Page 70 - FINAL COMPENDIUM 2020-2021 27.2.2022

HIGH REFERRAL ACCURACY FOR ORAL CANCERS AND ORAL POTENTIALLY MALIGNANT
DISORDERS USING TELEMEDICINE

Haron N, Rajendran S, Kallarakkal TG, Zain RB, Ramanathan A, Abraham MT, Lau SH, Cheng LC, Chong SMY, Mohamed
Azahar FA, Mohamad Zaini Z, Chan SW, Goh YC, Lim D, Khairi J, Abidin MZ, Abdul Rahman ZA, Liew CS, Fong SC, Yang YH,
Ismail SM, Cheong SC

Objective: To evaluate the accuracy of MeMoSA®, a mobile phone application to review
images of oral lesions in identifying oral cancers and oral potentially malignant disorders
requiring referral. Materials and methods: A prospective study of 355 participants,
including 280 with oral lesions/variants was conducted. Adults aged ≥18 years old treated
at tertiary referral centres were included. Images of the oral cavity were taken using
MeMoSA®. The identification of the presence of lesion/variant and referral decision made
using MeMoSA® were compared to clinical oral examination, using kappa statistics for
intra-rater agreement. Sensitivity, specificity, concordance and F1 score were computed.
Images were reviewed by an off-site specialist and inter-rater agreement was evaluated.
Images from sequential clinical visits were compared to evaluate observable changes in
the lesions. Results: Kappa values comparing MeMoSA® with clinical oral examination in
detecting a lesion and referral decision was 0.604 and 0.892, respectively. Sensitivity and
specificity for referral decision were 94.0% and 95.5%. Concordance and F1 score were
94.9% and 93.3%, respectively. Inter-rater agreement for a referral decision was 0.825.
Progression or regression of lesions were systematically documented using MeMoSA®.
Conclusion: Referral decisions made through MeMoSA® is highly comparable to clinical
examination demonstrating it is a reliable telemedicine tool to facilitate the identification
of high-risk lesions for early management.

Keywords: Clinical oral examination, Early detection, Oral cancer, Oral medicine, Oral potentially
malignant disorders, Telemedicine.

Published in Oral Dis. 2021 Apr 29. doi: 10.1111/odi.13892. Epub ahead of print

Nabihah Haron Thomas George Kallarakkal
Senthilmani Rajendran Anand Ramanathan
Siew Chinn Fong Oral Cancer Research & Coordinating Centre (OCRCC)
Cancer Research Malaysia Faculty of Dentistry
Selangor, Malaysia University of Malaya
Kuala Lumpur, Malaysia
Zuraiza Mohamad Zaini
Siew Wui Chan Rosnah Binti Zain
Yet Ching Goh Faculty of Dentistry
Daniel Lim MAHSA University
Zainal Ariff Abdul Rahman Selangor, Malaysia
Siti Mazlipah Ismail
Department of Oral and Maxillofacial Clinical Sciences Mannil Thomas Abraham
Faculty of Dentistry Sherrie Mei Yee Chong
University of Malaya Juliana Khairi
Kuala Lumpur, Malaysia Department of Oral and Maxillofacial Surgery
Hospital Tengku Ampuan Rahimah
Ministry of Health, Malaysia

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