title: A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma.
abstract: BACKGROUND
  Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins.
  
  
  METHODS
  After obtaining clearance from the in-house ethical review committee, a prospective study was conducted at Aga Khan University Hospital, Karachi, from August 15, 2009 to March 14, 2010. A sample of 56 consenting patients with biopsy-proven OSCC were included in the study, giving us 280 tumor margins. Margins were analyzed using toluidine blue staining and frozen section histopathology. A receiver operator curve (ROC) was then applied to compare assessment of margin status by toluidine blue and frozen section.
  
  
  RESULTS
  Of the 280 examined margins 11 stained positive with toluidine blue, three were positive on frozen section biopsy, and three were positive on final histopathology. Toluidine blue staining had sensitivity and specificity of 100% and 97%, respectively. The diagnostic accuracy of toluidine blue was found to be 97.1% with a positive predictive value (PPV) of 27.2% and a negative predictive value (NPV) of 100%.
  
  
  CONCLUSIONS
  Toluidine blue can be used as an effective screening modality for the assessment of intraoperative margins in resource limited environments and reducing the number of frozen section biopsies performed. Further by providing real-time clinical information within minutes it can reduce indirect costs such as operating room time. It may also be used as an ad hoc for frozen section biopsies where frozen section facilities are available.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Jinnah Medical And Dental College Hospital, SR-6, Sector 7/A, Korangi Industrial Area, Karachi - 74800 Karachi, Pakistan. doc_montsj@yahoo.com
authors.forename: Montasir
authors.initials: M
authors.lastname: Junaid
authors.forename: Moaz M
authors.initials: MM
authors.lastname: Choudhary
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Sobani
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.forename: Sadaf
authors.initials: S
authors.lastname: Qadeer
authors.forename: Naeem S
authors.initials: NS
authors.lastname: Ali
authors.forename: Mumtaz J
authors.initials: MJ
authors.lastname: Khan
authors.forename: Anwar
authors.initials: A
authors.lastname: Suhail
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010154:Pakistan; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014048:Tolonium Chloride
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride