The influence of toluidine blue staining on decision-making for the selection of biopsy sites in oral disorders

Abstract

Purpose: The aim of this study is to evaluate the influence of toluidine blue (TB) staining on decision-making processes for the identification of biopsy sites in oral lesions. Material-Methods: Original and TB-stained images of oral mucosal lesions that required histopathological examination were accessed through archives. Twenty dental specialists were asked to select and mark their choice of biopsy sites on both original and TB-stained images using a standard circle selection tool of software. The X and Y coordinates of the center points of selections were calculated by a custom made image processing algorithm in Matlab. In order to assess the dispersity of the selected centers from the mean center, the distances of the selected points from this average point were calculated using Euclidean distance. Data was analysed using Wilcoxon test. Results: The study involved original and TB-stained images of 5 suspicious lesions. The histological diagnoses of oral lesions were reported as bening for 3 cases and malignant for 2 cases. 20 dental specialists marked their choice of biopsy site on a total of 200 images. The results revealed that the biopsy selections varied significantly between original and TB-stained images in certain cases. In 60% of cases, specialists showed statistically significant agreement in biopsy site selection on TB-stained images compared to original images (p <0.05). Conclusion: While the study did not evaluate the accuracy of site selection against a gold standard, the observed consensus among specialists suggests the potential utility of TB staining in enhancing the consistency and objectivity of biopsy site selection for suspicious oral lesions.

Keywords

• Oral mucosal lesion
• tissue biopsy
• biopsy site selection
• vital staining
• toluidine blue

References

1. Kumari P, Debta P, Dixit A. Oral potentially malignant disorders: etiology, pathogenesis, and transformation into oral cancer. Front Pharmacol 2022; 13:825266. google scholar
2. El M, Parmar S, Praveen P. Premalignant lesions and conditions of the oral cavity. In: Bonanthaya K, Panneerselvam E, Manuel S, Kumar VV, Rai A. (Eds), Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore, 2021, p. 1845-1852. google scholar
3. Bugshan A, Farooq I. Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis. F1000Res 2020; 9:229. google scholar
4. Sujir N, Ahmed J, Pai K, Denny C, Shenoy N. Challenges in early diagnosis of oral cancer: cases series. Acta Stomatol Croat 2019; 53:174-80. google scholar
5. Gonzalez-Moles MÂ, Aguilar-Ruiz M, Ramos-Gartfa P. Challenges in the early diagnosis of oral cancer, evidence gaps and strategies for improvement: a scoping review of systematic reviews. Cancers (Basel) 2022; 14:4967. google scholar
6. Çankaya H, Güneri P, Epstein JB. Adjunctive methods and devices for clinical detection of oral squamous cell carcinoma. Oral Health Prev Dent 2015; 13:29-39. google scholar
7. Carreras-Torras C, Gay-Escoda C. Techniques for early diagnosis of oral squamous cell carcinoma: Systematic review. Med Oral Patol Oral Cir Bucal 2015; 20:305-15. google scholar
8. Vijayakumar V, Reghunathan D, Edacheriyan B. Role of toluidine blue staining in suspicious lesions of oral cavity and oropharynx. Indian J Otolaryngol Head Neck Surg 2019; 71:142-6. google scholar

9. Mascitti M, Orsini G, Tosco V, Monterubbianesi R, Balercia A, Putignano A, Procaccini M and Santarelli A. An overview on current non-invasive diagnostic devices in oral oncology. FrontPhysiol 2018; 9:1510. google scholar
10. Peralta-Mamani M, Terrero-Perez Â, Tucunduva RMA, Rubira CMF, Santos PSDS, Honorio HM, Rubira-Bullen IRF. Occurrence of field cancerization in clinically normal oral mucosa: A systematic review and meta-analysis. Arch Oral Biol 2022; 143: 105544. google scholar
11. Walsh T, Macey R, Kerr AR, Lingen MW, Ogden GR, Warnakulasuriya S. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst Rev 2021; 7:010276. google scholar
12. Bramati C, Abati S, Bondi S, Lissoni A, Arrigoni G, Filipello F, Trimarchi M. Early diagnosis of oral squamous cell carcinoma may ensure better prognosis: A case series. Clin Case Rep 2021; 9:05004. google scholar
13. Chhabra N, Chhabra S, Sapra N. Diagnostic modalities for squamous cell carcinoma: an extensive review of literature-considering toluidine blue as a useful adjunct. J Maxillofac Oral Surg 2015; 14:188-200. google scholar
14. Driemel O, Kunkel M, Hullmann M, von Eggeling F, Müller-Richter U, Kosmehl H, Reichert TE. Diagnosis of oral squamous cell carcinoma and its precursor lesions. J Dtsch Dermatol Ges 2007; 5:1095-100. google scholar
15. Tsui IF, Garnis C, Poh CF. A dynamic oral cancer field: unraveling the underlying biology and its clinical implication. Am J Surg Pathol 2009; 33:1732-8. google scholar
16. Güneri P, Epstein JB, Kaya A, Veral A, Kazandı A, Boyacioglu H. The utility of toluidine blue staining and brush cytology as adjuncts in clinical examination of suspicious oral mucosal lesions. Int J Oral Maxillofac Surg 2011; 40:155-61. google scholar
17. Singh S, Halder A, Sinha O, Chakrabarty N, Chatterjee T, Adhikari A, et al. Spectroscopic studies on the biomolecular recognition of toluidine blue: key information towards development of a non-contact, non-invasive device for oral cancer detection. Front Oncol 2020; 10:529132. google scholar
18. Prajeesh KM, Soni S. A study of toluidine blue staining in suspected oral malignancies in patients presenting to tertiary care hospital in central India. Indian J Otolaryngol Head Neck Surg 2019; 71:492-7. google scholar
19. Winton Kalluvelil SR, Narayanan VS. Acetic acid versus toluidine blue as screening tools for oral potentially malignant disorders. Indian J Cancer 2023; 60:427-31. google scholar
20. Mills S. How effective is toluidine blue for screening and diagnosis of oral cancer and premalignant lesions? Evid Based Dent 2022; 23:34-5. google scholar
21. Kim DH, Song EA, Kim SW, Hwang SH. Efficacy of toluidine blue in the diagnosis and screening of oral cancer and pre-cancer: A systematic review and meta-analysis. Clin Otolaryngol 2021; 46:23-30. google scholar
22. Sharma D, Rimal J, Kumar Mahaıjan I, Shrestha A, Shrestha A, Regmee P. Evaluation of oral potentially malignant disorders with autoflorescence, reflectance spectroscopy and vital staining and their correlation with histopathology - Hospital based prospective study. Oral Oncol 2021; 118:105312. google scholar
23. Swathi KV, Maragathavalli G, Uma Maheswari TN. Comparing the efficacy of chemiluminescence with lugol's iodine versus toluidine blue in the diagnosis of dysplasia in tobacco associated oral lesions - A diagnostic study. Indian J Dent Res 2021; 32:459-66. google scholar
24. Simple M, Suresh A, Das D, Kuriakose MA. Cancer stem cells and field cancerization of oral squamous cell carcinoma. Oral Oncol 2015; 51:643-51. google scholar
25. Junaid M, Choudhary MM, Sobani, ZA. A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma. World J Surg Onc 2012; 10:57. google scholar
26. Algadi HH, Abou-Bakr AA, Jamali OM, Fathy LM. Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma. BMC Cancer 2020; 20:1147. google scholar
27. Ranjan H. “Evaluating the effectiveness of toluidine blue for obtaining safe margins in resection of oral squamous cell carcinoma". ASCR 2023; 4:39-44. google scholar