Confocal microscopy in oral cancer and oral potentially malignant disorders: A systematic review

Oral Dis. 2023 Nov;29(8):3003-3015. doi: 10.1111/odi.14291. Epub 2022 Jul 10.


Objective: To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral potentially malignant disorders.

Methods: Databases Medline, Embase, Evidence-Based Medicine, and Web of Science were searched with articles screened and included if their primary objective was the use of a confocal microscope in diagnosis of oral cancer or epithelial dysplasia, in vivo or ex vivo.

Results and discussion: Twenty-eight relevant studies were identified of which 21 studies included oral squamous cell carcinoma specimens. Fifteen studies included in vivo use. The studies included both qualitative and fluorescence confocal microscope and reflectance confocal microscope analysis along with quantitative analysis of carcinoma and dysplasia. Thirteen studies reported the predictive value of their confocal device in the diagnosis of dysplasia and carcinoma. The quantitative software-based studies show promise in objectifying the diagnostic process for identifying abnormalities within the microstructure of the oral mucosa.

Conclusions: There was heterogeneity in the criteria for diagnosis of dysplasia and oral squamous cell carcinoma with experience levels of assessors impacting method efficacy. Both qualitative and quantitative confocal assessment methodologies have been explored, the latter highlighting the potential of future machine-augmented diagnostic precision.

Keywords: confocal microscopy; dysplasia; in vivo microscopy; oral cancer.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Carcinoma, Squamous Cell* / diagnostic imaging
  • Carcinoma, Squamous Cell* / pathology
  • Head and Neck Neoplasms*
  • Humans
  • Microscopy, Confocal / methods
  • Mouth Diseases* / diagnosis
  • Mouth Neoplasms* / diagnostic imaging
  • Mouth Neoplasms* / pathology
  • Precancerous Conditions* / pathology
  • Squamous Cell Carcinoma of Head and Neck