ABSTRACT
Objective:
The purpose of the study is to compare and evaluation of the diagnostic efficiency of Toluidine Blue, Lugol’s iodine and Acetic acid in the detection of potentially malignant disorders (PMD’S).
Materials and methods: The study population consisted of 30 patients with clinically suspicious PMD’S. The lesions were stained consecutively with toluidine blue, lugol’s iodine & acetic acid depending on the retention of the dyes, the biopsy site was determined and sent for histological confirmation.
Statistical Analysis Chi-square test was used to compare between Toluidine blue, Lugol’s iodine and Acetic acid. Diagnostic efficiency was calculated by sensitivity and specificity test to determine the utility of the test results. Results: There was significant difference in percentage of staining between Toluidine blue and Acetic acid (p< 0.05) was reported. …show more content…
In the present study, among the 30 potentially malignant lesions, 7(23.3%) were homogenous leukoplakia, 16 (53.3%) were non homogenous leukoplakia and 7(23.34%) were erosive lichen planus. All patients with leukoplakia had the habit of smoking, alcoholic and pan chewing, whereas patients with lichen planus had no history of Tobacco abuse.
On performing comparative analysis between different staining modalities with Histopathological grades, non-significant results were reported. The sensitivity and specificity for Acetic acid was 83.3% and 8.3% respectively and for Toluidine blue, the sensitivity and specificity was 57.6% and 25% respectively. This was in agreement with previous results. [10,16] DISCUSSION
The concept of initial presence of a precursor lesion subsequently developing into cancer is well established and an early detection of oral mucosal epithelial dysplasia could halt the progression of these lesions into malignant transformation.[9] Thus, the establishment of adjunctive techniques is useful to clinical judgments. The study consisted of 30 patients with age group of (20-69 years) mean age of (41.43), in these 25 males and 5 females with the habit of smoking, alcoholic and pan chewing. All the lesions were stained consecutively with Toluidine blue, Lugol’s iodine & Acetic acid and the dye retention were recorded. Histopathological examination revealed that 9 (30.0%) were hyperplasia, 4 (13.3%) showed mild dysplasia; of the latter 15 lesion showed moderate dysplasia and 2 were severe dysplasia. Comparing Toluidine blue and Lugol’s stain using Chi square test the values are (0.341) not statistically significant p >0.05. This could because of scientific background that the glycogen content is inversely related to degree of keratosis. Throughout the oral mucosa the content of glycogen varies with the keratinization. There is a correlation between the degree of inflammation and glycogen content.[11] This may limit the use of Lugol’s in benign lesions. In our study comparison with Toluidine blue and acetic acid stain shows the values are not statistically significant p> 0.05.This could because of small sample size . On comparison with Lugol’s and Acetic acid the results were statistically significant p< 0.05.This results correlating with other results, its already established the Acetic acid used in detection of cervical cancer. Overall comparison of histopathological results with Toluidine blue, Lugol’s and Acetic acid the results were the following; in 9 hyperplasia , 7 stained with Toluidine blue, in mild dysplasia all the 4 were stained with Toluidine blue, in 15 moderate dysplasia, 13 were stained with Toluidine blue, in two severe dysplasia all were stained. These results showed there is a simple correlation between dye retention and histopathological gradings. This shows Toluidine blue clearly delineates the high risk group. The two false negative cases of homogenous leukoplakia show no dysplastic feature on histopathology. On comparison of histopathology with Lugol’s the results were, of the 9 hyperplasia 8 stained with Lugol’s, mild dysplasia all the 4 stained with Lugol’s, of the 15 moderate dysplasia 13 stained, 2 severe dysplasia all the 2 stained with Lugol’s. This shows Lugol’s …show more content…
The literature on Toluidine blue is large and a recent systematic review 50 identified 77 publications. However, only 14 of these evaluated the ability of the dye to identify oral cancers that would not otherwise have been diagnosed by unaided clinical examination. Unfortunately these studies are of limited relevance to the use of the dye as a screening test, because none were randomized controlled trials, none were conducted in a primary care setting and most studies were case series conducted by specialists on high-risk populations often with known
Objective:
The purpose of the study is to compare and evaluation of the diagnostic efficiency of Toluidine Blue, Lugol’s iodine and Acetic acid in the detection of potentially malignant disorders (PMD’S).
