High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine

[[abstract]]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. SUBJECTS AND METHODS: A prospective study of 355 participants, including 280 with oral lesions/variants was conducted. Adults aged ≥18 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 was 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