Global Research Trends on Use of VELScope for Diagnosis of Oral Mucosal Lesions: A Bibliometric Analysis

1. Assistant Professor, Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India. 2. Assistant Professor, Department of Oral, Maxillofacial Pathology and Oral Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India.

Abstract

Introduction: The Visually Enhanced Lesion Scope (VELscope®) is a handheld medical device that can be used to clinically visualise and diagnose oral mucosal lesions. It works by the application of direct fluorescence and the loss of fluorescence in visible and non visible high-risk oral lesions. Numerous publications have offered insights on the possible use of VELscope® for identifying oral mucosal lesions. By analysing patterns in publication outputs, citation metrics and collaborative networks, researchers can gain insights into the development, influence and key contributors in the field of VELscope®, guiding future research directions and policy decisions.

Aim: To track down and analyse all studies published on the application of VELscope® in the diagnosis of oral mucosal lesions and to assist future researchers by highlighting the most cited earlier publications.

Materials and Methods: This bibliometric analysis was conducted using articles published on the applications of VELscope® in detecting oral mucosal lesions between 2006 and 2022. In December 2023, a comprehensive search was performed on PubMed and Scopus databases using medical subject heading terms like “VELscope®,” “Autofluorescence imaging system,” and “Oral” in several combinations. Bibliographic data regarding the top 100 most cited articles were extracted and collated.

Results: The analysis showed that the most contributions came from the journals “Oral Oncology,” “Oral Diseases,” and “Photodiagnosis and Photodynamic Therapy,” with significant contributions from researchers in the USA and India. The highest number of publications occurred in 2015, with a notable peak in the decade 2011-2020. The articles were cumulatively cited 4,559 times.

Conclusion: The current bibliographic analysis provided valuable insights into the development and impact of research on the applications of VELscope® in dentistry by highlighting publication trends, influential works, leading authors and collaborative networks. These insights can guide future research directions, inform policy decisions and enhance understanding of the evolution and scholarly influence.

Fluorescence, Optical imaging, Visually enhanced lesion scope

Early diagnosis of oral mucosal lesions aids in timely management and boosts the prognosis of the patient’s prognosis. The main approach currently used for clinical interpretation of these lesions involves detecting epithelial alterations in the oral mucosa by visual examination and palpation (1). While biopsy is considered the gold standard for diagnosis, it is an invasive, painful, expensive and time-consuming procedure that requires a well-trained healthcare professional (2). Easy visualisation of suspicious lesions at an early stage can aid the clinicians in effective management.

The increased demand for non invasive diagnostics to replace standard white light oral examinations for the identification of oral lesions has led to the development of several light-induced fluorescence visualisation devices, such as the VELscope® (3). The VELscope® is a handheld medical device used to clinically visualising and diagnosing oral mucosal lesions (4). The VELscope® system works by the application of direct fluorescence and observing loss of fluorescence in high-risk oral lesions, both visible and non visible (1). The system comprises of a digital camera for taking pictures of tissues and a blue light source that emits light with a wavelength of 400-460 nm. Healthy epithelial tissue emits green autofluorescence, whereas the fluorescent light, appearing dark (5). The VELscope® has several applications (6): distinguishing between normal and abnormal mucosa, delineation between benign and malignant changes and visualisation of involved margins intraoperatively. The World Health Organisation (WHO) as an efficient tool for oral cancer prevention. It reportedly has a sensitivity of 98% and a specificity of 96%-100% (7).

Continuous improvements and advancements in VELscope® technology could potentially address some of its current limitations, such as cost-effectiveness, reliability, training and user expertise. However, ongoing research is needed to evaluate these advancements and ensure they provide meaningful improvements in diagnostic capabilities. Addressing these gaps through comprehensive research and evidence-based guidelines will be crucial in maximising the potential benefits of VELscope® in dental practice and improving early detection of oral mucosal lesions.

The potential application of VELscope® in the identification of oral mucosal lesions has been presented in several publications. The present review aims to track and analyse all studies published on the VELscope® application in diagnosing oral mucosal lesions and to assist future researchers by highlighting the most cited earlier publications.

Material and Methods

This bibliometric analysis was conducted using articles published on the applications of VELscope® in detecting oral mucosal lesions between 2006 and 2023. In December 2023, databases such as Scopus, PubMed and Google Scholar were comprehensively searched by two reviewers independently. Keywords like “VELscope®,” “Autofluorescence imaging system,” and “Oral” were used along with Boolean operators in several combinations as follows: (autofluorescence OR fluorescence OR VELscope®) AND (oral OR mouth) AND (dysplasia OR malignancy OR cancer OR carcinoma OR neoplasm OR lesions). The review included studies that assessed the use of VELscope® in the diagnosis of oral lesions. On initial literature search using keywords, a total of 112 articles were extracted. 12 articles were excluded as they were not related to the applications of VELscope® in dentistry. Finally, 100 articles were included in the review, as detailed in (Table/Fig 1) (1),(2),(3),(4),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41),(42),(43),(44),(45),(46),(47),(48),(49),(50),(51),(52),(53),(54),(55),(56),(57),(58),(59),(60),(61),(62),(63),(64),(65),(66),(67),(68),(69),(70),(71),(72),(73),(74),(75),(76),(77),(78),(79),(80),(81),(82),(83),(84),(85),(86),(87),(88),(89),(90),(91),(92),(93),(94),(95),(96).

