Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma (original) (raw)
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Toluidine Staining as a Screening Tool for Soft Tissue Margins of Cancerous Oral Lesions
2020
Background:As the world is becoming advanced, the number of diseases also seems to be increasing. Mouth cancer and oral lesions are known as dangerous and fatal diseases. The experimentation is in the process. The problem is not new; it has been the cause of deaths of many patients since many decades. The increase in cancer patients has been recorded up to 43% in the last 8.1 years and it has been observed that most of the cancerous cells are malignant at the time of diagnosis and treatment.It is mandatory for the physician or the dental experts to diagnose oral cancer in the early stage and remove the tumor along with safe margins to decrease the chances of reoccurrence of the disease.The objective of the study is to detect the usefulness of the toulidine blue dye as a cost effective, less time consuming and a user-friendly screening tool for the tumor margins intra-operatively.Methods:Fifty patients with biopsy proven oral squamous cell carcinoma who were advised surgical resectio...
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2006
Verification of oral cancer relies on histo-pathological diagnosis of suspect or malignant lesions. There is evidence for further pre-surgical screening procedures to localize tumor borders and define other malignant lesions. Important methods are: visual examination, including pan-endoscopy, fluorescence imaging, and brush biopsy, as well as radiologic techniques such as conventional radiography, computed tomography, magnetic resonance imaging, scintigraphy, and ultrasonography, which may reduce the mortality rate associated with oral cancer. In addition, toluidine blue staining is a simple, inexpensive, and excellent diagnostic tool. Herein we show that the clinical use of in vivo staining is effective to define the superficial tumor borders and to detect malignant or pre-malignant cells in the surrounding area of the tumor following detection of a malignancy of the oral cavity. In our reported case, the main tumor mass was surrounded by layers of an intact mucosa, yet in a distance of more than 1 cm a group of malignant or pre-malignant cells in the surrounding area required a resection of the tumor in a size that would have been unaddressed during visual examination alone followed by clinical routine program of presurgical examinations after the detection of a malignancy of the oral cavity.
Cureus
Background The incidence of oral cavity cancer is increasing. During oral carcinoma surgery, to achieve a tumor-free margin, intraoperative margin assessment includes two primary methods, namely, clinical examination and frozen section analysis. With extensive preoperative imaging investigations and intraoperative clinical margin assessment, the need for further cost and resource-intensive frozen section analysis has recently come under question. This study aimed to assess whether frozen section analysis can be safely omitted in most cases of early oral squamous cell carcinoma surgeries for cost-effectiveness. Methodology A hospital-based, observational study including 30 admitted cases of early oral squamous cell carcinoma was conducted at the Department of General Surgery, Pradyumna Bal Memorial Hospital, Bhubaneswar. All consecutive confirmed cases of early oral squamous cell carcinoma of all age groups and both genders after considering the inclusion and exclusion criteria were involved in the study. A comparative assessment of the free margins after tumor excision was done by the surgeon followed by frozen section analysis. Results The mean age was 53.03 ± 13.72 years, with a male-to-female ratio of 6.5:1. Carcinoma of the lower alveolus with gingivobuccal sulcus was the most common presentation of the study (33.33%). In our study, clinically assessed margins had a sensitivity of 75.39%, a specificity of 94.43%, and an accuracy of 92.77%. Frozen section assessed margins had a sensitivity of 66.5%, a specificity of 96.94%, and an accuracy of 92.77%. Conclusions Based on the accuracy of clinically assessed and frozen section assessed margins, this study concluded that surgically resected/excised specimen by the surgeon plays a vital role in assessing the adequacy of resected/excised margins in early oral squamous cell carcinoma (cT1, T2, N0) cases, which can possibly replace the costly frozen section analysis.
Cureus, 2022
Background and objective Head and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients. Methods A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed. Results Among the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%. Conclusion The frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.
Utility of Toluidine Blue Staining and Brush Biopsy in Precancerous and Cancerous Oral Lesions
Acta Cytologica, 2007
To evaluate the usefulness of toluidine blue and brush biopsy in precancerous oral lesions and squamous cell carcinoma. Study Design The study was conducted at Moti Lal Nehru Medical College, Allahabad, India. Ninetysix patients with suspicious oral lesions who attended the outpatient clinics of otorhinolaryngology were screened with in vivo toluidine blue staining and oral brush biopsy. Results Oral brush biopsy showed high specificity and sensitivity. Toluidine blue staining was highly sensitive and moderately specific for malignant lesions but less sensitive for premalignant lesions. Conclusion Early detection of oral carcinoma is possible even at the precancerous stages by using noninvasive, painless and outpatient procedures, such as in vivo toluidine blue staining and brush biopsy.
Journal of Maxillofacial and Oral Surgery, 2014
Introduction Oral Squamous Cell Carcinomas have been considered as the most prevalent malignancies in the head and neck region and are frequently undiagnosed until symptomatic with an advanced stage of disease. So there is an urgent need to device methods for the detection of oral premalignant lesions and oral cancer at an early stage in order to improve the survival rate for patients. A number of tests have been done for the detection of oral cancer which include oral brush biopsy, the Vizilite, oral autofluorescence including chemiluscence, photodynamic detection, toluidine blue staining, methylene blue staining, incisional biopsy and many more. Material The article reviews various diagnostic modalities available at present for detection of squamous cell carcinomas and oral epithelial dysplasias based on advanced PUBMED search of the English language literature from the year 1972 to present in order to help us select the most suitable among them fulfilling the desired criteria of being non-invasive, highly specific and sensitive, economically viable, having a scope to be used for mass screening, easy to process, having low inter examiner variability and possibly not requiring high expertise to conduct and interpret the results. Conclusion After reviewing various diagnostic modalities, we conclude that toluidine blue staining emerges as a clear winner among all these and it can act as a valuable adjunct to incisional biopsy in detection of oral cancer and may not substitute it except in certain circumstances when its results are carefully correlated with the patient history and clinical characteristics of the mucosal disorder, considering the fact that incisional biopsy has been reported to cause dissemination of cancer cells in the circulation there by increasing the possibility of metastasis. We must emphasize that toludine blue is a screening modality and not a diagnostic procedure like biopsy and hence cannot replace a confirmatory biopsy as a whole Keywords Squamous cell carcinoma Á Diagnostic Modalities Á Toluidine Blue Á Screening Test
Assessing Frozen Section Surgical Margin Status in Oral Squamous Cell Carcinoma
Journal of Evolution of Medical and Dental Sciences, 2021
BACKGROUND A key technique that is used by the pathologists during intraoperative consultation is frozen section evaluation. It is very important for the surgeons to know if the surgical margin is clear of malignant cells and the status of dysplasia during oncosurgery. There should be concordance between the frozen section margin and paraffin-embedded section. The purpose of the study was to evaluate and validate the accuracy of frozen section surgical margin status in oral squamous cell carcinoma (OSCC) among 2 observers. METHODS A total of 25 histologically diagnosed OSCC cases from April 2018 to April 2019 were included in the study. A total of 122 surgical margin slides (61 frozen sections and paraffin-embedded slides) were retrieved. The interobserver agreement of frozen section margin status with paraffin-embedded was analyzed. RESULTS Interobserver agreement in frozen section margin was 73.80 % with a kappa value of 0.048 (slight) and P-value 0.344. The interobserver agreemen...
A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma
World Journal of Surgical Oncology, 2012
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%. Cite this article as: Junaid et al.: A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma.
Frontiers in Oncology, 2020
BackgroundInadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017).MethodsA cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed.ResultsOne hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the freque...