A Chemiluminescent Light System in Combination with Toluidine Blue to Assess Suspicious Oral Lesions-clinical Evaluation and Review of the Literature

Overview

Journal Clin Oral Investig

Specialty Dentistry

Date 2014 Jun 4

PMID 24888605

Citations 12

Authors

P W Kammerer

R K Rahimi-Nedjat

T Ziebart

A Bemsch

C Walter

B Al-Nawas

F P Koch

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of the study was an evaluation of an acetic acid wash and chemiluminescent light system in combination with toluidine blue in order to detect visual identified, potentially malignant lesions.

Materials And Methods: Forty-four patients with 50 oral lesions of primary uncertain visible dignity were included. Next to a clinical examination, a screening with ViziLite® (VL) as well as toluidine blue (TB; together ViziLite® Plus (VLP)) was conducted. Histopathology served as gold standard and sensitivity (SE), specificity (SP), positive as well as negative predictive value (PPV, NPV) was calculated descriptively. Additionally, a PubMed literature search using the key words "ViziLite" and "chemiluminescence oral cancer" was conducted.

Results: Histological diagnosis showed 40 lesions of reactive/inflammatory nature, moderate dysplasia (n = 3) and oral squamous cell carcinoma (OSCC n = 7). All OSCCs and one dysplasia were identified correct via clinical diagnosis (SE 90 %, SP 100 %, PPV 100 %, NPV 97.5 %). VL examination could show all malignancies with low specificity (SE 100 %, SP 30 %, PPV 26 %, NPV 100 %). TB and VLP were positive in all cases of cancer and in one case of inflammation (SE 80 %, SP 97.5 %, PPV 89 %, NPV 95 %). In the review, eight clinical trials with similar results were included.

Conclusions: The adjunct of TB to VL reduces the number of false positives without increasing the rate of false negatives.

Clinical Relevance: Clinical evidence to justify the additional cost of the system for diagnosis of suspicious lesions is weak. However, for the potential role of VLP in detection of lesions not otherwise identified in the visual exam in general dental practice further studies are required.

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References

Mehrotra R, Singh M, Thomas S, Nair P, Pandya S, Nigam N . A cross-sectional study evaluating chemiluminescence and autofluorescence in the detection of clinically innocuous precancerous and cancerous oral lesions. J Am Dent Assoc. 2010; 141(2):151-6. DOI: 10.14219/jada.archive.2010.0132. View

Kujan O, Oliver R, Khattab A, Roberts S, Thakker N, Sloan P . Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation. Oral Oncol. 2006; 42(10):987-93. DOI: 10.1016/j.oraloncology.2005.12.014. View

MacAulay C, Poh C, Guillaud M, Michele Williams P, Laronde D, Zhang L . High throughput image cytometry for detection of suspicious lesions in the oral cavity. J Biomed Opt. 2012; 17(8):086004-1. DOI: 10.1117/1.JBO.17.8.086004. View

Driemel O, Dahse R, Hakim S, Tsioutsias T, Pistner H, Reichert T . Laminin-5 immunocytochemistry: a new tool for identifying dysplastic cells in oral brush biopsies. Cytopathology. 2007; 18(6):348-55. DOI: 10.1111/j.1365-2303.2006.00401.x. View

Zadik Y, Orbach H, Panzok A, Smith Y, Czerninski R . Evaluation of oral mucosal diseases: inter- and intra-observer analyses. J Oral Pathol Med. 2011; 41(1):68-72. DOI: 10.1111/j.1600-0714.2011.01070.x. View

Awan K, Morgan P, Warnakulasuriya S . Utility of chemiluminescence (ViziLite™) in the detection of oral potentially malignant disorders and benign keratoses. J Oral Pathol Med. 2011; 40(7):541-4. DOI: 10.1111/j.1600-0714.2011.01048.x. View

Epstein J, Silverman Jr S, Epstein J, Lonky S, Bride M . Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue. Oral Oncol. 2007; 44(6):538-44. DOI: 10.1016/j.oraloncology.2007.08.011. View

Toyoshima T, Koch F, Kaemmerer P, Vairaktaris E, Al-Nawas B, Wagner W . Expression of cytokeratin 17 mRNA in oral squamous cell carcinoma cells obtained by brush biopsy: preliminary results. J Oral Pathol Med. 2009; 38(6):530-4. DOI: 10.1111/j.1600-0714.2009.00748.x. View

Robinson P, Mickelson A . Early diagnosis of oral cavity cancers. Otolaryngol Clin North Am. 2006; 39(2):295-306. DOI: 10.1016/j.otc.2005.12.001. View

10.

Brocklehurst P, Kujan O, Glenny A, Oliver R, Sloan P, Ogden G . Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev. 2010; (11):CD004150. DOI: 10.1002/14651858.CD004150.pub3. View

11.

Huber M, Bsoul S, Terezhalmy G . 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. 2004; 35(5):378-84. View

12.

Kammerer P, Klein M, Moergel M, Gemmel M, Draenert G . Local and systemic risk factors influencing the long-term success of angular stable alloplastic reconstruction plates of the mandible. J Craniomaxillofac Surg. 2013; 42(5):e271-6. DOI: 10.1016/j.jcms.2013.10.004. View

13.

Lonky N, Mann W, Massad L, Mutch D, Blanco J, Vasilev S . Ability of visual tests to predict underlying cervical neoplasia. Colposcopy and speculoscopy. J Reprod Med. 1995; 40(7):530-6. View

14.

Sciubba J . Oral precancer and cancer: etiology, clinical presentation, diagnosis, and management. Compend Contin Educ Dent. 2002; 21(10A):892-8, 900-2; quiz 903. View

15.

Epstein J, Oakley C, Millner A, Emerton S, van der Meij E, Le N . 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. 1997; 83(5):537-47. DOI: 10.1016/s1079-2104(97)90117-7. View

16.

Guneri P, Epstein J, Ergun S, Boyacioglu H . Toluidine blue color perception in identification of oral mucosal lesions. Clin Oral Investig. 2010; 15(3):337-45. DOI: 10.1007/s00784-010-0398-6. View

17.

Downer M, Moles D, Palmer S, Speight P . A systematic review of test performance in screening for oral cancer and precancer. Oral Oncol. 2004; 40(3):264-73. DOI: 10.1016/j.oraloncology.2003.08.013. View

18.

Koch F, Kaemmerer P, Biesterfeld S, Kunkel M, Wagner W . Effectiveness of autofluorescence to identify suspicious oral lesions--a prospective, blinded clinical trial. Clin Oral Investig. 2010; 15(6):975-82. DOI: 10.1007/s00784-010-0455-1. View

19.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M . Cancer statistics, 2009. CA Cancer J Clin. 2009; 59(4):225-49. DOI: 10.3322/caac.20006. View

20.

Ujaoney S, Motwani M, Degwekar S, Wadhwan V, Zade P, Chaudhary M . Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: A cross-sectional study. BMC Clin Pathol. 2012; 12:6. PMC: 3315728. DOI: 10.1186/1472-6890-12-6. View