title: Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity--a clinical and histological assessment.
abstract: BACKGROUND
  The value of chairside adjunctive tests in the detection of oral potentially malignant disorders (OPMDs) remains uncertain.
  
  
  OBJECTIVE
  To determine the effectiveness of toluidine blue in detecting leukoplakia and erythroplakia and its accuracy in identifying cases with oral epithelial dysplasia.
  
  
  METHODS
  Ninety-two patients attending two oral medicine clinics in London, presenting with white and red patches of the oral mucosa, were investigated by the application of toluidine blue. Eighty-two patients were clinically diagnosed as OPMDs and 10 were frictional keratoses. A surgical biopsy was performed to assess epithelial dysplasia.
  
  
  RESULTS
  Of 64 oral leukoplakias, 34 (53.1%) were positive for toluidine blue and among nine erythroplakias seven stained positive. Of 41 oral dysplasia cases, a little more than half of the lesions (n = 23) were stain positive, an estimated sensitivity of 56.1%. TBlue test had a higher sensitivity for detecting higher-grade dysplastic lesions (5/8 moderate dysplasia, sensitivity 62.5%; 5/7 severe dysplasia; sensitivity 71.4%) compared with lower grades of dysplasia, but the differences were not significant (P = 0.60).
  
  
  CONCLUSIONS
  We report here the utility of TBlue for the detection of oral leukoplakia and erythroplakia. The test has the potential to detect OPMDs and yielded a sensitivity of 56.1% and specificity of 56.9% to detect oral epithelial dysplasia.
authors.affiliation: Oral Medicine and Head & Neck Pathology, Department of Clinical & Diagnostic Sciences, King's College London Dental Institute, London, UK.
authors.forename: Kh
authors.initials: Kh
authors.lastname: Awan
authors.forename: Yh
authors.initials: Y
authors.lastname: Yang
authors.forename: Pr
authors.initials: P
authors.lastname: Morgan
authors.forename: S
authors.initials: S
authors.lastname: Warnakulasuriya
mesh_terms: D019342:Acetic Acid; D000428:Alcohol Drinking; D001706:Biopsy; D004396:Coloring Agents; D003581:Cytodiagnosis / Q000379:methods; D004848:Epithelium / Q000473:pathology; D004919:Erythroplasia / Q000175:diagnosis; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology; D009062:Mouth Neoplasms / Q000175:diagnosis*; D011230:Precancerous Conditions / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012907:Smoking; D014048:Tolonium Chloride
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride; D019342:Acetic Acid