Efficacy of Toluidine Blue and Brush Biopsy in Oral Lesions

Abstract

Background: Oral cancer is a global health problem and its early detection is of prime importance. In vivo stains and brush biopsy have emerged in recent years to aid as clinical diagnostic tools. Aims and objectives: In our study we assessed the efficacy and accuracy of Toluidine blue and brush biopsy in comparison to wedge biopsy in patients with oral premalignancies and malignant lesions. Materials and methods: The study group comprised of 172 subjects with clinically suspicious premalignant and malignant oral lesions. All the lesions were stained with toluidine blue and dye retention were recorded with photographs. Brush biopsy was done for early assessment of cancer. Wedge biopsy was done for confirmation of diagnosis. The data thus compiled were statistically analyzed using statistical software SPSS version 16. Results: In the present study 127 cases were females and 45 were males; among them 84.3% had the habit of areca nut/tobacco. Maximum cases (62%) were seen in buccal mucosa. Histopathologically 73% carcinomas, 27% premalignant and benign lesions were diagnosed. Toluidine blue showed a few false positive results in inflammatory lesions. Sensitivity and Specificity of combined evaluation of toluidine blue and brush biopsy in malignant lesions were 93% and 95% respectively and in premalignant lesions were 88% and 90% respectively. Positive predictive value was 96%. Conclusion: Combined evaluation of toluidine blue and brush biopsy technique is non invasive, painless outpatient procedure which has high sensitivity and specificity in detecting premalignant and malignant lesions. This is an ideal screening tool which can minimize false negatives.