title: Toluidine blue aids in detection of dysplasia and carcinoma in suspicious oral lesions.
abstract: OBJECTIVE
  Accurate clinical identification of 'higher-risk' oral premalignant lesions or 'higher-risk' areas within lesions is important. Assessment methods that predict their presence have great utility.
  
  
  METHODS
  A cross-sectional, observational study enrolled a consecutive sample of consenting patients diagnosed with oral leukoplakia, erythroleukoplakia, or erythroplakia. Medical history, visual oral examination, ViziLite(®) examination, toluidine blue staining (TBlue(®) ), and finally a biopsy were completed in a single clinic visit. Seventy-seven of 100 examined lesions in 43 patients were biopsied. Sensitivity, specificity, and positive and negative predictive values were computed for visual examination, ViziLite(®) , and TBlue(®) using biopsy results as the gold standard.
  
  
  RESULTS
  The sensitivity of TBlue(®) in detecting high-risk lesions (carcinoma in situ or carcinoma) was 94 (71-100, P < 0.0003) and specificity 45 (32-58, P < 0.53), while for carcinoma, sensitivity was 100 (54-100, P < 0.032) and specificity 39 (28-52, P < 0.097). The results of ViziLite(®) testing either by itself or in combination with the information from toluidine blue testing revealed low sensitivity for the detection of high-risk lesions.
  
  
  CONCLUSIONS
  Clinical examination of leukoplakia, erythroplakia, or erythroleukoplakia lesions combined with toluidine blue staining may aid in the identification of severe dysplasia (carcinoma in situ) or carcinoma. This may help in determining whether, when, and where (the site within a lesion) a biopsy should be taken.
authors.affiliation: Private practice in oral Medicine, Mountain View, CA, USA.
authors.forename: N
authors.identifier: http://orcid.org/0000-0001-6068-3075
authors.initials: N
authors.lastname: Chainani-Wu
authors.affiliation: Northern California Institute for Research and Education (NCIRE), San Francisco, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Madden
authors.affiliation: Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Cox
authors.affiliation: College of Dentistry at the University of Illinois in Chicago, Chicago, IL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Sroussi
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.|City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Epstein
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000000981:diagnostic imaging / Q000473:pathology; D049449:Luminescence; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011230:Precancerous Conditions / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D014048:Tolonium Chloride
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride
keywords: chemiluminescent light; dysplasia; erythroleukoplakia; erythroplakia; oral cancer; oral leukoplakia; toluidine blue