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Abstract The ability to control oral and oropharyngeal cancer will depend on two cornerstones: prevention and early diagnosis. Dentists’ knowledge and education in detecting oral cancer at its precancerous phase is the key to prevent its progression to later stages. Currently, the new innovative visual-based techniques show promising results. The present study we have investigated the efficiency of the OralID system to give the possibility for a simple detection, and screening of oral precancerous and early cancerous lesions. We found that the direct visual fluorescence system utilized in our study cannot fully replace the gold standard, i.e., the histopathology procedure. Nonetheless, its usefulness for clinical examination, in monitoring oral lesions, and before performing a biopsy was fully demonstrated. This device may add sensitivity to the oral tissue examination and considered as adjunct for high-risk patients. Our data found no difference between CIS and invasive SCC in terms of the FV field expansion. The information is important because the usual recommendation for preinvasive high-grade lesions tend to be more conservative with smaller margins of normal-looking mucosa. The study results suggest that preinvasive lesions may have extensive lateral fields, some occult, and as such, would require a more aggressive therapy. Also, the fluorescence can’t differentiate between inflammation and carcinogenesis as, hemoglobin absorbs light and it is more abundant during carcinogenesis as a result of increased micro vascularization. However, hemoglobin also increases as a result of trauma or inflammation. In our study the sensitivity in identifying malignant or dysplastic lesions is 100% as the device showed fluorescent loss over the lesions and the areas around in 16 cases assured by histopathology and in the rest 4 cases it showed fluorescent retained over the lesions assured by histopathology as no dysplastic changes only inflammation that meant sensitivity 100%. Specificity 40% as after histopathological examination only 8 cases was taken with a safety fluorescent margin (negative results) and 4 cases showed mild dysplasia, 4 cases showed sever dysplasia and 4 cases showed invasive carcinoma (positive results). This low specificity in distinguishing high-risk lesions (dysplastic) from benign ones may limit the utility of the device as a routine screening tool and that it cannot be used in guiding the biopsy but in screening of dysplastic or malignant lesions its sensitivity is 100%. |