The articles were listed in decreasing order of citations. The literature search lasted from the earliest published paper (2006) to 2023. After thoroughly assessing the titles and abstracts of these articles to confirm their relevance to using VELscope® for identifying oral lesions, a list of the 100 most-cited publications was compiled. The total number of citations was divided by the number of years since publication to calculate the mean citation density of each study (7). When more than one article had the same total number of citations, the article with the highest citation density was given preference in the ranking. The data were extracted onto an Excel spreadsheet and the results were tabulated. Descriptive data synthesis was done and represented graphically where applicable.

Results

The literature search yielded 455 published articles in the Scopus database from 2006 to the present. Of these, 355 publications were classified as ‘articles’ and 100 publications were reviews. In PubMed, the number of articles published on the applications of VELscope® between 2006 and the present was 85, among which 49 were ‘articles’, 32 were ‘reviews’ and four were short communications. The top 100 most cited articles were retrieved and arranged in descending order of citations for further bibliometric analysis (1),(2),(3),(4),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41),(42),(43),(44),(45),(46),(47),(48),(49),(50),(51),(52),(53),(54),(55),(56),(57),(58),(59),(60),(61),(62),(63),(64),(65),(66),(67),(68),(69),(70),(71),(72),(73),(74),(75),(76),(77),(78),(79),(80),(81),(82),(83),(84),(85),(86),(87),(88),(89),(90),(91),(92),(93),(94),(95),(96).

Article and citation analysis: The top 100 most cited articles on applications of VELscope® were cited 4,559 times. The median number of citations was 204, ranging from 407 (article rank No. 1) to 1 (article rank No. 100). The top three ranked articles received more than 200 citations. The top-cited article (citation=407) was ‘Adjunctive techniques for oral cancer examination and lesion diagnosis: A systematic review of the literature,’ published by Patton LL et al., in the Journal of the American Dental Association in 2008 (8). The second most cited paper (citation=252) was published in Oral Oncology by Awan KH et al., titled ‘Evaluation of an autofluorescence-based imaging system (VELScope™) in the detection of oral potentially malignant disorders and benign keratoses’ in 2011 (9). The third most cited publication (citation=231) was by Mehrotra R and Gupta DK, published in the Journal of the American Dental Association in 2010 (10).

The article with the highest citation density (29.07) was of an article by Patton LL et al., titled ‘Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature’. This article was published in the Journal of the American Dental Association in 2008 (8). On the other hand, Comisi JC’s case report titled ‘Oral human papillomavirus lesion identified using VELscope® instrumentation: A case report’ received the lowest citation density (0.14). The article appeared in the journal General Dentistry in 2008 (89).

Among the top 100 most cited articles on applications of VELscope®, 46 publications were categorised as ‘original research’, 24 were classified as ‘review articles’ and 17 were ‘randomised controlled trials’. Other papers were classified as ‘systematic reviews’ (n=8), ‘case reports’ (n=4) and correspondence (n=1). The various study designs of the included publications are represented in (Table/Fig 2).

Journal analysis revealed that the top 100 publications on the use of VELscope® that received the most citations were published in 69 different journals overall. Upon careful examination of the journals, it became clear that the journal titled “Oral Oncology” had contributed the most publications (n=7). This was followed by ‘Oral Diseases’ and ‘Photodiagnosis and Photodynamic Therapy’, with five publications each. In total, 18 of the 69 journals contributed more than one publication. All the journals with two or more contributions to the top 100 most cited publications have been listed in (Table/Fig 3).

All the contributing journals’ impact factors and h-index were recorded. The impact factor ranged from 26.22 to 0.01. Fourteen out of the top 100 most cited articles on VELscope® appeared in journals with an impact factor of more than 5. The ‘International Journal of Oral Science’ had the highest impact factor (26.22), while the ‘Dentistry Today’ journal had the lowest impact factor (0.01). Both of these journals contributed one article each.

The h-index of the included journals ranged from 367 to 6. A total of 26 out of the 100 articles were published in journals with an h-index of more than 100. The journal with the highest h-index of 367 was PLOS ONE, which contributed three articles to the top 100 most cited list. The journal ‘Acta Medica Bulgarica’ had the least h-index of 6. The article had one contribution to the top 100 cited articles list.

