Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas.
OBJECTIVE
The objective of this study was to evaluate the reliability of in vivo staining with toluidine blue in the detection of oral epithelial dysplasia, in situ carcinoma, and invasive squamous cell carcinomas in potentially malignant epithelial lesions (PMELs) and superficial oral ulcerations suggesting malignancy.


METHODS
Fifty patients with PMELs and superficial oral ulcerations suggestive of malignancy were selected from those treated at the Oral Medicine Service, Faculty of Dentistry, Araraquara, Brazil. All lesions were submitted to staining with an aqueous solution of 1% toluidine blue, followed by biopsy and histologic analysis. The sensitivity, specificity, and positive and negative predictive values were calculated.


RESULTS
Histologic diagnosis revealed that 14% of the lesions analyzed were in situ carcinoma and invasive squamous cell carcinomas, 12% were epithelial dysplasias, 13% were keratosis, 40% were lichen planus, and 8% were other benign lesions. The sensitivity of the staining was 77%, the specificity 67%, and the positive and negative predictive values 43.5% and 88.9%, respectively.


CONCLUSIONS
Staining with toluidine blue was demonstrated to be highly reliable in the detection of in situ carcinoma and invasive squamous cell carcinoma, because false-negative results for the lesions did not occur. Toluidine blue staining is an adjunct to clinical judgment and not a substitute for either judgment or biopsy.
Onofre
M A
MA
Oral Medicine Service, Department of Diagnosis and Surgery, School of Dentistry Araraquara-UNESP, São Paulo, Brazil. maonofre@foar.unesp.br
Sposto
M R
MR
Navarro
C M
CM
D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D004396:Coloring Agents; D003238:Connective Tissue / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis / Q000473:pathology; D017676:Lichen Planus, Oral / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis* / Q000473:pathology; D009061:Mouth Mucosa / Q000473:pathology; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology; D019226:Oral Ulcer / Q000175:diagnosis / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014048:Tolonium Chloride
D004396:Coloring Agents; D014048:Tolonium Chloride