Comparative efficacy of chemiluminescence and toluidine blue in the detection of potentially malignant and malignant disorders of the oral cavity

Abstract

Context: Early detection of oral cancer is of paramount importance in determining the prognosis of oral cancer. Literature suggests that several diagnostic modalities have been proposed to aid a clinician in early detection of oral cancer without much conclusive evidence.

Aims: The present study aims to compare toluidine blue and chemiluminescence screening methods in early detection of carcinoma in North Indian population and also to evaluate these methods with histopathological diagnosis.

Methods: In this prospective study, 42 patients with clinically visible premalignant lesions were included. Demographic data were collected, and suspicious lesions were examined by chemiluminescence light (Vizilite) and followed by local application of toluidine blue (Mashberg's recommendation). Findings were recorded for each lesion under standard incandescent light as positive or negative. Biopsy and histopathological analysis of the tissues were performed.

Statistical analysis: Sensitivity, specificity and positive and negative predictive values for the chemiluminescence technique and toluidine blue were calculated for diagnostic tests.

Results and conclusions: In the present study, toluidine blue test was found to be moderately sensitive (63.33%) whereas chemiluminescence test (Vizilite) was found to be highly sensitive (90%); however, the test has limited specificity (50%). Thus, the study concluded that both toluidine blue and Vizilite can be used as an adjunct to simple, conventional visual examination and in screening procedure for oral potentially malignant disorders.

Keywords: Chemiluminescence; sensitivity; specificity; toluidine blue.

Figure 1

Use of Vizilite as an oral cancer screening method. (a) Activating Vizilite capsule by flexing it, (b) examination of the patient's oral cavity with Vizilite, (c) application of toluidine blue stain with cotton bud, (d) removal of mechanical retention of dye with 1% acetic acid

Figure 2

Use of Vizilite and toluidine blue stain as an oral cancer screening method. (a) Clinically identified leukoplakia on left buccal mucosa under conventional visual examination, (b) Vizilite true positive, (c) toluidine blue true positive, (d) histopathologically moderate epithelial dysplasia (H&E, ×10), (e) clinically identified proliferative verrucous leukoplakia on left buccal mucosa under conventional visual examination, (f) Vizilite false negative, (g) toluidine blue true positive, (h) histopathologically proliferative verrucous leukoplakia (H&E, ×10)

Figure 3

Use of Vizilite and toluidine blue stain as an oral cancer screening method. (a) Clinically identified nonhomogenous leukoplakia on left buccal mucosa under conventional visual examination, (b) Vizilite true positive, (c) toluidine blue false negative, (d) histopathologically mild epithelial dysplasia (H&E, ×10), (e) clinically identified nonhomogenous leukoplakia on left buccal mucosa under conventional visual examination, (f) Vizilite true positive, (g) toluidine blue true positive, (h) histopathologically carcinoma in situ (H&E, ×10)

Figure 4

(a) Clinically identified Nonhomogenous leukoplakia on left buccal mucosa under conventional visual examination, (b) Vizilite True Positive, (c) Toluidine blue True positive, (d) Histopathologically Oral squamous cell carcinoma (H&E 10X)