The use of toluidine blue in the detection of pre-malignant and malignant oral lesions

Abstract

The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.

Oral Cancer and Potentially Cancerous Lesions - Early Detection and Diagnosis

“…96,97 In contrast, a recently published paper of case series by Cancela-Rodriguez et al reported higher specificity than sensitivity. 89 Whilst the sensitivity of 65.5% was lower than previous reports, the specificity of 73.3% was consistent with other studies. The PPV of 35.2% was also lower, which the authors attributed to the lower prevalence of dysplastic and malignant lesions in their study when compared with others, whereas the NPV of 90.6% was again consistent with other papers.…”

“…The PPV of 35.2% was also lower, which the authors attributed to the lower prevalence of dysplastic and malignant lesions in their study when compared with others, whereas the NPV of 90.6% was again consistent with other papers. 89 On the whole, the relatively lower specificity values were a result of relatively high numbers of false positive findings. In several studies, TB stained normal variations of anatomy, and benign inflammatory and traumatic lesions due to their increased cell activity.…”

“…5,89 The increased nuclear density and the loss of intracellular adherence in dysplastic and malignant tissues allows TB dye to penetrate through the epithelium and be retained in these tissues, thereby staining these areas of abnormality blue. 89,90 Although TB has primarily been marketed as an adjunct for detecting potentially malignant and malignant oral lesions not identified by COE, it has also been recommended for determining the risk of potentially malignant oral lesions progressing to cancer, monitoring suspicious lesions, determining the optimal biopsy site, assessing the extent and margins of potentially malignant and malignant oral lesions, and for assessing the outcome after treatment for dysplasia and cancer in follow-up appointments. 90,91 Until recently, TB was commercially available as kits under the trade names 'OraScan' (Germiphene), 'OraScreen' (StaffordMiller Ltd.) and 'OraTest' (Zila Pharmaceuticals).…”

“…In several studies, TB stained normal variations of anatomy, and benign inflammatory and traumatic lesions due to their increased cell activity. 89,[96][97][98][99][100] To reduce the number of unnecessary biopsies and to exclude inflammatory and traumatic lesions, Mashberg suggested restaining any TB-stained lesion after 10 to 14 days. 98 Any lesion that still stained after this period should be evaluated for cancer by biopsy, 98 as OSCC, CIS and high-grade dysplasia retained TB fairly consistently.…”

Chemiluminescence and Toluidine Blue as Diagnostic Tools for Detecting Early Stages of Oral Cancer: An invivo Study

“…Toluidine blue, an acidophilic metachromatic dye of thiazine group selectively stains acidic tissue components (sulfates, carboxylates and phosphate radicals), thus staining DNA and RNA [21][22][23][24][25]. Toluidine blue has been established as a diagnostic adjunct in detecting oral lesions related to invasive carcinomas, carcinoma in situ or early asymptomatic oral carcinomas [26][27][28][29][30][31][32].…”