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Стандартизація надання стоматологічної допомоги як складова успішної клінічної практики

Стандартизація надання стоматологічної допомоги як складова успішної клінічної практики

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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Список литературы

1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2017. CA Cancer J. Clin. 2017. 67(1). 7-30.
2. Howlander N., Noone A.M., Krapcho M., et al., eds. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute, 2015. Available at: https://seer.cancer.gov/csr/1975_2010/. Accessed March 15, 2017.
3. Chaturvedi A.K., Engels E.A., Anderson W.F., Gillison M.L. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J. Clin. Oncol. 2008. 26(4). 612-619.
4. Tota J.E., Anderson W.F., Coffey C., et al. Rising incidence of oral tongue cancer among white men and women in the United States, 1973–2012. Oral Oncol. 2017. 67. 146-152.
5. Patel S.C., Carpenter W.R., Tyree S., et al. Increasing incidence of oral tongue squamous cell carcinoma in young white women, age 18 to 44 years. J. Clin. Oncol. 2011. 29(11). 1488-1494.
6. DʼSouza G., Westra W.H., Wang S.J., et al. Differences in the prevalence of human papillomavirus (HPV) in head and neck squamous cell cancers by sex, race, anatomic tumor site, and HPV detection method [published online ahead of print December 8, 2016]. JAMA Oncol. http://dx.doi.org/ 10.1001/jamaoncol.2016.3067.
7. DʼSouza G., Cullen K., Bowie J., Thorpe R., Fakhry C. Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PLoS One. 2014. 9(1). e86023.
8. Chaturvedi A.K., Engels E.A., Pfeiffer R.M., et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J. Clin. Oncol. 2011. 29(32). 4294-4301.
9. Bouquot J.E. Common oral lesions found during a mass screening examination. JADA. 1986. 112(1). 50-57.
10. Shafer W.G., Waldron C.A. Erythroplakia of the oral cavity. Cancer. 1975. 36(3). 1021-1028.
11. Mehanna H.M., Rattay T., Smith J., McConkey C.C. Treatment and follow-up of oral dysplasia: a systematic review and meta-analysis. Head Neck. 2009. 31(12). 1600-1609.
12. Arduino P.G., Surace A., Carbone M., et al. Outcome of oral dysplasia: a retrospective hospital-based study of 207 patients with a long follow-up. J. Oral Pathol. Med. 2009. 38(6). 540-544.
13. Thomson P.J. Field change and oral cancer: new evidence for widespread carcinogenesis? Int. J. Oral Maxillofac. Surg. 2002. 31(3). 262-266.
14. Cankovic M., Ilic M.P., Vuckovic N., Bokor-Bratic M. The histological characteristics of clinically normal mucosa adjacent to oral cancer. J. Cancer Res. Ther. 2013. 9(2). 240-244.
15. Lingen M., Tampi M., Urquhart O., et al. Adjuncts for the evaluation of potentially malignant disorders in the oral cavity: diagnostic test accuracy systematic review and meta-analysis. JADA. 2017. 148(11).
16. Rethman M.P., Carpenter W., Cohen E.E.W., et al.; for the American Dental Association Council on Scientific Affairs Expert Panel on Screening for Oral Squamous Cell Carcinomas. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. JADA. 2010. 141(5). 509-520.
17. Macey R., Walsh T., Brocklehurst P., et al. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst. Rev. 2015. 5. CD010276.
18. Walsh T., Liu J.L., Brocklehurst P., et al. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst. Rev. 2013. 11. CD010173.
19. Hsu J., Brozek J.L., Terracciano L., et al. Application of GRADE: making evidence-based recommendations about diagnostic tests in clinical practice guidelines. Implement. Sci. 2011. 6. 62.
20. Schünemann H.J., Wiercioch W., Etxeandia I., et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014. 186(3). E123-E142.
21. Brouwers M.C., Kerkvliet K., Spithoff K.; Consortium ANS. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ. 2016. 352. i1152.
22. Knowledge Ecology International. WHO conflict of interest guidelines. Available at: http://keionline.org/node/1062. Accessed June 16, 2016.
23. Gualtero D.F., Suarez Castillo A. Biomarkers in saliva for the detection of oral squamous cell carcinoma and their potential use for early diagnosis: a systematic review. Acta Odontol. Scand. 2016. 74(3). 170-177.
24. Stuani V.T., Rubira C.M., SantʼAna A.C., Santos P.S. Salivary biomarkers as tools for oral squamous cell carcinoma diagnosis: a systematic review. Head Neck. 2017. 39(4). 797-811.
