Diagnostic accuracy of biopsy versus full excision for diagnosis of oral cancer: a systematic review

Objectives: To review studies assessing diagnostic accuracy of biopsy of oral lesions for diagnosis of oral cancer and potentially malignant disorders, compared with full excision.

Methods: Systematic review: four databases were searched for studies conducted within developed countries and published between 2009 and January 2020.

Results: Six studies met inclusion criteria, with wide variation in methods and results. For identifying dysplasia or malignancy, sensitivity of biopsy (versus excision) ranged from 42% to 86% and specificity from 75% to 100% across two studies, while concordance varied from 27% to 89% across four studies. For identifying malignant-only lesions, sensitivity was 71% and 94% in two studies, while specificity ranged from 17% to 100% across four studies.

Conclusions: There are few published studies assessing biopsy accuracy, with varying results. Further research should evaluate factors impacting accuracy, such as biopsy depth; multiple biopsies of large lesions; discordance between pathologists; and regular follow-up.