Improving the Diagnostic Performance by Adding Methylation Marker to Conventional Visual Examination in Identifying Oral Cancer

Background: Visual oral examination (VOE) is a conventional oral cancer screening method. This study aimed to evaluate the value of methylation marker to assist VOE in identifying oral epithelial dysplasia and oral squamous cell carcinoma (OED/OSCC) from non‐cancerous lesions in a real‐world situation. Methods: 201 patients with high‐risk personal habits who self‐perceived oral anomaly were VOE examined, ZNF582 methylation (ZNF582^m) tested, and histologically diagnosed. Results: Among them, 132 patients (65.7%) were histologically diagnosed OED/OSCC. Using VOE, 56.1% OED/OSCC patients had possible oral cancer, whereas 37.7% non‐OED/OSCC patients had leukoplakia. ZNF582^m‐positive was detected in 90.2% OED/OSCC patients and 44.9% non‐OED/OSCC patients. Various logistic regression models were postulated to evaluate the diagnostic performance of conventional VOE and new strategies using ZNF582^m. ROC analysis and its corresponding C‐index demonstrated that either triage or co‐testing models of VOE and ZNF582^m could improve diagnostic performance and discriminative abilities compared with the VOE only approach. Conclusions: In conclusion, methylation marker test shows equivalent performance to an experienced judgment by oral maxillofacial surgeons and plays a significantly supplementary role in increasing the efficacy in identifying oral malignant lesions. ZNF582^m may be an especially important tool for family physicians or general dentists to properly diagnose suspicious oral lesions.