Toluidine blue (1 WW) was applied as an oral rinse for 20 sec.

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PMID: 20161875 Language: English Italian This article has been cited by other articles in PMC.

Summary Toluidine blue stain is used as a marker to differentiate lesions at high risk of progression in order to improve early diagnosis of oropharyngeal carcinomas.

This study focused on 45 oral mucosal lesions in 32 patients (13 female, 19 male).

Of the 45 lesions examined, 26 (57.0) were defined clinically benign, while 19 (42.3) were defined as suspected lesions (premalignant or malignant).

According to the clinical examination, the sensitivity was 53 (1630) and for toluidine blue staining 96.2 (2627) (p 0.0007).

In conclusion toluidine blue stain has been shown to be a reliable aid when clinical examination is unable to differentiate lesions at high risk of progression and then it improves early diagnosis for oral cavity and oropharyngeal cancer.

Lo studio ha preso in considerazione 45 lesioni del cavo orale e dellorofaringe che riguardavano 32 pazienti.

In 9 casi venivano eseguite biopsie multiple, 19 pazienti erano di sesso maschile e 13 di sesso femminile.

Le lesioni definite clinicamente benigne erano 2645 (57,0) mentre 19 (42,3) erano definite sospette (premaligne o maligne).

Introduction Prognosis of oropharyngeal squamous cell carcinoma (SCC) (oral cavity and pharynx) depends on early diagnosis, despite advanced surgical techniques and adjuvant treatment, the 5-year survival rate remains 40-50.

Unfortunately, oral cancer is usually detected when it becomes symptomatic and, at this stage, at least two thirds of the patients present an advanced disease.

This requires treatment which gives rise to a high rate of morbility and mortality and, furthermore, early detection of oro-pharyngeal pre-malignant lesions is important to improve the survival rate and quality of life (QoL).

Furthermore, in many cases, this may be very difficult because often, when a white patch or plaque, like a clinically defined leukoplakia, is observed, it is difficult to define it as another disorder (inflammatory or reactive).

In a lesion that appears as a leukoplakia, in 16 of the cases, the lesion is already malignant while in the dysplasic leukoplasic lesions, the risk of cancer development has been reported to be as high as 43 within a mean time of 8.1 years.

Various techniques have been developed to support clinical examinations, with the aim of improving early oro-pharyngeal cancer diagnosis.

Since dysplasia and in situ carcinoma contain much more DNA and RNA than the normal surrounding epithelium, the use of in vivo staining, by means of toluidine blue dye, is based on the fact that it is an acidophilic dye that selectively stains acidic tissue components such as DNA and RNA.

Toluidine blue staining is considered to be sensitive in identifying early oro-pharyngeal premalignant and malignant lesions 11.

In the present study, the use of toluidine blue staining was taken into consideration to identify clinically doubtful oro-pharyngeal lesions and to compare the clinical evaluation with toluidine blue stain and with the histological evaluation.

Material and Methods The study focuses on 45 oral mucosa lesions from 32 patients (13 female, 19 male, mean age 59 years, range 42-82), coming under observation at the Department of Otolaryngology- Head and Neck Surgery, at the University of Catanzaro.

In 9 cases, multiple biopsies were made, All lesions were examined by an otolaryngologist (A.G.) with a long experience in head and neck cancer lesions and, according to the visual inspection 26 lesions were considered benign while 19 were suspected as premalignant or malignant.

The lesions varied in size from 0.5 cm to 1.5 cm in minimum diameter (mean 0.8 cm) to 2.5 cm in maximum diameter (mean 1.8 cm).

The site of the lesion was tongue in 11 cases, buccal mucosa in 9, floor of the mouth in 8 and hard or soft palate in 4.

Informed consent from the patients, to perform a biopsy,was obtained prior to application of toluidine blue stain.

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