title: Differentiating vulvar intraepithelial neoplasia from nonneoplastic epithelial disorders. The toluidine blue test.
abstract: OBJECTIVE
  To determine the effectiveness of the toluidine blue test in the differentiation of vulvar intraepithelial neoplasia (VIN) and nonneoplastic epithelial disorders (NNEDs).
  
  
  METHODS
  This retrospective clinical study included all women with VIN (n = 24) and NNED (n = 72) referred to a vulvar clinic at a university hospital during a two-year period. Vulvoscopy, staining of vulvar epithelium with 1% toluidine blue and punch biopsy were performed.
  
  
  RESULTS
  Vulvar epithelium demonstrated toluidine blue staining in 100% of the patients with VIN 3, in 83% of women with VIN 1-2, in 50% of the women with squamous cell hyperplasia and in 10% of the women with lichen sclerosus. The differences in staining between the groups were statistically significant (P < .001). The sensitivity of toluidine blue staining for the detection of VIN was 92%; the negative predictive value 96% in teh investigated cohort. The specificity for strong staining was 88%.
  
  
  CONCLUSIONS
  The toluidine blue test is an inexpensive and reliable method of separating VIN from hyperplastic NNED areas and choosing a biopsy site on the vulva.
authors.affiliation: Department of Gynecology and Obstetrics, University of Vienna Medical School, Allgemeines Krankenhaus, Vienna, Austria.
authors.forename: E A
authors.initials: EA
authors.lastname: Joura
authors.forename: H
authors.initials: H
authors.lastname: Zeisler
authors.forename: A
authors.initials: A
authors.lastname: Lösch
authors.forename: M O
authors.initials: MO
authors.lastname: Sator
authors.forename: S
authors.initials: S
authors.lastname: Müllauer-Ertl
mesh_terms: D000328:Adult; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014048:Tolonium Chloride; D014844:Vulva / Q000473:pathology; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000473:pathology; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D014048:Tolonium Chloride