?clerk 2013 Feb 19th

62 (CCB) 10 (BMI 26):

1.2.3.?Head and Neck Surgery and Oncology, 3rd

98

XXX1OOO123OXO89XOO54XXO28OOX22OXX18XOX10Carcinoma in situtumor1~2cm1~2potentially malignant oral lesionmalignant42.6Malignant transformation in 1458 patients with potentially malignant oral mucosal disorders: a follow-up study based in a Taiwanese hospital journal of oral pathology and medicine 20073021Problem :the validity of visual screening Intervention : visual inspection Comparison : punch biopsy & NIH follow upOutcome : sensitivity & specificity : oral cancer, visual, sensitivity : PubMed : Systematic review > cross sec >... The Oxford 2011 Levels of Evidence

Systematic review

Meta-analysis

RCT & cohort

(Gold standard) ?

??Chang IHJournal of the Chinese Medical Association : JCMA2011DecOOOOOYang KYLaryngoscope. 2007 JanOOXOORamadas KOralOncol. 2003 SepOOOOOSankaranarayanan RCancer. 2000 FebOOOOO

Duration, population,sample size2005~2010, 18~97 male only,138781995~2002, 35+ male & female,78969ExcutorENT doctor & dentistUniversity graduatesPositive criteriaA non-healingulcer for more than 2 weeks, a persistent white or red lesion,a lesion that bled easily, or an irregular surface lesion insidethe oral cavity were regarded as positive findings.anatomical variations, benignlesions, preleukoplakia, homogeneous leukoplakia,ulcerated leukoplakia, verrucous leukoplakia, nodularleukoplakia, erythroplakia, oral submucousfibrosis and oral cancerPositive confirmPunch biopsyPunch biopsyPositive non-confirmexcludeFalse-positiveNegative follow upf/u for 6-monthsf/u for 6~24months

(Sensitivity) = 98.9%

(Specificity) = 98.7% = 13149 / (13149+172+272) = 96.7%Positive Predictive Value = 62.1%PPV = 282 / (282+172+272) = 38.8%Negative Predictive Value > 99.9%

23Positive Likelihood Ratio () LR True positive rate / False positive rate Sensitivity / ( 1Specificity )= 98.9% / (1 - 96.7%) = 29.96Negative Likelihood Ratio () LR False negative rate / True negative rate ( 1Sensitivity) / Specificity= (1 98.9%) / 96.7% = 0.01

The amount by which the pretest probability is increased in patients with a positive testThe amount by which the pretest probability of disease is reduced in patients with a negative test24Likelihood Ratios () Likelihood RatioInterpretation>10Strong evidence to rule in disease510Moderate evidence to rule in disease25Weak evidence to rule in disease0.52.0No significant change in the likelihood0.20.5Weak evidence to rule out disease0.10.2Moderate evidence to rule out disease