Toluidine Blue Test for Early Detection of High-risk Oral Potentially Malignant Disorders and Oral Cancer - An Evaluative Study.

Abstract

Introduction: Oral cancer (OCa) is the malignancy of the mucosal part of the lip and oral cavity. Toluidine blue (TB) is a non-invasive adjunct screening tool to detect dysplasia. This study aims to validate TB stain as a diagnostic adjunct for early detection of oral potentially malignant disorders (OPMDs) and OCa in the primary healthcare settings in Sri Lanka.

Materials and methods: A descriptive cross-sectional study was conducted in the primary healthcare settings. Capacity development workshops were carried out for the dental surgeons working in the primary healthcare settings in Gampaha and Kandy districts. Study materials (questionnaires, TB test-kits and guidebooks) were distributed among the workshop participants. Completed questionnaires and opinion were traced back with histopathological findings. SPSS version 26 was used to analyse the data.

Results: A total of 162 patients were recruited from peripheral clinics. Majority (74.1%) of the patients were male. Among the total participants, the TB test was positive for 74 (45.7%) cases. According to the histopathological findings, most TB-positive patients were with moderate/severe epithelial dysplasia followed by oral squamous cell carcinomas and oral submucous fibrosis with epithelial dysplasia. Eighty-eight (54.3%) cases were negative for the TB test. Sex and histopathological categories with TB positivity showed a significant association (P = 0.034) as well as a statistically significant association.

Discussion: TB test is a reliable staining method to identify dysplastic lesions in the oral cavity. Further, it helps the clinicians to identify the most appropriate site to perform an incisional biopsy.