25. Guyatt G., Oxman A.D., Sultan S., et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J. Clin. Epidemiol. 2013. 66(2). 151-157.
26. Guyatt G., Rennie D., Meade M.O., Cook D.J., eds. Usersʼ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 3rd ed. New York, NY: McGraw-Hill Education, 2015.
27. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer stat facts: oral cancer and pharynx cancer. Available at: https://seer.cancer.gov/statfacts/html/oralcav.html. Accessed August 10, 2017.
28. Howden L.M., Meyer J.A. Age and sex composition: 2010‒2010 census briefs (C2010BR-03). Available at: https://www.census.gov/prod/cen2010/ briefs/c2010br-03.pdf. Accessed August 10, 2017.
29. Zhang Y., Coello P.A., Brozek J., et al. Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach. Health Qual. Life Outcomes. 2017. 15(1). 52.
30. Guyatt G.H., Oxman A.D., Kunz R., et al. What is “quality of evidence” and why is it important to clinicians? BMJ. 2008. 336(7651). 995-998.
31. Andrews J., Guyatt G., Oxman A.D., et al. GRADE guidelines, 14: going from evidence to recommendations: the significance and presentation of recommendations. J. Clin. Epidemiol. 2013. 66(7). 719-725.
32. Andrews J.C., Schunemann H.J., Oxman A.D., et al. GRADE guidelines, 15: going from evidence to recommendation — determinants of a recommendationʼs direction and strength. J. Clin. Epidemiol. 2013. 66(7). 726-735.
33. Balshem H., Helfand M., Schunemann H.J., et al. GRADE guidelines, 3: rating the quality of evidence. J. Clin. Epidemiol. 2011. 64(4). 401-406.
34. Schunemann H.J., Oxman A.D., Brozek J., et al. GRADE: assessing the quality of evidence for diagnostic recommendations. ACP J. Club. 2008. 149(6). 2.
35. Alonso-Coello P., Oxman A.D., Moberg J., et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices, 2 — clinical practice guidelines. BMJ. 2016. 353. i2089.
36. Graham R., Mancher M., Wolman D.M., Greenfield S., Steinberg E., eds. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press, 2011.
37. Guyatt G.H., Alonso-Coello P., Schunemann H.J., et al. Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. J. Clin. Epidemiol. 2016. 80. 3-7.
38. Olson C.M., Burda B.U., Beil T., Whitlock E.P. Screening for oral cancer: a targeted evidence update for the U.S. Preventive Services Task Force; 2013. Rockville, MD, Agency for Healthcare Research and Quality (US), Report No. 13-05186-EF-1.
39. Mehrotra R., Mishra S., Singh M., Singh M. The efficacy of oral brush biopsy with computer-assisted analysis in identifying precancerous and ancerous lesions. Head Neck Oncol. 2011. 3. 39.
40. Trakroo A., Sunil M.K., Trivedi A., et al. Efficacy of oral brush biopsy without computer-assisted analysis in oral premalignant and malignant lesions: a study. J. Int. Oral Health. 2015. 7(3). 33-38.
41. Svirsky J.A., Burns J.C., Carpenter W.M., et al. Comparison of computerassisted brush biopsy results with follow up scalpel biopsy and histology. Gen. Dent. 2002. 50(6). 500-503.
42. Seijas-Naya F., Garcia-Carnicero T., Gandara-Vila P., et al. Applications of OralCDx(R) methodology in the diagnosis of oral leukoplakia. Med. Oral Patol. Oral Cir. Bucal. 2012. 17(1). e5-e9.
43. Sciubba J.J. Improving detection of precancerous and cancerous oral lesions: computer-assisted analysis of the oral brush biopsy — U.S. Collaborative OralCDx Study Group. JADA. 1999. 130(10). 1445-1457.
44. Scheifele C., Schmidt-Westhausen A.M., Dietrich T., Rei-chart P.A. The sensitivity and specificity of the OralCDx technique: evaluation of 103 cases. Oral Oncol. 2004. 40(8). 824-828.
45. Rahman F., Tippu S.R., Khandelwal S., et al. A study to eva-luate the efficacy of toluidine blue and cytology in detecting oral cancer and dysplastic lesions. Quintessence Int. 2012. 43(1). 51-59.
46. Ng S.P., Mann I.S., Zed C., Doudkine A., Matisic J. The use of quantitative cytology in identifying high-risk oral lesions in community practice. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2012. 114(3). 358-364.
47. Navone R., Pentenero M., Rostan I., et al. Oral potentially malignant lesions: first-level micro-histological diagnosis from tissue fragments sampled in liquid-based diagnostic cytology. J. Oral Pathol Med. 2008. 37(6). 358-363.