Materials and methods: The study population consisted of 30 patients with clinically suspicious PMD’S. The lesions were stained consecutively with toluidine blue, lugol’s iodine & acetic acid depending on the retention of the dyes, the biopsy site was determined and sent for histological confirmation.
Statistical Analysis Chi-square test was used to compare between Toluidine blue, Lugol’s iodine and Acetic acid. Diagnostic efficiency was calculated by sensitivity and specificity test to determine the utility of the test results. Results: There was significant difference in percentage of staining between Toluidine blue and Acetic acid (p< 0.05) was reported. …show more content…
In the present study, among the 30 potentially malignant lesions, 7(23.3%) were homogenous leukoplakia, 16 (53.3%) were non homogenous leukoplakia and 7(23.34%) were erosive lichen planus. All patients with leukoplakia had the habit of smoking, alcoholic and pan chewing, whereas patients with lichen planus had no history of Tobacco abuse.
On performing comparative analysis between different staining modalities with Histopathological grades, non-significant results were reported. The sensitivity and specificity for Acetic acid was 83.3% and 8.3% respectively and for Toluidine blue, the sensitivity and specificity was 57.6% and 25% respectively. This was in agreement with previous results. [10,16] DISCUSSION
The concept of initial presence of a precursor lesion subsequently developing into cancer is well established and an early detection of oral mucosal epithelial dysplasia could halt the progression of these lesions into malignant transformation.[9] Thus, the establishment of adjunctive techniques is useful to clinical judgments. The study consisted of 30 patients with age group of (20-69 years) mean age of (41.43), in these 25 males and 5 females with the habit of smoking, alcoholic and pan chewing. All the lesions were stained consecutively with Toluidine blue, Lugol’s iodine & Acetic acid and the dye retention were recorded. Histopathological examination revealed that 9 (30.0%) were hyperplasia, 4 (13.3%) showed mild dysplasia; of the latter 15 lesion showed moderate dysplasia and 2 were severe dysplasia. Comparing Toluidine blue and Lugol’s stain using Chi square test the values are (0.341) not statistically significant p >0.05. This could because of scientific background that the glycogen content is inversely related to degree of keratosis. Throughout the oral mucosa the content of glycogen varies with the keratinization. There is a correlation between the degree of inflammation and glycogen content.[11] This may limit the use of Lugol’s in benign lesions. In our study comparison with Toluidine blue and acetic acid stain shows the values are not statistically significant p> 0.05.This could because of small sample size . On comparison with Lugol’s and Acetic acid the results were statistically significant p< 0.05.This results correlating with other results, its already established the Acetic acid used in detection of cervical cancer. Overall comparison of histopathological results with Toluidine blue, Lugol’s and Acetic acid the results were the following; in 9 hyperplasia , 7 stained with Toluidine blue, in mild dysplasia all the 4 were stained with Toluidine blue, in 15 moderate dysplasia, 13 were stained with Toluidine blue, in two severe dysplasia all were stained. These results showed there is a simple correlation between dye retention and histopathological gradings. This shows Toluidine blue clearly delineates the high risk group. The two false negative cases of homogenous leukoplakia show no dysplastic feature on histopathology. On comparison of histopathology with Lugol’s the results were, of the 9 hyperplasia 8 stained with Lugol’s, mild dysplasia all the 4 stained with Lugol’s, of the 15 moderate dysplasia 13 stained, 2 severe dysplasia all the 2 stained with Lugol’s. This shows Lugol’s …show more content…
The literature on Toluidine blue is large and a recent systematic review 50 identified 77 publications. However, only 14 of these evaluated the ability of the dye to identify oral cancers that would not otherwise have been diagnosed by unaided clinical examination. Unfortunately these studies are of limited relevance to the use of the dye as a screening test, because none were randomized controlled trials, none were conducted in a primary care setting and most studies were case series conducted by specialists on high-risk populations often with known