Toluidine blue color perception in identification of oral mucosal lesions

Abstract

The objective of this study is to examine observer agreement on the rank of the color tones after toluidine blue staining of a mucosal lesion. Cohort study with repeated measures is the design of the study. Twenty observers ranked and scored 8 specified areas on the color images of a lesion before and after toluidine blue application in two sessions. Inter and intra-observer variations were analyzed with Cohen's kappa. The L* (the black-white axis), a* (red-green axis), and b* (yellow-blue axis) values were measured and set as the gold standards. Intra and inter-observer agreements were к = 0.86 and к = 0.854. All color parameters were effective on the color ranking order (pL* = 0.00, pa* = 0.007, pb* = 0.00), although L* and b* were more effective on the ranking of the samples than a*. Areas that appeared pale blue visually had a significant blue component, but the observers were confused with the effect of whiteness of the area in clinical decision making.

Saliva as a Diagnostic Fluid

“…Classically, clinical diagnosis of oral cancer has been based on visual and palpation assessment, followed by biopsy and histopathological evaluation. However, this clinical assessment has been broadened by use of magnetic resonance imaging and computerized tomography [79]; toluidine blue staining [80] and light-based detection techniques [81]. More recently, detection of biomarkers in saliva has emerged as a novel approach for the diagnosis of OSCC and its developmental stages including, initial process, invasion, recurrence and treatment.…”

Toluidine blue staining as an adjunctive tool for early diagnosis of dysplastic changes in the oral mucosa

“…Toluidine blue is a cationic metachromatic dye that may selectively bind to free anionic groups such as sulfate, phosphate, and carboxylate radicals of large molecules (6). It has been used for decades as an aid to the identification of mucosal abnormalities of the cervix as well as in the oral cavity.…”

“…In vivo, toluidine blue stains deoxyribonucleic acid and/or may be retained in intracellular spaces of dysplastic epithelium and clinically appear as royal blue areas (6). Toluidine blue staining is considered to be sensitive in identifying early oral premalignant and malignant lesions (4).…”

Comparison of chemiluminescence and toluidine blue in the diagnosis of dysplasia in leukoplakia: a cross‐sectional study

“…Guneri et al . suggested a digital method for objective color analysis to eliminate the subjective color perception; however, this needs to be validated with larger studies …”