Utility of Lugol’s iodine in assessing the margin status of early stage oral cavity cancer-could it be a simple and effective way to achieve R0 resection?

Subbiah Shanmugam; Sathiyaseelan Balakrishnan

doi:10.18203/issn.2454-5929.ijohns20240055

Authors

Subbiah Shanmugam Kilpauk Medical College, Chennai, Tamil Nadu, India
Sathiyaseelan Balakrishnan Kilpauk Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240055

Keywords:

Oral cancer, Lugol’s iodine, Close margin, Tongue, Buccal mucosa

Abstract

Background: It is often challenging to distinguish between dysplastic and normal mucosa during surgery. Use of staining agents that will identify abnormal mucosa may improve results. Because Lugol's iodine is readily available, simple to use, and cost-effective, it was chosen as the preferred staining agent. To determine the effectiveness of Lugol’s iodine application in achieving R0 resection in early-stage oral cavity malignancy and thereby leading to better outcomes after treatment.

Methods: In this study we included 49 patients and randomized them into two arms. One arm we did wide excision for early-stage oral cavity cancers guided by subjective assessment of margins by surgeons and in another arm, we used Lugol’s iodine to define the margin. We analysed the margin status and thereby the need for the adjuvant therapy between these two groups.

Results: In those 49 patients, two of them had microscopically positive margin. One belonged to Lugol’s iodine arm and other belonged to control arm. 17 patients had close margin at mucosal site (less than 5 mm) out of which 11 belonged to control arm and 5 belonged to Lugol’s iodine arm.

Conclusions: Lugol’s iodine may be a simple and reliable method in achieving better resection margins and R0 resections for early-stage oral cavity cancer. By using this simple and cost-effective method we may reduce the possibility of ending up with positive or close margins and thereby avoiding the need of chemotherapy and radiation as adjuvant therapy in those patients.

Metrics

Metrics Loading ...

References

Gupta B, Bray F, Kumar N, Johnson NW. Associations between oral hygiene habits, diet, tobacco and alcohol and risk of oral cancer: a case–control study from India. Cancer Epidemiol. 2017;51:7-14.

Laprise C, Shahul HP, Madathil SA, Thekkepurakkal AS, Castonguay G, Varghese I et al. Periodontal diseases and risk of oral cancer in Southern India: results from the HeNCe Life study. Int J Canc. 2016;139(7):1512-9.

Ajay P, Ashwinirani S, Nayak A, Suragimath G, Kamala K, Sande A et al. Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years. J. Oral Res. Rev. 2018;10(1):11.

Borse V, Konwar AN, Buragohain P. Oral cancer diagnosis and perspectives in India. Sens Int. 2020;1:100046.

Nagaraju K, Prasad S, Ashok L. Diagnostic efficiency of toluidine blue with Lugol's iodine in oral premalignant and malignant lesions. Indian J Dent Res. 2010;21(2):223.

Epstein JB, Scully C, Spinelli J. Toluidine Blue and Lugol’s Iodine application in the assessment of Oral Malignant disease and lesions at risk of malignancy. J Oral Pathol Med. 1992;21(4):160-3.

Nakanishi Y, Ochiai A, Shimoda T, Yamaguchi H, Tachimori Y, Kato H et al. Epidermization in the Esophageal Mucosa: Unusual epithelial changes clearly detected by Lugol’s staining. Am J Surg Pathol 1997;21(5):605-9.

Isacsson G, Shear M. Content and distribution of glycogen in oral epithelial dysplasia. Scand J Dent Res 1981;89(1):79-88.

Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg. 1990;160(4):410-4.

Binahmed A, Nason RW, Abdoh AA. The clinical significance of the positive surgical margin in oral cancer. Oral Oncol. 2007;43(8):780-4.

Mehanna HM, Rattay T, Smith J, McConkey CC. Treatment and follow-up of oral dysplasia-A systematic review and meta-analysis. Head Neck. 2009;31(12):1600-9.

McMahon J, Devine JC, McCaul JA, McLellan DR, Farrow A. Use of Lugol’s iodine in the resection of oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg. 2010;48(2):84–7.

Kurita H, Kamata T, Li X, Nakanishi Y, Shimane T, Koike T. Effectiveness of vital staining with iodine solution in reducing local recurrence after resection of dysplastic or malignant oral mucosa. Br J Oral Maxillofac Surg. 2012;50(2):109-12.

Yajima Y, Noma H, Furuya Y, Nomura T, Yamauchi T, Kasahara K et al. Quantification of telomerase activity of regions unstained with iodine solution that surround oral squamous cell carcinoma. Oral Oncol. 2004;40(3):314-20.

Yokoo K, Noma H, Inoue T, Hashimoto S, Shimono M. Cell proliferation and tumour suppressor gene expression in iodine unstained area surrounding oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2004;33(1):75-83.