The study of use of toluidine blue as an adjunctive tool to clinical examination in early diagnosis of clinically suspicious oral premalignant and malignant lesions: a study of fifty cases
Keywords:Toluidine blue, Leukoplakia, Erythroplakia, Squamous cell carcinoma, Early detection, Adjunctive tool
Background: Oral carcinoma is among the most prevalent malignancies of head and neck region and is often diagnosed in the advanced stage with significant morbidity and treatment cost. Thus, there is a need for early detection of oral premalignant and malignant lesions. Toluidine blue staining can be used for early detection of these lesions.
Methods: The study included 50 patients with clinically suspicious oral premalignant and malignant lesions. These lesions were subjected to toluidine blue staining and biopsy. Diagnoses were confirmed by histopathological examination.
Results: Sensitivity and specificity of toluidine blue for oral premalignant lesions was 92.30% and 80% respectively with the positive predictive value of 92.30%, negative predictive value of 80% and accuracy of 88.88%. Sensitivity and specificity of toluidine blue for oral malignant lesions was 96.30% and 80% respectively with the positive predictive value of 96.30%, negative predictive value of 80% and accuracy of 93.75%.
Conclusions: The simplicity of toluidine blue staining and its accuracy suggest that it can be a useful adjunctive tool to diagnosis of oral lesions. Results should be carefully evaluated and correlated with clinical findings and histopathological diagnosis.
Scully C, Bagan JVS. Scott- Brown’s Otorhinolaryngology, Head and Neck Surgery. In: Gleeson M, ed. 7th ed. London: Hodder Arnold; 2008.
Jemal A, Thimas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin. 2002;52:181-2.
Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll SurgEngl. 1995;46:518-39.
Hegde MC, Kamath PM, Shreedharan S, Dannana NK, Raju RM. Supravital staining: it’s role in detecting early malignancies. Indian J Otolaryngol Head Neck Surg. 2006;58:31-4.
Banoczy J, Sugar L. Longitudinal studies on oral leukoplakia. J oral Pathol. 1972;1:265-9.
Chiesa F, Tradati N, Sala L, Costa L, Podrecca S, Barachi P, et al. Follow-up of oral leukoplakia after carbon dioxide laser surgery. Arch Otolaryngol Head Neck Surg. 1990;116:177-80.
Rodriguez PC, Lapiedra RC, Gomez GE, Martinez SL, Warnakulasuriya S. The use of toludine blue in the detection of premalignant and malignant oral lesions. J Oral Pathol Med. 2011;40:300-4.
Upadhyay J, Rao NN, Upadhyay RB, Agarwal P. Reliability of toluidine blue vital staining in detection of potentially malignant oral lesions-time to reconsider. Asian Pacific J Cancer Prev. 2011;12:1757-60.
Lekawale H, Raikwar KR, Ghodke M, Gawande P, Deshmukh V, Garde JB. Postoperative morbidity in squamous cell carcinoma of oral cavity. Ind J App Res. 2016;6(12):528-31.
Petkowicz B, Skiba M, Tomaszewski T, Wysokinska-Miszczuk J. Leukoplakia in clinical and epidemiological aspect- analysis of cases. Dent Med Probl. 2004;41:635-41.
Starzynska A, Pawłowska A, Renkielska D, Michajłowski I, Sobjanek M, Błazewicz I. Oral premalignant lesions: epidemiological and clinical analysis in the northern Polish population. Postepy Dermatol Alergol. 2014;31:341-50.
Iype E M, Pandey M, Mathew A, Thomas G, Sebastian P, Nair M K. Oral cancer among patients under the age of 35 years. J Postgrad Med. 2001;47:171.
Dewan AK, Dabas SK, Pradhan T, Mehta S, Dewan A, Sinha R. Squamous cell carcinoma of the superior Gingivobuccal sulcus: An 11- year Institutional experience of 203 cases. Jpn J Clin Oncol. 2014;44(9):807-11.
Liu L, Kumar SKS, Sedghizadeh PP, Jayakar AN, Shuler CF. Oral squamous cell carcinoma incidence by subsite among diverse racial and ethnic population in California. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(4):470-80.
