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A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma

BACKGROUND: Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most c...

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Autores principales: Junaid, Montasir, Choudhary, Moaz M, Sobani, Zain A, Murtaza, Ghulam, Qadeer, Sadaf, Ali, Naeem S, Khan, Mumtaz J, Suhail, Anwar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349537/
https://www.ncbi.nlm.nih.gov/pubmed/22500814
http://dx.doi.org/10.1186/1477-7819-10-57
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author Junaid, Montasir
Choudhary, Moaz M
Sobani, Zain A
Murtaza, Ghulam
Qadeer, Sadaf
Ali, Naeem S
Khan, Mumtaz J
Suhail, Anwar
author_facet Junaid, Montasir
Choudhary, Moaz M
Sobani, Zain A
Murtaza, Ghulam
Qadeer, Sadaf
Ali, Naeem S
Khan, Mumtaz J
Suhail, Anwar
author_sort Junaid, Montasir
collection PubMed
description BACKGROUND: Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins. METHODS: After obtaining clearance from the in-house ethical review committee, a prospective study was conducted at Aga Khan University Hospital, Karachi, from August 15, 2009 to March 14, 2010. A sample of 56 consenting patients with biopsy-proven OSCC were included in the study, giving us 280 tumor margins. Margins were analyzed using toluidine blue staining and frozen section histopathology. A receiver operator curve (ROC) was then applied to compare assessment of margin status by toluidine blue and frozen section. RESULTS: Of the 280 examined margins 11 stained positive with toluidine blue, three were positive on frozen section biopsy, and three were positive on final histopathology. Toluidine blue staining had sensitivity and specificity of 100% and 97%, respectively. The diagnostic accuracy of toluidine blue was found to be 97.1% with a positive predictive value (PPV) of 27.2% and a negative predictive value (NPV) of 100%. CONCLUSIONS: Toluidine blue can be used as an effective screening modality for the assessment of intraoperative margins in resource limited environments and reducing the number of frozen section biopsies performed. Further by providing real-time clinical information within minutes it can reduce indirect costs such as operating room time. It may also be used as an ad hoc for frozen section biopsies where frozen section facilities are available.
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spelling pubmed-33495372012-05-11 A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma Junaid, Montasir Choudhary, Moaz M Sobani, Zain A Murtaza, Ghulam Qadeer, Sadaf Ali, Naeem S Khan, Mumtaz J Suhail, Anwar World J Surg Oncol Research BACKGROUND: Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins. METHODS: After obtaining clearance from the in-house ethical review committee, a prospective study was conducted at Aga Khan University Hospital, Karachi, from August 15, 2009 to March 14, 2010. A sample of 56 consenting patients with biopsy-proven OSCC were included in the study, giving us 280 tumor margins. Margins were analyzed using toluidine blue staining and frozen section histopathology. A receiver operator curve (ROC) was then applied to compare assessment of margin status by toluidine blue and frozen section. RESULTS: Of the 280 examined margins 11 stained positive with toluidine blue, three were positive on frozen section biopsy, and three were positive on final histopathology. Toluidine blue staining had sensitivity and specificity of 100% and 97%, respectively. The diagnostic accuracy of toluidine blue was found to be 97.1% with a positive predictive value (PPV) of 27.2% and a negative predictive value (NPV) of 100%. CONCLUSIONS: Toluidine blue can be used as an effective screening modality for the assessment of intraoperative margins in resource limited environments and reducing the number of frozen section biopsies performed. Further by providing real-time clinical information within minutes it can reduce indirect costs such as operating room time. It may also be used as an ad hoc for frozen section biopsies where frozen section facilities are available. BioMed Central 2012-04-16 /pmc/articles/PMC3349537/ /pubmed/22500814 http://dx.doi.org/10.1186/1477-7819-10-57 Text en Copyright ©2012 Junaid et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Junaid, Montasir
Choudhary, Moaz M
Sobani, Zain A
Murtaza, Ghulam
Qadeer, Sadaf
Ali, Naeem S
Khan, Mumtaz J
Suhail, Anwar
A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title_full A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title_fullStr A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title_full_unstemmed A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title_short A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
title_sort comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349537/
https://www.ncbi.nlm.nih.gov/pubmed/22500814
http://dx.doi.org/10.1186/1477-7819-10-57
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