Source
Unit of Oral Medicine, Division of Maxillofacial Medical Diagnostic and Surgical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust and UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD. t.hodgson@eastman.ucl.ac.uk
Abstract
BACKGROUND AND OBJECTIVE:
This study aimed to assess the effectiveness of the UK National Guidelines for identifying patients with potentially malignant oral disease which were introduced in 2000.
DESIGN:
Retrospective audit.
SETTING:
The oral medicine unit in a university teaching hospital in London.
METHODS:
All new referrals over a one year period were retrospectively reviewed in a departmental audit to evaluate guideline effectiveness. Reasons for referral and final diagnosis were compared in a randomly selected sub-population.
RESULTS:
Four hundred and eighty-seven of 901 new patients referred were classified as having potentially malignant disease from the referral letter. In a randomly selected subgroup of 241 patients, 18 actually had malignant (8) or dysplastic lesions (10). Of 75 patients referred with a persistent oral ulcer, only nine were actually malignant or dysplastic. Eight of 116 patients referred with a white patch and none with red patches were found to have dysplastic or malignant lesions. The criteria failed to identify three carcinomas and two severely dysplastic lesions (15% of the malignant or dysplastic lesions). All of the latter had been referred by primary care physicians with orofacial pain of unknown cause.
CONCLUSIONS:
UK National Guidelines discriminate poorly between potentially malignant and other oral mucosal disease.