{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T11:16:22Z","timestamp":1760267782448,"version":"3.37.3"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T00:00:00Z","timestamp":1609372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR001445 (Pilot project)"],"award-info":[{"award-number":["UL1TR001445 (Pilot project)"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was \u2265 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244446","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T19:08:35Z","timestamp":1609441715000},"page":"e0244446","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2402-3787","authenticated-orcid":true,"given":"Stella K.","family":"Kang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2259-305X","authenticated-orcid":true,"given":"Rahul D.","family":"Mali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Scott","family":"Braithwaite","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander R.","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"McDevitt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"key":"pone.0244446.ref001","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"68","author":"F Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"pone.0244446.ref002","first-page":"7","volume-title":"Cancer statistics, 2019.","author":"RL Siegel","year":"2019"},{"key":"pone.0244446.ref003","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1177\/154405910808700104","article-title":"Molecular pathogenesis of oral squamous cell carcinoma: implications for therapy","volume":"87","author":"S Choi","year":"2008","journal-title":"J Dent Res"},{"key":"pone.0244446.ref004","volume-title":"Malignant surface epithelial tumours: Squamous cell carcinoma","author":"P Sloan","year":"2017","edition":"4"},{"key":"pone.0244446.ref005","doi-asserted-by":"crossref","first-page":"83","DOI":"10.5125\/jkaoms.2019.45.2.83","article-title":"Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients.","volume":"45","author":"YC Sim","year":"2019","journal-title":"Journal of the Korean Association of Oral and Maxillofacial Surgeons"},{"key":"pone.0244446.ref006","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.oraloncology.2019.02.001","article-title":"Survival outcomes after treatment of cancer of the oral cavity (1985\u20132015).","volume":"90","author":"DK Zanoni","year":"2019","journal-title":"Oral Oncol"},{"key":"pone.0244446.ref007","unstructured":"Noone et al. 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