Meta-analysis of measures of performance reported in oral cancer and precancer screening studies

Objective: To elicit a range of values for sensitivity, specificity and other measures of performance in screening for oral cancer and precancer. Method: A literature search which included three databases was conducted. Strict inclusion criteria were applied. Values for sensitivity (Sn) and specificity (Sp), from seven investigations, were expressed as a receiver operator characteristic (ROC) curve. Meta-analysis of the combined results was used to produce a summary operator characteristic (SROC) curve. Results: The pooled weighted value of Sn from the seven studies was 0.796. From the SROC, the corresponding value of Sp at this level of Sn was 0.977 (95% Cl 0.941, 0.991). When Sp was held at 0.977, the corresponding value of Sn from the SROC was 0.796 (95% Cl 0.594, 0.912). Conclusions: The reports selected for eventual inclusion revealed a high level of heterogeneity with respect to the location of investigations, prevalence of lesions, the personnel used and other factors. The meta-analysis indicated that overall the studies had high discriminatory ability. The estimates of Sn and Sp, and values obtained for other measures of screening performance, were considered suitable for input to a simulation model in assessing the likely cost-utility of a variety of screening scenarios in further planned research.