Living Evidence-Informed Guideline on the Early Detection of Oral Squamous Cell Carcinoma and Potentially Malignant Disorders: Cytology Adjuncts to Determine the Need for Biopsy, Version 2026 1.0

Authors

• Olivia Urquhart
• Ankita Shashikant Bhosale
• Carolina Martins-Pfeifer
• Francisca Verdugo-Paiva
• Alonso Carrasco-Labra
• Julia Pimentel
• Natalie Sadek
• Nishant Agrawal
• Anil K Chaturvedi
• JoAnn Gurenlian
• Eva Grayzel
• A Ross Kerr
• Marco Magalhaes
• Carol Anne Murdoch-Kinch
• Alexander T Pearson
• James C Melville
• Anita S H Patel
• Alessandro Villa
• Michael Glick
• Mark W Lingen

Language

English

Publication Date

3-1-2026

Journal

Journal of the American Dental Association

DOI

10.1016/j.adaj.2025.12.017

PMID

41781073

Abstract

Background: Early detection of oral potentially malignant disorders and oral cavity cancer can improve patient prognosis. The guideline panel addressed the use of cytology adjuncts to screen adults without mucosal abnormalities and determine the need for biopsy among adults with mucosal abnormalities.

Types of studies reviewed: The guideline panel used the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations. The authors conducted reviews to assess the benefits and harms of cytology adjuncts and people and clinician values and preferences as they relate to adjunct tests and biopsy of mucosal abnormalities. As part of the framework, the panel also considered resources required, equity, acceptability, and feasibility when formulating recommendations.

Results: The panel formulated 3 recommendations and 3 good practice statements. For adults with and without mucosal abnormalities, they formulated conditional recommendations against cytology adjuncts. Their use should be reserved for specific circumstances among adults with mucosal abnormalities when a biopsy is not possible or indicated. In the good practice statements, clinicians are urged to perform a clinical oral examination in all adult patients.

Conclusions and practical implications: Biopsy remains the first choice for reaching a definitive diagnosis of an oral potentially malignant disorder and oral squamous cell carcinoma, and cytology adjuncts should be reserved for specific situations when the clinician and patient agree it is the best course of action. When implementing or adapting these recommendations, local contexts should be considered to ensure equitable access to early detection.

Keywords

Humans, Mouth Neoplasms, Early Detection of Cancer, Biopsy, Carcinoma, Squamous Cell, Precancerous Conditions, Oral cancer, cytology, early detection, living guideline, potentially malignant disorder

Published Open-Access

yes

Recommended Citation

Urquhart, Olivia; Bhosale, Ankita Shashikant; Martins-Pfeifer, Carolina; et al., "Living Evidence-Informed Guideline on the Early Detection of Oral Squamous Cell Carcinoma and Potentially Malignant Disorders: Cytology Adjuncts to Determine the Need for Biopsy, Version 2026 1.0" (2026). Faculty, Staff and Student Publications. 197.
https://digitalcommons.library.tmc.edu/uthdb_docs/197