title: Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: A cross-sectional study.
abstract: BACKGROUND
  Early detection holds the key to an effective control of cancers in general and of oral cancers in particular. However, screening procedures for oral cancer are not straightforward due to procedural requirements as well as feasibility issues, especially in resource-limited countries.
  
  
  METHODS
  We conducted a cross-sectional study to compare the performance of chemiluminescence, toluidine blue and histopathology for detection of high-risk precancerous oral lesions. We evaluated 99 lesions from 55 patients who underwent chemiluminescence and toluidine blue tests along with biopsy and histopathological examination. We studied inter-as well as intra-rater agreement in the histopathological evaluation and then using latent class modeling, we estimated the operating characteristics of these tests in the absence of a reference standard test.
  
  
  RESULTS
  There was a weak inter-rater agreement (kappa < 0.15) as well as a weak intra-rater reproducibility (Pearson's r = 0.28, intra-class correlation rho = 0.03) in the histopathological evaluation of potentially high-risk precancerous lesions. When compared to histopathology, chemiluminescence and toluidine blue retention had a sensitivity of 1.00 and 0.59, respectively and a specificity of 0.01 and 0.79, respectively. However, latent class analysis indicated a low sensitivity (0.37) and high specificity (0.90) of histopathological evaluation. Toluidine blue had a near perfect high sensitivity and specificity for detection of high-risk lesions.
  
  
  CONCLUSIONS
  In our study, there was variability in the histopathological evaluation of oral precancerous lesions. Our results indicate that toluidine blue retention test may be better suited than chemiluminescence to detect high-risk oral precancerous lesions in a high-prevalence and low-resource setting like India.
authors.affiliation: Lata Medical Research Foundation, Nagpur, India. manjuhemant@gmail.com.
authors.forename: Shweta
authors.initials: S
authors.lastname: Ujaoney
authors.forename: Mukta B
authors.initials: MB
authors.lastname: Motwani
authors.forename: Shirish
authors.initials: S
authors.lastname: Degwekar
authors.forename: Vijay
authors.initials: V
authors.lastname: Wadhwan
authors.forename: Prajakta
authors.initials: P
authors.lastname: Zade
authors.forename: Minal
authors.initials: M
authors.lastname: Chaudhary
authors.forename: Vinay
authors.initials: V
authors.lastname: Hazarey
authors.forename: Tushar P
authors.initials: TP
authors.lastname: Thakre
authors.forename: Manju
authors.initials: M
authors.lastname: Mamtani