Journal Club/ Research paper discussion/Critical appraisal

Name of the Student
Professor’s Name
Medicine
10th January 2018
Article Critique
Introduction
Different studies have highlighted the importance of early diagnostic screening in preventing the risk of oral cancer. Presently, the measures that are routinely used to screen oral cancer are the conventional oral examination (COE) and scalpel biopsy. However, scalpel biopsy is only performed if there is evidence of suspicious lesions within the oral milieu. On the contrary, various adjunctive techniques are implicated in diagnosing dysplastic changes. This is because dysplastic changes are one of the significant early symptoms of oral cancer. For example, the VELscope (an instrument that uses autofluorescence) can detect metabolic dysfunctions in such dysplastic tissues (Ganga et al. 67-74). The present article criticizes an article that explored the role of VELscope in early screening of oral cancer.
Description and Citation of the Critiqued Article
The authors of he article were Ganga, R, Gundre, D, Bansal, S, Shirsat, P, Prasad, P, and Desai, R. and it was published in 2017. The name of the article is “evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic, and malignant lesions of the oral cavity using VELscope” and it was published in the 75th volume of the journal named Oral Oncology from page numbers 67 to 74.
Critique of the Background and Purpose of the Study
Although conventional oral examination (COE) and scalpel biopsy are the recommended screening methods for oral cancer, early detection of dysplastic changes within the oral mucosa has received full attention.

Hence, the authors explored one primary research question “whether a VELscope could effectively identify dysplastic and neoplastic changes in the oral mucosal lesions that were screened through conventional oral examination?” The authors hypothesized that VELscope could efficiently identify dysplastic and neoplastic changes in the oral mucosal lesions that were screened through conventional oral examination. Hence, the background of the study was pertinent, and the seminal research was original. This is because the authors wanted to confirm subjective diagnostic criteria for oral cancer with objective ones.
Critique of Research Methodology
The study was conducted in a prospective manner, and purposive sampling was done to select the study participants (n=200). Patients who presented with oral lesions and reported to the microbiology department formed the study population. Hence, the study was conducted as a cross-sectional study. However, no experimental controls were designed before the start of the study. The authors obtained informed consent from the study participants. Hence, the study complied with the ethical guidelines of clinical research. Since the authors did not conduct a power analysis nor estimated the Numbers Needed to Treat (NNT), the sample size might not ensure the validity of the findings. The study participants were divided into two groups based on the type of lesions that were diagnosed by the VELscope; one group of lesion exhibited fluorescence visualization loss (FVL) while the other displayed retention of fluorescence visualization. Both groups were followed by with histopathological diagnosis (scalpel biopsy) to confirm the findings of VELscope.
Appraisal of the Results
The results were presented regarding false positive and false negative about the confirmatory diagnosis through histopathological interventions. The sensitivity, specificity, positive and negative predictive values for the determinations with VELscope was estimated. These parameters were presented with their 95% confidence intervals (CIs). However, the authors did not report the respective significance values (p-values) for the 95% CIs. The sensitivity and specificity values were estimated to be 76% and 66.29% respectively, while the positive (PPV) and negative predictive values (NPV) were 24.36% and 95.08% respectively (Ganga et al. 67-74). Except for the negative predictive values, the 95% CIs for the other parameters were very wide. Hence, the authors appropriately concluded that VELscope findings alone could not confirm the diagnosis of oral cancer; instead, it should be supplemented with the appropriate histopathological diagnosis. The only take home point from this study is that the high NPV could alleviate the anxiety of such patients who suffer from apprehensions of oral cancer. Moreover, the researchers were not blinded; hence, chances of subjective bias may not be ruled out in this study.
Works Cited
Ganga, R, Gundre, D, Bansal, S, Shirsat, P, Prasad, P, and Desai, R. Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic, and malignant lesions of the oral cavity using VELscope. Oral Oncology 2017; 75: pp. 67-74.