48. Navone R., Marsico A., Reale I., et al. Usefulness of oral exfoliative cytology for the diagnosis of oral squamous dysplasia and carcinoma. Minerva Stomatol. 2004. 53(3). 77-86.
49. Nanayakkara P.G., Dissanayaka W.L., Nanayakkara B.G., Amaratunga E.A., Tilakaratne W.M. Comparison of spatula and cytobrush cytological techniques in early detection of oral malignant and premalignant lesions: a prospective and blinded study. J. Oral Pathol. Med. 2016. 45(4). 268-274.
50. Mehrotra R., Singh M.K., Pandya S., Singh M. The use of an oral brush biopsy without computer-assisted analysis in the evaluation of oral lesions: a study of 94 patients. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2008. 106(2). 246-253.
51. Koch F.P., Kunkel M., Biesterfeld S., Wagner W. Diagnostic efficiency of differentiating small cancerous and precancerous lesions using mucosal brush smears of the oral cavity: a prospective and blinded study. Clin. Oral Investig. 2011. 15(5). 763-769.
52. Kammerer P.W., Koch F.P., Santoro M., et al. Prospective, blinded comparison of cytology and DNA-image cytometry of brush biopsies for early detection of oral malignancy. Oral Oncol. 2013. 49(5). 420-426.
53. Fontes K.B., Cunha K.S., Rodrigues F.R., Silva L.E., Dias E.P. Concordance between cytopathology and incisional biopsy in the diagnosis of oral squamous cell carcinoma. Braz. Oral Res. 2013. 27(2). 122-127.
54. Delavarian Z., Mohtasham N., Mosannen-Mozafari P., et al. Evaluation of the diagnostic value of a modified liquid-based cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer. Med. Oral Patol. Oral Cir. Bucal. 2010. 15(5). e671-e676.
55. Mehrotra R., Singh M., Thomas S., et al. A cross-sectional study evaluating chemiluminescence and autofluorescence in the detection of clinically innocuous precancerous and cancerous oral lesions. JADA. 2010. 141(2). 151-156.
56. Awan K.H., Morgan P.R., Warnakulasuriya S. Evaluation of an autofluorescence based imaging system (VELscope) in the detection of oral potentially malignant disorders and benign keratoses. Oral Oncol. 2011. 47(4). 274-277.
57. Farah C.S., McIntosh L., Georgiou A., McCullough M.J. Efficacy of tissue autofluorescence imaging (VELScope) in the visualization of oral mucosal lesions. Head Neck. 2012. 34(6). 856-862.
58. Hanken H., Kraatz J., Smeets R., et al. The detection of oral premalignant lesions with an autofluorescence based imaging system (VELscopeTM): a single blinded clinical evaluation (published correction appears in Head Face Med. 2013. 9. 26. Assaf, Alexandre Thomas [added]). Head Face Med. 2013. 9. 23.
59. Koch F.P., Kaemmerer P.W., Biesterfeld S., Kunkel M., Wagner W. Effectiveness of autofluorescence to identify suspicious oral lesions: a prospective, blinded clinical trial. Clin. Oral Investig. 2011. 15(6). 975-982.
60. Onizawa K., Saginoya H., Furuya Y., Yoshida H., Fukuda H. Usefulness of fluorescence photography for diagnosis of oral cancer. Int. J. Oral Maxillofac. Surg. 1999. 28(3). 206-210.
61. Petruzzi M., Lucchese A., Nardi G.M., et al. Evaluation of autofluorescence and toluidine blue in the differentiation of oral dysplastic and neoplastic lesions from non dysplastic and neoplastic lesions: a crosssectional study. J. Biomed. Opt. 2014. 19(7). 76003.
62. Scheer M., Neugebauer J., Derman A., et al. Autofluorescence imaging of potentially malignant mucosa lesions. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2011. 111(5). 568-577.
63. Warnakulasuriya K.A., Johnson N.W. Sensitivity and specificity of OraScan (R) toluidine blue mouthrinse in the detection of oral cancer and precancer. J. Oral Pathol. Med. 1996. 25(3). 97-103.
64. Upadhyay J., Rao N.N., Upadhyay R.B., Agarwal P. Reliability of toluidine blue vital staining in detection of potentially malignant oral lesions: time to reconsider. Asian Pac. J. Cancer Prev. 2011. 12(7). 1757-1760.
65. Singh D., Shukla R.K. Utility of toluidine blue test in accessing and detecting intra-oral malignancies. Indian J. Otolaryngol. Head Neck Surg. 2015. 67(suppl. 1). 47-50.
