Utility of Toluidine Blue Test in Accessing and Detecting Intra-Oral Malignancies

Abstract

In vivo staining reveals cytological details that might otherwise not be apparent. The aim of the study was to test the utility of toluidine blue test in detecting various types of malignant and premalignant lesions in early stage. Fifty patients with lesion in oral cavity having suspicion of malignancy clinically were selected. After subjecting the patients to clinical examination, the suspicious lesions were stained with 1 % toluidine blue. The biopsy site was selected on the basis of clinical appearance and dye retention and in the sites where no retention of the stain occurred, clinical judgment directed the biopsy site. The sensitivity of toluidine blue in detecting premalignant or malignant lesions was found to be 97.8 % and the over all specificity was found to be 100 %. The positive predictive value, negative predictive value and diagnostic accuracy was reported to be 100, 80 and 90 % respectively. Toluidine Blue staining is highly a reliable source for the detection of insitu and invasive carcinomas. Staining with this stains is an adjunct to clinical judgment, assist in the choice of biopsy site, follow up of premalignant lesions and marginal demarcation of the malignant lesions enabling an intervention method to be adopted earlier for the disease, which carries a high rate of morbidity and mortality.

Toluidine blue staining in identification of a biopsy site in potentially malignant lesions: A case–control study

“…[ 12 ] in their study compared exfoliative cytology and toluidine blue staining and found the sensitivity and specificity to be 81.35% and 66.67%, respectively, which is similar to our study. Singh and Shukla[ 13 ] in their studies showed that sensitivity and specificity were a staggering 97.8% and 100%, respectively, higher than any previous study conducted and they were significantly higher than our study. Their results could possibly be due to the fact that the lesions in their study were at a more advanced stage and were present for longer durations than our study.…”

Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity

“…Data from 15 included studies (N ¼ 1,453 lesions) showed that when vital staining adjuncts are used in patients with clinically evident, suspicious lesions, 87% of patients with the target condition (PMDs or OSCC) will be classified correctly, and 71% of patients who are healthy will be classified correctly (sensitivity, 0.87; 95% CI, 0.80 to 0.94; specificity, 0.71; 95% CI, 0.61 to 0.82). 45,[63][64][65][66][67][68][69][70][71][72][73][74][75][76] Patients who test positive for the target condition via vital staining are 3 times more likely to have the disease than are those without the disease (positive LR, 3.04; 95% CI, 2.06 to 4.48). Patients who test negative for the target condition via vital staining are 0.18 times as likely not to have the disease as are those with the disease (negative LR, 0.18; 95% CI, 0.10 to 0.32).…”

“…Of the remaining 99,750 people who are healthy, 70,823 of them will be identified correctly as healthy, and 28,927 will not. The guideline panel determined the overall quality of the evidence for this comparison to be low because of serious issues of risk of bias and indirectness (eTable 6, 45,[63][64][65][66][67][68][69][70][71][72][73][74][75][76] available online at the end of this article).…”

“…Negative likelihood ratio, 0.18 (95% CI, 0.10 to 0.32). Sources: Allegra and colleagues, 76 Awan and colleagues, 75 Cancela-Rodriguez and colleagues, 74 Chaudhari and colleagues, 73 Chen and colleagues, 72 Cheng and Yang, 71 Du and colleagues, 70 Mashberg, 69 Nagaraju and colleagues, 68 Onofre and colleagues, 67 Rahman and colleagues, 45 Silverman and colleagues, 66 Singh and Shukla, 65 Upadhyay and colleagues, 64 and Warnakulasuriya and Johnson. 63 † We estimated the prevalence by using data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (300,682 people living with oral cavity and pharynx cancer in the United States in 2013) and the 2010 census data for adults 45 years or older collected by the US Census Bureau.…”

Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma

“…The ability of TB to detect oral and oropharyngeal carcinoma is well documented. The sensitivity and specificity rates for use of TB as a screening tool for oral premalignant and malignant lesions ranged from 77.0-100.0% and 65.5-100.0%, respectively [11,[29][30][31][32]. Onofre et al [11] and Warnakulasuriya et al [30] reported that TB was 100.0% sensitive for detecting oral carcinoma without false-negative results.…”