність і застосовувати додаткові методи дослідження при виявленні підозрілих уражень. Автори наголошують на необхідності консультування, оскільки пацієнти можуть відкладати встановлення діагнозу через занепокоєння та заперечення.
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 reviewed. This is an update 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 randomized 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 implications. 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.
Ключевые слова
Американська стоматологічна асоціація; плоскоклітинний рак порожнини рота; потенційно злоякісні захворювання; клінічні рекомендації; точність діагностичного тесту
American Dental Association; oral squamous cell carcinoma; potentially malignant disorders; clinical recommendations; diagnostic test accuracy
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Оригінал надрукований в
The Journal of the American Dental Association,
Volume 148, Issue 10, October 2017, Pages 712-727.e10
https://doi.org/10.1016/j.adaj.2017.07.032