Application of toluidine blue for early detection of oral cancer and precancerous lesions

Background: Oral cancer is a significant global health concern, often diagnosed at advanced stages with poor prognosis and high mortality rates. Early detection of malignant and premalignant oral lesions is crucial for improving patient outcomes. This observational study aims to identify specific regions of oral lesions for histopathological diagnosis and assess the correlation between toluidine blue dye uptake in oral tissues and histopathological findings in premalignant and cancerous lesions. Methods: A total of 216 cases of oral lesions were selected based on predetermined inclusion and exclusion criteria without restrictions on age, gender, religion, or socioeconomic status. Patients were identified through medical records and clinical investigations, focusing on individuals with nonhealing oral ulcers persisting for over three weeks without a prior clinical diagnosis of oral cancer. Only toluidine blue-positive cases were considered for further examination. Histopathological analyses were performed on toluidine blue-positive areas to determine the presence of premalignant and malignant lesions. Results: Among the 216 cases, histopathological findings revealed 98 cases of hyperplastic epithelium, 14 cases of verrucous carcinoma, 34 cases of premalignant lesions, 12 cases of dysplasia, and 58 cases of squamous cell carcinoma (SCC). The toluidine blue dye demonstrated a 100% staining response rate, with an 86.2% accuracy in detecting carcinoma and a 15.7% accuracy for premalignant lesions. A significant histopathological difference was observed between oral potentially malignant lesions and SCC. Conclusion: The findings indicate that toluidine blue dye can enhance the early detection of malignant and premalignant oral lesions, improving diagnostic accuracy compared to traditional visual or therapeutic approaches. This method can aid clinicians in identifying high-risk oral lesions promptly, potentially improving patient outcomes.