Prevalence of Malignant Neoplastic Oral Lesions Among Children and Adolescents
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This systematic review evaluated 42 studies to assess the scientific evidence regarding the prevalence of malignant oral lesions in children and adolescents around the world. A total of 64,522 biopsies were assessed among the 42 studies. At least 1.93% (1100) lesions were malignant. Lymphomas and sarcomas were the most commonly diagnosed malignant lesions. There was significant heterogeneity in the studies included, as some reported 0% malignancies through 30% malignancies, and, by continent, with Africa having the highest frequency of malignancy. Squamous cell carcinoma represented 8.38% of biopsied malignancies.
- Malignancies in children and adolescents occur, but at an overall low frequency. Squamous cell carcinomas can occur in this young age group despite the known risk factors of smoking and alcohol. Suspicious lesions in any age group require further evaluation.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Malignant neoplasms that affect children and adolescents are predominantly embryonic and generally affect blood system cells and supporting tissues.
AIM
This study aimed to summarize the scientific evidence about the prevalence of malignant lesions in the oral cavity of children and adolescents.
DESIGN
In this systematic review and meta-analysis (PROSPERO CRD42020158338), data were obtained from seven databases and the gray literature. Cross-sectional observational studies on the prevalence of biopsied oral pediatric malignancies were included. The Newcastle-Ottawa Scale assessed the quality of the included studies, and the GRADE approach evaluated the evidence certainty. The meta-analysis prevalence was calculated using MedCalc® software, adopting a 95% confidence level (CI; random-effect model).
RESULTS
Forty-two studies were included in the meta-analysis. Of the 64,522 biopsies, the prevalence of malignant lesions was 1.93% (n = 1,100; 95% CI = 1.21%-2.80%). Countries with a low socioeconomic profile showed the highest prevalence. The sample size did not influence the prevalence of oral malignancies, and unspecified lymphomas (12.08%; 95% CI = 5.73%-20.37%) and rhabdomyosarcoma (10.53%; 95% CI = 7.28%-14.30%) were the most common lesions.
CONCLUSIONS
Oral malignant lesions biopsied in children and adolescents had a prevalence of <3%, and lymphomas and sarcomas were the most prevalent lesions.
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Additional Info
Prevalence of Malignant Neoplastic Oral Lesions Among Children and Adolescents: A Systematic Review and Meta-Analysis
Int J Paediatr Dent 2021 Jul 01;31(4)504-519, DS de Paula, CE Nóbrega Malta, WH de Brito, JV Mota Lemos, EL Cetira Fillho, FW Gurgel Costa, APN Nunes Alves, PG de Barros SilvaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The stated aim of this systematic review and meta-analysis was to summarize the frequency of malignant diagnoses from oral cavity biopsies in children and adolescents. It is important to note that this “prevalence-based approach” is an alternate, and arguably more prone to sampling bias, than an incidence-based approach using data from published cancer registries (eg, Surveillance, Epidemiology, and End Results). Another important point of context is that “the usual suspects” in pediatric oncology (leukemia, central nervous system tumors, lymphoma, bone and soft tissue sarcomas) are different than those in adults (carcinomas) and a high degree of regional variation (eg, endemic Burkitt lymphoma in Africa) absolutely exists.
Published studies from 18 countries and encompassing 64,522 biopsies were included in this work. The heterogeneity in the frequency of malignancy among pediatric oral biopsies was striking (ranging from 0 to >40%). Due to this large degree of variability in the component studies, the random effects model used for the ensuing meta-analysis gave nearly equal weight to all of the 42 studies, regardless of their individual sample size (see Fig. 2). Statistically, this makes sense; however, one could make the argument that continuing with the meta-analysis on such heterogenous data is not very useful with regard to addressing the stated study aim. Indeed, the 1.93% stated overall prevalence of malignant diagnoses in pediatric oral biopsies is not very representative of the patient population that I have personally worked with (where most of the pediatric biopsies are mucoceles, hyperplastic dental follicles, and occasional benign epithelial or mesenchymal proliferations). Indeed, the world map in Figure 4 provides a striking visual of this phenomenon.
Beyond the heterogeneity, I think another important “takeaway” for clinicians is that the most common pediatric malignancies presenting in the oral cavity were lymphomas and sarcomas, and clinically these can present as a mass or lytic lesion with a differential that could certainly overlap with benign entities. Additionally, squamous and salivary carcinomas collectively made up greater than 15% of the malignant pediatric biopsies, so one should never be too quick to exclude these entities strictly due to patient age. Pediatric biopsies have their own unique management challenges; but, whenever in doubt, take it out and send it to your friendly neighborhood pathologist, please.