Predicting Oral Cancer From Precursor Lesions: Assessing Current Methods and Future Directions.

PURPOSE: Oral potentially malignant disorders (OPMDs) pose a significant clinical challenge due to their potential to develop into oral squamous cell carcinoma, a prevalence of 4%-5% of the US population, and malignant transformation rates that approach 10%. Current methods to assess risk of OPMD progression to oral cancer are fraught with limitations and incompletely predict risk. METHODS: We review existing diagnostic and prognostic tools for OPMDs, examining their validation evidence, performance characteristics, and clinical utility. RESULTS: Although some tools provide rule-in or rule-out capabilities, each tool interrogates a single biological layer, and none provides comparable positive predictive value and negative predictive value in a single tool. CONCLUSION: A framework integrating multiomic data across multiple different biologic processes and time points inclusive of benign mimics is needed to better identify which lesions are true OPMDs, and which warrant escalation and intervention versus surveillance or de-escalation.