Evaluating the Role of VELscope in Oral Cancer and Pre-Cancer Screening: A Scoping Review.

[BACKGROUND] Oral cancer continues to be a major public health concern, particularly in low- and middle-income countries (LMICs), where late-stage diagnosis significantly contributes to high mortality. The Visually Enhanced Lesion Scope (VELscope), which uses tissue autofluorescence technology, aids in the identification of suspicious oral lesions. The objective of this scoping review is to systematically map the existing evidence on the effectiveness of VELscope in detecting pre-malignant and malignant oral lesions.

[METHODS] This scoping review was carried out following the Arksey and O'Malley framework and JBI methodology and was reported per PRISMA-ScR guidelines. Four databases (PubMed, Embase, Scopus, and Cochrane Library) were searched between January 2010 - December 2024. A total of 27 studies involving 3,875 participants were included, assessing VELscope's diagnostic accuracy either alone or in combination with other tools.

[RESULTS] VELscope demonstrated high sensitivity (>75%) in 20 studies, with values ranging from 30% to 100%. However, specificity varied more widely (15%-100%), with 16 studies reporting specificity of less than 75%. The diagnostic accuracy of VELscope was significantly influenced by clinicians' training and experience. While VELscope effectively enhanced lesion visualization and guided biopsy site selection, its low specificity often resulted in false positives and unnecessary referrals. Diagnostic accuracy also improved significantly when it was used in combination with conventional oral examination (COE), the toluidine blue test (TBT), or Raman spectroscopy.

[CONCLUSION] VELscope serves as a valuable adjunctive tool to COE, improving lesion detection in high-risk populations. However, its standalone diagnostic use is limited due to low specificity. Targeted clinician training and integration into multimodal screening protocols are essential to optimize its clinical utility. Further studies are warranted to assess its clinical effectiveness in community-based cancer screening among high-risk population with behavioural risk factors, as well as to conduct cost-effectiveness analyses.