Oral likenoid lezyonlarda displazik ve malign değişimlerin saptanması amacıyla biyopsi öncesinde toluidin mavisi uygulanması

Abstract

Giriş

Oral liken planus (OLP) immun aracılı patogeneze sahip, premalign olabilen kronik bir hastalıktır. Oral likenoid displazi (OLD) ise sıklıkla OLP ile karışan likenoid bulguların eşlik ettiği prekanseröz bir tablodur.

Amaç

Bu çalışmada klinik olarak OLP tanısı alan hastalarda biyopsi alınmasından önce toluidin mavisi uygulamasının displastik değişiklikleri saptamadaki etkinliğinin araştırılması amaçlanmıştır.

Yöntem

Çalışmaya klinik bulguları OLP ile uyumlu olan 30 hasta dahil edilmiştir. Çalışmaya alınan hastaların demografik ve klinik özellikleri kaydedilip, uygulama öncesi ve sonrasında klinik görüntüleme yapılmıştır. Biyopsi alınacak alanlar lezyonun toluidin mavisi ile boyama sonuçlarına göre belirlenmiştir. Histopatolojik olarak tüm preperatlar OLP’un tanısal özellikleri ve displazik bulguların varlığı açısından değerlendirilmiştir.

Bulgular

30 hastanın (21 kadın, 9 erkek) yaş ortalaması 51.03 (26-70 yaş), hastalık süresinin median de-ğeri 12.00±67.23 ay (2-360 ay) olarak saptandı. Toluidin mavisi uygulamasından sonra altı hastada (%20.0) mavi renkli tutulum izlendi. Histopatolojik incelemede 17 hastada OLP bulguları (%56.7), dokuz hastada OLP ve displazi bulguları (%30.0) ve dört hastada (%13.3) likenoid displazi saptandı. Mavi renkli boyanma izlenen lezyonların tümünde (altı hasta) displazi saptandı. Boyanma ile displazi arasındaki ilişki anlamlı olarak bulundu (p<0.05). Bu hastaların dördünde (%66.7) OLP ve displazi, ikisinde (%33.3) likenoid displazi izlendi. Histopatolojik olarak displazi özelliği gösteren hastalarda displazi varlığı ile mitoz varlığı arasındaki ilişki istatistiksel olarak anlamlı bulundu (p<0.05). Boyanma gösteren lezyonlardan alınan biyopsilerde de mitoz varlığına bakıldığında istatistiksel olarak anlamlı ilişki tespit edildi (p<0.05).

Sonuçlar

Çalışmamızda klinik olarak klasik OLP ile uyumlu hastalarda toluidin mavisi uygulanması sonrasında boyanan tüm alanlarda displazi saptandığı, ancak 

displazi saptanan bazı hastalarda da boyanma olmadığı görülmüştür. Buna göre uygulamanın sensitivitesi %46, spesifitesi %100, pozitif prediktif değeri %100, negatif prediktif değeri ise %70.8 olarak bulunmuştur. Toluidin mavisi uygulaması displazinin saptanması için spesifik  olmasına rağmen oral likenoid lezyonlardaki duyarlılığı düşüktür ve duyarlılığı arttırmak için yeni bir metoda ihtiyaç vardır.

Keywords

• oral liken planus,oral likenoid displazi,toludin mavisi,displazi,oral likenoid lezyonlar

Toluidine blue application to detect dysplasia and malignant changes in patients with oral lichenoid lesions

Abstract

Background 

Oral lichen planus (OLP) is a chronic disease with immune-mediated pathogenesis which can be premalignant. Oral lichenoid dysplasia (OLD) is a precancerous process with lichenoid features which is frequently confused with OLP.

Objective

In this study, we aimed to investigate the efficacy of toluidine blue (TB) administration before biopsy to detect the dysplastic changes in patients who were clinically diagnosed with OLP.

Methods

Thirty consecutive patients with oral lichenoid lesions whose clinical findings were consistent with OLP were included in the study. Demographic and clinical characteristics of the patients studied were recorded and clinical photos were taken before and after the administration of TB. Areas to be biopsied were determined according to the results of the TB staining. Histopathologically, all the specimens were evaluated in terms of the diagnostic features of OLP and the presence of dysplastic findings. 

Results

The mean age of the 30 patients (21 females, 9 males) included in the study was 51.03 (26-70 years) and the median value of disease duration was 12.00 ± 67.23 months (2-360 months). Six patients (20.0%) had positive staining after application of TB. Histopathological examination revealed OLP findings in 17 patients (56.7%), OLP and dysplasia findings in nine patients (30.0%) and lichenoid dysplasia in four patients (13.3%). Dysplasia was detected in all of the lesions (six patients) which were stained blue with TB. The relationship between staining and dysplasia was significant (p<0.05). OLP and dysplasia were observed in four of these six patients (66.7%), and lichenoid dysplasia was observed in the other two (33.3%). The relationship between presence of dysplasia and presence of mitosis was found statistically significant in patients with histopathological dysplasia (p<0.05). When the presence of mitosis was evaluated in biopsies taken from the stained lesions, a statistically significant relation was found (p<0.05).

Conclusions

In our study, it was observed that dysplasia was detected in all stained areas after the application of TB to clinically classical OLP patients, but there was no staining in some patients despite the presence of dysplasia. Therefore, the sensitivity of the application was 46%, specificity was 100%, positive predictive value was 100% and negative predictive value was 70.8%. TB application is a specific test to detect the dysplasia; however because of the low sensitivity in oral lichenoid lesions, another method is needed to increase the sensitivity.

Keywords

• Oral lichen planus,oral lichenoid dysplasia,Toluidine blue,dysplasia,oral lichenoid lesions

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