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Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology


Clinical and histological evaluation of toluidine blue positive and negative stained oral mucosal lesions


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Author Details: Parul Khare Sinha, Madhvika Patidar, Vineet Raj, Shaleen Chandra, Nitin Agarwal

Volume : 2

Issue : 3

Online ISSN : 2395-6194

Print ISSN : 2395-6186

Article First Page : 120

Article End Page : 124


Abstract

Introduction: Screening of suspicious oral precancerous lesions can aid in early detection of oral cancer thus reducing the mortality and morbidity associated with this condition. Incisional biopsy remains a gold standard for diagnosis of oral potentially malignant disorders. Toluidine blue is a basic metachromatic stain that demonstrates affinity for DNA and RNA. It offers a potentially simple, inexpensive, and sensitive chair-side solution for screening of early oral squamous cell carcinoma and high-grade dysplasias. The aim of this study was to assess the reliability of toluidine blue stain as clinical screening test, for presence of epithelial dysplasia in oral mucosal lesions. In this study, biopsy was done in patients with oral pre-malignant lesions to relate their toluidine blue status to outcome as well as to conventional histopathologic features.
Method: Study Group consisted of 51 patients with potentially malignant oral mucosal lesions like homogenous leukoplakia (20), non-homogenous leukoplakia (16), erythroplakia (6), oral submucous fibrosis (5) and tobacco pouch keratosis (4). Patients were subjected to toluidine blue vital stain and were observed for positive and negative staining. Biopsy was taken from both toludine blue positive as well as negative lesions and graded for epithelial dysplasia to analyze the role of toludine blue staining in selecting lesions requiring biopsy.
Results: Out of 51 lesions 46 cases stained positive with toluidine blue vital stain. The overall sensitivity and specificity of toluidine blue staining in identifying dysplastic lesions was found to be 97.6% and 50% respectively.
Conclusion: Staining with toluidine blue was demonstrated to be highly reliable in the detection of dysplasia since false-negative results for the lesions did not occur. Toluidine blue staining can be an adjunct to clinical judgment and not a substitute for either judgment or biopsy.

Keywords:
Epithelial dysplasia, potentially malignant disorders, Pre-malignant lesions, Oral mucosal lesions, Toluidine blue