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Published in: Clinical Oral Investigations 9/2015

01-12-2015 | Original Article

Assessing the accuracy of autofluorescence, chemiluminescence and toluidine blue as diagnostic tools for oral potentially malignant disorders—a clinicopathological evaluation

Authors: K. H. Awan, P. R. Morgan, S. Warnakulasuriya

Published in: Clinical Oral Investigations | Issue 9/2015

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Abstract

Objectives

Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders.

Materials and methods

A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia.

Results

Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively.

Conclusion

While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity.

Clinical relevance

These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.
Literature
1.
go back to reference IARC monographs on the evaluation of carcinogenic risks to humans (2012) Personal habits and indoor combustions. A review of human carcinogens. Lyon, France: Vol 100 E; IARC Press IARC monographs on the evaluation of carcinogenic risks to humans (2012) Personal habits and indoor combustions. A review of human carcinogens. Lyon, France: Vol 100 E; IARC Press
2.
go back to reference Warnakulasuriya S (2009) Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45:309–316CrossRefPubMed Warnakulasuriya S (2009) Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45:309–316CrossRefPubMed
3.
go back to reference Ferlay J, Pisani P, Parkin DM (2004) GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. IARC Cancer Base (2002 estimates). IARC Press, Lyon Ferlay J, Pisani P, Parkin DM (2004) GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. IARC Cancer Base (2002 estimates). IARC Press, Lyon
4.
go back to reference Cancer Research UK, UK Cancer incidence (2011) by Country Summary, January 2014 Cancer Research UK, UK Cancer incidence (2011) by Country Summary, January 2014
5.
go back to reference Conway DI, Stockton DL, Warnakulasuriya KA, Ogden G, Macpherson LM (2006) Incidence of oral and oropharyngeal cancer in United Kingdom (1990-1999)—recent trends and regional variation. Oral Oncol 42(6):586–592CrossRefPubMed Conway DI, Stockton DL, Warnakulasuriya KA, Ogden G, Macpherson LM (2006) Incidence of oral and oropharyngeal cancer in United Kingdom (1990-1999)—recent trends and regional variation. Oral Oncol 42(6):586–592CrossRefPubMed
6.
go back to reference Mashberg A, Samit A (1995) Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA Cancer J Clin 45:328–351CrossRefPubMed Mashberg A, Samit A (1995) Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA Cancer J Clin 45:328–351CrossRefPubMed
7.
go back to reference Patton LL (2003) The effectiveness of community-based visual screening and utility of adjunctive diagnostic aids in the early detection of oral cancer. Oral Oncol 39:708–723CrossRefPubMed Patton LL (2003) The effectiveness of community-based visual screening and utility of adjunctive diagnostic aids in the early detection of oral cancer. Oral Oncol 39:708–723CrossRefPubMed
8.
go back to reference Sciubba J (1999) Improving detection of precancerous and cancerous oral lesions. J Am Dent Assoc 130:1445–1457CrossRefPubMed Sciubba J (1999) Improving detection of precancerous and cancerous oral lesions. J Am Dent Assoc 130:1445–1457CrossRefPubMed
9.
go back to reference Tsantoulis PK, Kastrinakis NG, Tourvas AD et al (2007) Advances in the biology of oral cancer. Oral Oncol 43:523–534CrossRefPubMed Tsantoulis PK, Kastrinakis NG, Tourvas AD et al (2007) Advances in the biology of oral cancer. Oral Oncol 43:523–534CrossRefPubMed
11.
go back to reference Warnakulasuriya S, Johnson NW, van der Waal I (2007) Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 36:575–580CrossRefPubMed Warnakulasuriya S, Johnson NW, van der Waal I (2007) Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 36:575–580CrossRefPubMed
12.
go back to reference Patton LL, Epstein JB, Kerr AR (2008) Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature. J Am Dent Assoc 139(7):896–905CrossRefPubMed Patton LL, Epstein JB, Kerr AR (2008) Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature. J Am Dent Assoc 139(7):896–905CrossRefPubMed
13.
14.
go back to reference Awan KH, Morgan PR, Warnakulasuriya S (2011) Evaluation of an autofluorescence based imaging system (VELscope™) in the detection of oral potentially malignant disorders and benign keratoses. Oral Oncol 47(4):274–277CrossRefPubMed Awan KH, Morgan PR, Warnakulasuriya S (2011) Evaluation of an autofluorescence based imaging system (VELscope™) in the detection of oral potentially malignant disorders and benign keratoses. Oral Oncol 47(4):274–277CrossRefPubMed
15.
go back to reference Awan KH, Morgan PR, Warnakulasuriya S (2011) Utility of chemiluminescence (ViziLite®) in the detection of oral potentially malignant disorders and benign keratoses. J Oral Pathol Med 40(7):541–544CrossRefPubMed Awan KH, Morgan PR, Warnakulasuriya S (2011) Utility of chemiluminescence (ViziLite®) in the detection of oral potentially malignant disorders and benign keratoses. J Oral Pathol Med 40(7):541–544CrossRefPubMed
16.
go back to reference Awan KH, Yang YH, Morgan PR, Warnakulasuriya S (2012) Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity—a clinical and histological assessment. Oral Dis 18:728–733CrossRefPubMed Awan KH, Yang YH, Morgan PR, Warnakulasuriya S (2012) Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity—a clinical and histological assessment. Oral Dis 18:728–733CrossRefPubMed
