Integrative strategies combining telemedicine and opportunistic screening to reduce diagnostic delays in oral cancer: a 4-year-retrospective study

Abstract

Aim: The primary aim was to develop and test a telemedicine program for oral cancer screening by dentists in primary care. The secondary aim was to analyze the sensitivity of the provisional diagnosis compared to the definitive diagnosis.

Methods: A retrospective observational study that used telemedicine for oral cancer case detection was conducted in Cordoba, Argentina from 2018 to 2023, oral medicine specialists provided in-person training for dentists on the clinical recognition and early diagnosis of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD), and telemedicine use for the early detection of oral cancer. The trained professionals conducted opportunistic screenings in their workplaces. When encountering a suspicious lesion on the oral mucosa, they collected relevant patient data and clinical photographs of the lesion, sharing these with the reference center. The specialized center was based at the Oral Medicine unit at the Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. The specialists suggested radiographic examinations and/or pre-surgical laboratory tests and, if necessary, expedited referral to the specialized center for in-person assessment and definitive diagnosis.

Results: Cases with clinical suspicion of OSCC and OPMD were referred to the reference center. In all cases, the definitive diagnosis was obtained within less than 1 month. Eleven out of 12 cases of OSCC were diagnosed within 2 weeks, with only 1 case diagnosed at 1 month due to some patient delay. The concordance between the clinical suspicion at the time of teleconsultation and the definitive diagnosis of OSCC by the specialists was absolute (Kappa test, coefficient 1), with a sensitivity and specificity of 100%.

Conclusions: Integrating telemedicine with other preventive strategies and timely referral to oral medicine specialists could potentially decrease diagnostic delays in OSCC and OPMD.

Keywords

Oral cancer / oral telemedicine / screening

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