Light-based adjuncts to determine the need for biopsy for early detection of oral squamous cell carcinoma and potentially malignant disorders: An evidence summary of a living systematic review, Version 2026 1.0

Background: Early detection of oral potentially malignant disorders and oral cancer has the potential to decrease negative consequences associated with late-stage diagnosis and improve prognosis. Light-based adjunct devices could have a role in oral cancer diagnostic pathways before definitive diagnosis with biopsy. In this living systematic review, the authors assessed the benefits and harms of light-based adjuncts to detect oral potentially malignant disorders and oral squamous cell carcinoma. Types of Studies Reviewed: The authors enhanced and updated systematic searches from systematic reviews in several databases (ie, MEDLINE, Epistemonikos, Embase, and Cochrane Central Register of Controlled Trials) through November 25, 2025. The authors independently screened and extracted diagnostic impact and test accuracy studies in duplicate using the Grading of Recommendations Assessment, Development and Evaluation approach and assessed the certainty in the evidence. Results: The authors identified 36 diagnostic test accuracy studies, 0 impact studies for people with mucosal abnormalities, and 0 studies for people without abnormalities. Low through very low certainty pooled sensitivity data across autofluorescence and tissue reflectance light-based tests (range, 0.86-0.91) in people with mucosal abnormalities could be acceptable. Pooled specificities (range, 0.26-0.56) suggested the test could result in many false-positive results. Conclusions and Practical Implications: The clinical usefulness of light-based adjuncts cannot be determined with a high degree of certainty for patients with or without mucosal abnormalities. Unnecessary anxiety, biopsies, and costs related to false-positive results in people with mucosal abnormalities need to be considered when balancing the test's clinical usefulness. The absence of evidence among people without mucosal abnormalities is problematic.