Novel Approach to Improving Specialist Access in Underserved Populations with Suspicious Oral Lesions

Abstract

Late detection and specialist referral result in poor oral cancer outcomes globally. High-risk LRMU populations usually do not have access to oral medicine specialists, a specialty of dentistry, whose expertise includes the identification, treatment, and management of oral cancers. To overcome this access barrier, there is an urgent need for novel, low-cost tele-health approaches to expand specialist access to low-resource, remote and underserved individuals. The goal of this study was to compare the diagnostic accuracy of remote versus in-person specialist visits using a novel, low-cost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application. A total of 189 subjects with suspicious oral lesions requiring biopsy (per the standard of care) were recruited and consented. Each subject was examined, and risk factors were recorded twice: once by an on-site specialist, and again by an offsite specialist. A novel, low-cost, smartphone-based intraoral camera paired with a custom software application were utilized to perform synchronous remote video/still imaging and risk factor assessment by the off-site specialist. Biopsies were performed at a later date following specialist recommendations. The study’s results indicated that on-site specialist diagnosis showed high sensitivity (94%) and moderate specificity (72%) when compared to histological diagnosis, which did not significantly differ from the accuracy of remote specialist telediagnosis (sensitivity: 95%; specificity: 84%). These preliminary findings suggest that remote specialist visits utilizing a novel, low-cost, smartphone-based telehealth tool may improve specialist access for low-resource, remote and underserved individuals with suspicious oral lesions.

Inter-observer agreement among specialists in the diagnosis of Oral Potentially Malignant Disorders and Oral Cancer using Store-and-Forward technology

“…A study compared the diagnostic accuracy of remote versus onsite specialist visits using a novel, lowcost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application found that on-site diagnosis showed high sensitivity (94%) and 69.2% speci city when compared with histopathological diagnosis, which did not signi cantly differ from the accuracy of remote specialist (sensitivity: 94%; speci city: 62.5%) [12] . Our study showed a speci city of 83.3% by the remote specialist 1, but a 60% speci city by the remote specialist 2, the reason being more years of experience in telediagnosis for the former as compared to the latter.…”