Efficacy of toluidine blue in the diagnosis and screening of oral cancer and pre‐cancer: A systematic review and meta‐analysis

Abstract

The accuracy of toluidine blue (TB) and chemiluminescence for diagnosing oral cancer and pre-cancer was evaluated. Methods: Two authors (working independently) comprehensively reviewed six databases (PubMed, Cochrane database, Embase, Web of Science, SCOPUS and Google Scholar) from their dates of inception until March 2020. Oral mucosal disorder, as detected by TB, was compared with that detected by chemiluminescence. True-positive, true-negative, false-positive and false-negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). The extent of interrater agreement was also assessed. Results: Twenty-nine prospective and retrospective studies were included. The diagnostic odds ratio (DOR) of TB was 7.017 (95% confidence interval [CI], 4.544; 10.836). The area under the summary receiver operating characteristic curve was 0.766. The correlation between the sensitivity and the false-positive rate was 0.196, indicating the absence of heterogeneity. TB exhibited moderate interrater reliability (0.6777; 95% CI, 0.43; 0.7455). Compared with chemiluminescence, as used in nine studies, TB had a lower sensitivity (0.659 vs 0.841), but a higher specificity (0.809 vs 0.345), negative predictive value (0.766 vs 0.690) and DOR (10.565 vs 5.203). Compared with clinical examination, as used in four studies, TB method had a higher sensitivity (0.891 vs 0.891), specificity (0.739 vs 0.634), negative predictive value (0.920 vs 0.714) and DOR (28.491 vs 8.526). Subgroup analysis showed that screening for severe dysplasia or more severe disease was significantly more sensitive, but less specific, than screening for all dysplasias. Conclusions: Although the diagnostic accuracy of TB in the diagnostic work-up of oral cancer and pre-cancer was higher than that of clinical examination, it was not high enough for TB to reliably be used alone. Instead, it should be combined with chemiluminescence or other diagnostic tools.

Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta‐analysis

“…1 Clinically, the high specificity of this method could reduce overtreatment (radical resection and debridement). 17 However, about 17% of our patients who were negative for frozen biopsy were false negative (AIFRS was missed). Missing an actual case of AIFRS (false-negative) would have a more serious clinical impact than "overcalling" the disease, because delayed or insufficient treatment can have adverse effects on prognosis.…”

Predictive Value of Delphian Lymph Node Metastasis in the Thyroid Cancer

“…In particular, the DLN specificity for the absence of CLNM was 86%; therefore, DLN reliably excluded false positives of CLNM. These patterns of values could reduce overtreatment (prophylactic contralateral CLND) with high specificity 32 . However, missing an actual contralateral CLNM (false negative) would have a greater clinical impact than “overcalling” a normal contralateral lymph node as a metastatic lymph node by DLN (false positive) because contralateral CLNM adversely affects the patient's prognosis and may increase the risk of recurrence.…”

“…These patterns of values could reduce overtreatment (prophylactic contralateral CLND) with high specificity. 32 However, missing an actual contralateral CLNM (false negative) would have a greater clinical impact than "overcalling" a normal contralateral lymph node as a metastatic lymph node by DLN (false positive) because contralateral CLNM adversely affects the patient's prognosis and may increase the risk of recurrence. The diagnostic accuracy of DLN in LLNM was similar to that of contralateral CLNM, which could be explained in the same way.…”

Management of oral leukoplakia: a position paper of the Society of Oral Medicine, Chinese Stomatological Association

“…Review and assessment of these studies can be found in other systematic reviews regarding diagnostic tools for oral squamous cell carcinoma and PMDs. 59,60 Moreover, most studies included in this position paper were not based on the Chinese population, and most studies published in Chinese did not meet the criteria of data inclusion. Some systematic reviews on the management and monitoring of OLK have also been conducted in recent years.…”