17.
go back to reference Epstein JB, Oakley C, Millner A, Emerton S, van der Meij E (1997) The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83(5):537–547CrossRefPubMed Epstein JB, Oakley C, Millner A, Emerton S, van der Meij E (1997) The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83(5):537–547CrossRefPubMed
18.
go back to reference Epstein JB, Feldman R, Dolor RJ, Porter SR (2003) The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer. Head Neck 25(11):911–921CrossRefPubMed Epstein JB, Feldman R, Dolor RJ, Porter SR (2003) The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer. Head Neck 25(11):911–921CrossRefPubMed
19.
go back to reference Onofre MA, Sposto MR, Navarro CM (2001) Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(5):535–540CrossRefPubMed Onofre MA, Sposto MR, Navarro CM (2001) Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(5):535–540CrossRefPubMed
20.
go back to reference Ram S, Siar CH (2005) Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions. Int J Oral Maxillofac Surg 34:521–527CrossRefPubMed Ram S, Siar CH (2005) Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions. Int J Oral Maxillofac Surg 34:521–527CrossRefPubMed
21.
go back to reference Poh CF, Zhang L, Anderson DW, Durham JS, Williams M, Priddy RW, Berean KW, Ng SP, Tseng OL, MacAulay C, Rosin MP (2006) Fluorescence visualization detection of field alterations in tumour margins of oral cancer patients. Clin Cancer Res 22:12 Poh CF, Zhang L, Anderson DW, Durham JS, Williams M, Priddy RW, Berean KW, Ng SP, Tseng OL, MacAulay C, Rosin MP (2006) Fluorescence visualization detection of field alterations in tumour margins of oral cancer patients. Clin Cancer Res 22:12
22.
go back to reference Güneri P, Epstein JB, Kaya A, Veral A, Kazandı A, Boyacioglu H (2011) The utility of toluidine blue staining and brush cytology as adjuncts in clinical examination of suspicious oral mucosal lesions. Int J Oral Maxillofac Surg 40(2):155–161CrossRefPubMed Güneri P, Epstein JB, Kaya A, Veral A, Kazandı A, Boyacioglu H (2011) The utility of toluidine blue staining and brush cytology as adjuncts in clinical examination of suspicious oral mucosal lesions. Int J Oral Maxillofac Surg 40(2):155–161CrossRefPubMed
23.
go back to reference Pavlova I, Williams M, El-Naggar A, Richards-Kortum R, Gillenwater A (2008) Understanding the biological basis of autofluorescence imaging for oral cancer detection: high-resolution fluorescence microscopy in viable tissue. Clin Cancer Res 14(8):2396–2404PubMedCentralCrossRefPubMed Pavlova I, Williams M, El-Naggar A, Richards-Kortum R, Gillenwater A (2008) Understanding the biological basis of autofluorescence imaging for oral cancer detection: high-resolution fluorescence microscopy in viable tissue. Clin Cancer Res 14(8):2396–2404PubMedCentralCrossRefPubMed
24.
go back to reference Huff K, Stark PC, Solomon LW (2009) Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice. Gen Dent 57(1):34–38PubMed Huff K, Stark PC, Solomon LW (2009) Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice. Gen Dent 57(1):34–38PubMed
25.
go back to reference Kerr AR, Sirois DA, Epstein JB (2006) Clinical evaluation of chemiluminescent lighting: an adjunct for oral mucosal examinations. J Clin Dent 17(3):59–63PubMed Kerr AR, Sirois DA, Epstein JB (2006) Clinical evaluation of chemiluminescent lighting: an adjunct for oral mucosal examinations. J Clin Dent 17(3):59–63PubMed
26.
go back to reference Huber MA, Bsoul SA, Terezhalmy GT (2004) Acetic acid wash and chemiluminescent illumination as an adjunct to conventional oral soft tissue examination for the detection of dysplasia: a pilot study. Quintessence Int 35(5):378–384PubMed Huber MA, Bsoul SA, Terezhalmy GT (2004) Acetic acid wash and chemiluminescent illumination as an adjunct to conventional oral soft tissue examination for the detection of dysplasia: a pilot study. Quintessence Int 35(5):378–384PubMed
27.
go back to reference Epstein JB, Silverman S Jr, Epstein JD, Lonky SA, Bride MA (2008) Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol 44(6):538–544CrossRefPubMed Epstein JB, Silverman S Jr, Epstein JD, Lonky SA, Bride MA (2008) Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol 44(6):538–544CrossRefPubMed
28.
go back to reference Oh ES, Laskin DM (2007) Efficacy of the ViziLite system in the identification of oral lesions. J Oral Maxillofac Surg 65:424–426CrossRefPubMed Oh ES, Laskin DM (2007) Efficacy of the ViziLite system in the identification of oral lesions. J Oral Maxillofac Surg 65:424–426CrossRefPubMed
29.
go back to reference Rashid A, Warnakulasuriya S (2014) The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review. J Oral Pathol Med. doi:10.1111/jop.12218 PubMed Rashid A, Warnakulasuriya S (2014) The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review. J Oral Pathol Med. doi:10.​1111/​jop.​12218 PubMed
Metadata
Title
Assessing the accuracy of autofluorescence, chemiluminescence and toluidine blue as diagnostic tools for oral potentially malignant disorders—a clinicopathological evaluation
Authors
K. H. Awan
P. R. Morgan
S. Warnakulasuriya
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 9/2015
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-015-1457-9

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