A total of 98 out of the 100 most cited articles were in the English language. An article by Matsumoto K, titled ‘Detection of potentially malignant and malignant lesions of the oral cavity using an autofluorescence visualisation device,’ was published in ‘The Journal of the Stomatological Society, Japan’ in the Japanese language (74). An article titled ‘Autofluorescence for the detection of potentially malignant and malignant lesions of the oral cavity lining’ was published in the French language in the ‘Journal of Stomatology Oral and Maxillofacial Surgery’ by Fricain JC (78). Translated English versions of both articles were obtained by contacting the respective corresponding authors.

The highest number of publications (n=11) was in 2015, followed closely by 2019 (n=10). The least number of publications was in the year 2007 (n=1). The maximum number of publications was noted in the decade 2011-2020 (n=71). The year-wise trend of the top 100 most cited articles are presented in (Table/Fig 4).

Author analysis: A total of 440 researchers authored the top 100 most cited articles. According to the results of the analysis, the top 100 cited papers had 1 author (n=10) to 6 authors (n=47). A total of 21 articles had two authors and 12 articles had three authors. Four or more contributors were involved in 57 articles. Among the 100 most cited articles, three authors (Assaf AT, CicciÙ M, Farah CS) had three papers each to their credit. A total of eight authors contributed two papers each. The author analysis has been illustrated in (Table/Fig 5).

The search revealed that researchers from 22 countries had contributed to the top 100 most cited articles. The United States of America and India had 14 publications each, which was the maximum. This was followed by Germany and Italy, which had 12 publications each. The countries with their contributions towards the top 100 most cited publications on the use of VELscope® for the diagnosis of oral mucosal lesions is illustrated in (Table/Fig 6).

Discussion

The most influential articles in the field of dentistry can be best identified through bibliographic analysis. Furthermore, the scientific value of an article is best judged by the number of times it is cited (97). Such a holistic analysis of existing literature highlights the lacunae in research on a particular topic and helps in further research (98). VELscope® can be used to diagnose oral mucosal lesions such as leukoplakia, lichen planus, oral squamous cell carcinoma, oral verrucopapillary lesions, fungal infections and oral submucous fibrosis.

The quality of an article is often determined by its citation count (99). In the present analysis, an article titled “Adjunctive techniques for oral cancer examination and lesion diagnosis: A systematic review of the literature,” authored by Patton LL et al., and published in the Journal of the American Dental Association in 2008, received the highest number of citations (8).

The majority of articles were published between 2006 and 2023 (a span of 18 years), which represents the publication period.

Usually the number of citations is directly proportional to time (99). Older publications benefit from time and usually have a higher number of citations. Meanwhile, more recent studies with strong scientific content may have less citations (100). Articles typically require a minimum of 6 to 15 years to receive a sufficient number of citations (101). This could explain why none of the recently released publications ranked first in the present analysis of the most cited articles. However, the citation score for recently published papers may benefit from tools like social media networking, electronic format journals, online-first publishing and open access options (102).

Approximately 46% of the publications were original research articles. The amount of evidence highlights the significance, excellence and applicability of the papers to more research (103).

Researchers and institutions from India and the United States of America (n=14 each) predominantly published articles on the use of VELscope® in diagnosing oral lesions. Factors such as the large populations in these nations, their focus on medical science and research could contribute to this trend (104). India has made rapid advancements in medical research and development in recent years (104).

This bibliographic analysis demonstrates the global research trend on the use of VELscope® in diagnosing oral mucosal lesions. This data can help identify research gaps and support future studies.

Limitation(s)

Despite the fact that a rigorous strategy was employed to identify and collate all the published articles, the present bibliographic analysis does have some potential limitations. The list of the most-cited manuscripts could have been different if a different database or search engine had been used, along with various keyword and search definition combinations. Additionally, some of the articles lacked author information. Also, older papers may receive fewer citations over time as they become less relevant and newer articles require a longer time to achieve a higher citation rate. The average number of citations per year was also estimated because older articles tend to benefit from the time effect and receive more citations, which appears unfair for current studies.

Conclusion

The present bibliographic analysis shows how research on using VELscope® to diagnose oral mucosal lesions has developed over time. It is anticipated that the data supplied here will help identify research gaps and encourage further studies. The most frequently cited papers on using VELscope® to diagnose oral mucosal lesions are identified and examined in the current bibliometric analysis. The list contains a number of important works by researchers who have transformed study and development in this area. The results of the present review not only show trends in current research and clinical practice but also shed light on how science has developed in the subject. The publications offered here will be a valuable resource for researchers and medical professionals.

DOI and Others

DOI: 10.7860/JCDR/2024/71182.19777

Date of Submission: Apr 09, 2024
Date of Peer Review: May 22, 2024
Date of Acceptance: Jun 17, 2024
Date of Publishing: Aug 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 09, 2024
• Manual Googling: May 24, 2024
• iThenticate Software: Jun 15, 2024 (16%)

ETYMOLOGY: Author Origin

EMENDATIONS: 6