66. Silverman S. Jr, Migliorati C., Barbosa J. Toluidine blue staining in the detection of oral precancerous and malignant lesions. Oral Surg. Oral Med. Oral Pathol. 1984. 57(4). 379-382.
67. Onofre M.A., Sposto M.R., Navarro C.M. Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2001. 91(5). 535-540.
68. Nagaraju K., Prasad S., Ashok L. Diagnostic efficiency of toluidine blue with Lugolʼs iodine in oral premalignant and malignant lesions. Indian J. Dent. Res. 2010. 21(2). 218-223.
69. Mashberg A. Reevaluation of toluidine blue application as a diagnostic adjunct in the detection of asymptomatic oral squamous carcinoma: a continuing prospective study of oral cancer III. Cancer. 1980. 46(4). 758-763.
70. Du G.F., Li C.Z., Chen H.Z., et al. Rose bengal staining in detection of oral precancerous and malignant lesions with colorimetric evaluation: a pilot study. Int. J. Cancer. 2007. 120(9). 1958-1963.
71. Cheng B., Yang L. The clinical evaluation of Oratest in detecting oral mucosal lesions. Hua Xi Kou Qiang Yi Xue Za Zhi. 2003. 21(2). 124-126.
72. Chen Y.W., Lin J.S., Fong J.H., et al. Use of methylene blue as a diagnostic aid in early detection of oral cancer and precancerous lesions. Br. J. Oral. Maxillofac. Surg. 2007. 45(7). 590-591.
73. Chaudhari A., Hegde-Shetiya S., Shirahatti R., Agra-wal D. Comparison of different screening methods in estimating the prevalence of precancer and cancer amongst male inmates of a jail in Maharashtra, India. Asian Pac. J. Cancer Prev. 2013. 14(2). 859-864.
74. Cancela-Rodriguez P., Cerero-Lapiedra R., Esparza-Gomez G., Llamas- Martinez S., Warnakulasuriya S. The use of toluidine blue in the detection of pre-malignant and malignant oral lesions. J. Oral Pathol. Med. 2011. 40(4). 300-304.
75. Awan K., Yang Y., Morgan P., Warnakulasuriya S. Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity: a clinical and histological assessment. Oral Dis. 2012. 18(8). 728-733.
76. Allegra E., Lombardo N., Puzzo L., Garozzo A. The usefulness of toluidine staining as a diagnostic tool for precancerous and cancerous oropharyngeal and oral cavity lesions. Acta Otorhinolaryngol. Ital. 2009. 29(4). 187-190.
77. Awan K.H., Morgan P.R., Warnakulasuriya S. Utility of chemiluminescence (ViziLite) in the detection of oral potentially malignant disorders and benign keratoses. J. Oral Pathol. Med. 2011. 40(7). 541-544.
78. Chainani-Wu N., Madden E., Cox D., et al. Toluidine blue aids in detection of dysplasia and carcinoma in suspicious oral lesions. Oral Dis. 2015. 21(7). 879-885.
79. Farah C.S., McCullough M.J. A pilot case control study on the efficacy of acetic acid wash and chemiluminescent illumination (ViziLite) in the visualisation of oral mucosal white lesions. Oral Oncol. 2007. 43(8). 820-824.
80. McIntosh L., McCullough M.J., Farah C.S. The assessment of diffused light illumination and acetic acid rinse (Microlux/DL) in the visualization of oral mucosal lesions. Oral Oncol. 2009. 45(12). e227-e231.
81. Ujaoney S., Motwani M.B., Degwekar S., et al. Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: a cross-sectional study. BMC Clin. Pathol. 2012. 12. 6.
82. Guneri P., Epstein J.B., Kaya A., et al. The utility of toluidine blue staining and brush cytology as adjuncts in clinical examination of suspicious oral mucosal lesions. Int. J. Oral Maxillofac. Surg. 2011. 40(2). 155-161.
83. Gupta A., Singh M., Ibrahim R., Mehrotra R. Utility of toluidine blue staining and brush biopsy in precancerous and cancerous oral lesions. Acta Cytol. 2007. 51(5). 788-794.
84. Epstein J.B., Silverman S. Jr, Epstein J.D., Lonky S.A., Bride M.A. Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol. 2008. 44(6). 538-544.
85. Mojsa I., Kaczmarzyk T., Zaleska M., et al. Value of the ViziLite Plus System as a diagnostic aid in the early detection of oral cancer/premalignant epithelial lesions. J. Craniofac. Surg. 2012. 23(2). e162-e164. 
86. Mark A. Oral cancer: what to do if something unusual shows up. JADA. 2017. 148(10). 778.
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

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