Sharma RG, Bang B, Verma H, Mehta JM. Profile of oral squamous cell cancer in a tertiary level medical college hospital: a 10 year study. Indian J Surgl Oncol. 2012;3(3):250-4.
Oliveira MLC, Wagner VP, Sant’ana Filho M, Carrard VC, Hugo FN, Martins MD. A 10-year analysis of the oral squamous cell carcinoma profile in patients from public health centers in Uruguay. Braz Oral Res. 2015;29:1-8.
Lee JJ, Hong WK, Hittelman WN, Mao L, Lotan R, Shin DM, et al. Predicting cancer development in oral leukoplakia: ten years of translational research. Clin Cancer Res. 2000;6:1702-10.
Pallagatti S, Sheikh S, Aggarwal A, Gupta D, Singh R, Handa R, et al. Toluidine blue staining as an adjunctive tool for early diagnosis of dysplastic changes in the oral mucosa. J Clin Exp Dent. 2013;5(4):e187-91.
Gaphor SM, Sabri ZA. Prevalence of oral premalignant and malignant Lesions among referred Kurdish patients Attending Department of Oral and Maxilofasial in Sulaimani Teaching Hospital. IOSR J Dent Med Sci. 2014;13(2):32-6.
Hosagadde S, Dabholkar J, Virmani N. A clinicopathological study of oral potentially malignant disorders. J Head Neck Physicians Surg 2016;4:29-34.
Prasan D. Clinicopathological study of oral cancers. IOSR J Dent Med Sci. 2015;14(6):35-8.
Shenoy R, Devrukhkar V, Chaudhari, Sharma BK, Sapre SB, Chikhale A. Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Indian J Cancer. 2012;49:21-6.
Ramasamy P, Sivapatham S. Assessment of factors associated with early and late diagnosis of buccal mucosa carcinoma. J App Pharm Sci. 2016;6(8):79-82.
Allegra E, Lombardo N, Puzzo L, Garozzo A. The usefulness of toluidine staining as a diagnostic tool for precancerous and cancerous oropharyngeal and oral cavity lesions. Acta Otorhinolaryngol Ital. 2009;29:187-90.
Desai VD, Narang P. Utility of toluidine blue in the detection of oral epithelial dysplasia: a diagnostic adjunct. Ind J Pub Heath Res Dev. 2015;6(1):82-5.
Sinha PK, Patidar M, Raj V, Chandra S, Agarwal N. Clinical and histological evaluation of toluidine blue positive and negative stained oral mucosal lesions. J Oral Med Oral Surg Oral Pathol Oral Radiol. 2016;2(3):120-4.
Sapna M, Rupnarayan R, Azeem MSM. Efficacy of toluidine blue and brush biopsy in oral lesions. Int J Oral Maxillofac Pathol. 2013;4(1):228.
Vashisht N, Ravikiran A, Samatha Y, Rao PC, Naik R, Vashisht D. Chemiluminescence and toluidine blue as diagnostic tools for detecting early stages of oral cancer: an in-vivo Study. J Clin Diagn Res. 2014;8:35-8.
Onofre MA, Sposto MR, Navarro CM. Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:535-40.
Rosenberg D, Cretin S. Use of meta-analysis to evaluate tolonium chloride in oral cancer screening. Oral Surg Oral Med Oral Pathol. 1989;67(5):621-7.
Gandolfo S, Pentenero M, Broccoletti R, Pagano M, Carrozzo M, Scully C. Toluidine blue uptake in potentially malignant oral lesions in vivo: clinical and histological assessment. Oral Oncol. 2006;42(1):89-95.
Guo Z, Yamaguchi K, Sanchez-Cespedes M, Westra WH, Koch WM, Sidranski D. Allelic losses in OraTest-directed biopsies of patients with prior upper aerodigestive tract malignancy. Clin Cancer Res. 2001;7(7):1963-8.
Mashberg A. Final evaluation of tolonium chloride rinse for screening of high risk patients with asymptomatic squamous carcinoma. J Am Dent Assoc. 1983;106:319-23.