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Oral likenoid lezyonlarda displazik ve malign değişimlerin saptanması amacıyla biyopsi öncesinde toluidin mavisi uygulanması

Year 2018, Volume: 1 Issue: 2, 42 - 51, 31.10.2018
https://doi.org/10.33204/mucosa.435522

Abstract

Giriş

Oral liken planus (OLP) immun aracılı patogeneze sahip, premalign olabilen kronik bir hastalıktır. Oral likenoid displazi (OLD) ise sıklıkla OLP ile karışan likenoid bulguların eşlik ettiği prekanseröz bir tablodur.

Amaç

Bu çalışmada klinik olarak OLP tanısı alan hastalarda biyopsi alınmasından önce toluidin mavisi uygulamasının displastik değişiklikleri saptamadaki etkinliğinin araştırılması amaçlanmıştır.

Yöntem

Çalışmaya klinik bulguları OLP ile uyumlu olan 30 hasta dahil edilmiştir. Çalışmaya alınan hastaların demografik ve klinik özellikleri kaydedilip, uygulama öncesi ve sonrasında klinik görüntüleme yapılmıştır. Biyopsi alınacak alanlar lezyonun toluidin mavisi ile boyama sonuçlarına göre belirlenmiştir. Histopatolojik olarak tüm preperatlar OLP’un tanısal özellikleri ve displazik bulguların varlığı açısından değerlendirilmiştir.

Bulgular

30 hastanın (21 kadın, 9 erkek) yaş ortalaması 51.03 (26-70 yaş), hastalık süresinin median de-ğeri 12.00±67.23 ay (2-360 ay) olarak saptandı. Toluidin mavisi uygulamasından sonra altı hastada (%20.0) mavi renkli tutulum izlendi. Histopatolojik incelemede 17 hastada OLP bulguları (%56.7), dokuz hastada OLP ve displazi bulguları (%30.0) ve dört hastada (%13.3) likenoid displazi saptandı. Mavi renkli boyanma izlenen lezyonların tümünde (altı hasta) displazi saptandı. Boyanma ile displazi arasındaki ilişki anlamlı olarak bulundu (p<0.05). Bu hastaların dördünde (%66.7) OLP ve displazi, ikisinde (%33.3) likenoid displazi izlendi. Histopatolojik olarak displazi özelliği gösteren hastalarda displazi varlığı ile mitoz varlığı arasındaki ilişki istatistiksel olarak anlamlı bulundu (p<0.05). Boyanma gösteren lezyonlardan alınan biyopsilerde de mitoz varlığına bakıldığında istatistiksel olarak anlamlı ilişki tespit edildi (p<0.05).

Sonuçlar

Çalışmamızda klinik olarak klasik OLP ile uyumlu hastalarda toluidin mavisi uygulanması sonrasında boyanan tüm alanlarda displazi saptandığı, ancak 

displazi saptanan bazı hastalarda da boyanma olmadığı görülmüştür. Buna göre uygulamanın sensitivitesi %46, spesifitesi %100, pozitif prediktif değeri %100, negatif prediktif değeri ise %70.8 olarak bulunmuştur. Toluidin mavisi uygulaması displazinin saptanması için spesifik  olmasına rağmen oral likenoid lezyonlardaki duyarlılığı düşüktür ve duyarlılığı arttırmak için yeni bir metoda ihtiyaç vardır.

References

  • Reference1. Al-Hashimi I, Schifter M, Lockhard PB, Brennan M, Bruce AJ et al. Oral lichen planus and lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 1-12.
  • Reference2. Chandrakala J, Vidya M, Hemavathy S, Srinath S, Suresh T, Yadav TS. Estimation of silver nucleolar organizer regions in oral lichen planus, oral lichenoid reactions and oral lichenoid dysplasia. J Oral Maxillofac Pathol. 2017;21(3):454.
  • Reference3. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol 2002; 46: 207-14.
  • Reference4. Ismail SB, Kumar SKS, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2007; 49: 89-106.
  • Reference5. Mignogna MD, Fedele S, Lo Russo L, Mignogna C, de Rosa G, Porter SR. Field cancerization in oral lichen planus. EJSO 2007; 33: 383-389.
  • Reference6. Gonzalez-Moles MA, Scully C, Gil-Montoya JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Diseases 2008; 14: 229-243.
  • Reference7. Gonzalez-Moles MA, Gil-Montoya JA, Ruiz-Avila I, Bravo M. Is oral cancer incidence among patients with oral lichen planus/oral lichenoid lesions underestimated? J Oral Pathol Med 2017; 46: 148-153.
  • Reference8. van der Meij EH, Schepman KP, van der Waal I. The posibble premalignant character of oral lichen planus and oral lichenoid lesions: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 164-71.
  • Reference9. Chieco P, Pagnoni M, Romagnoli E, Melchiorri C. A rapid and simple staining method, using toluidine blue, for analysing mitotic figures in tissue sections. Histochem J 1993; 25: 569-577.
  • Reference10.Patton LL, Elter JR, Southerland JH, Strauss RP. Knowledge of oral cancer risk factors and diagnostic concepts among North Carolina dentists. JADA 2005; 136: 602-610.
  • Reference11. Gandolfo S, Pentenero M, Brocoletti R, Pagano M, Carrozzo, et al. Toluidine blue uptake in potentially malignant oral lesions in vivo: Clinical and histological assessment. Oral Oncol 2006; 42: 89-95.
  • Reference12. Mashberg A. Final evaluation of tolonium chloride rinse for screening of high-risk patients with asymptomatic squamous carcinoma. JADA 1983; 106: 319-323.
  • Reference13.McIntyre G.T, Oliver R.J. Update on precancerous lesions. Dent Update 1999; 26: 382-386.
  • Reference14.Missmann M, Jank Siegfried J, Laimer K, Gassner R. A reason for the use of toluidine blue staining in the presurgical management of patients with oral squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 741-743.
  • Reference15.Siddiqui IA, Farooq MU, Siddiqui RA, Rafi SMT. Role of toluidine blue in early detection of oral cancer. Pak J Med Sci 2006; 22: 184-187.
  • Reference16. Xue J-L, Fan MW, Wang S-Z, Chen X-M, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med 2005; 34: 467-72.
  • Reference17. Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: a retrospective study of 690 British patients. Oral Dis 2006; 12: 263-468.
  • Reference18. Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS, Elsaadany BA, Ahmed EM. Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095 patient data. Oral Oncol 2017; 68: 92-102.
  • Reference19. Scully C, Eisen D, Carrozzo M. Management of oral lichen planus. Am J Clin Dermatol 2000; 1: 287-306.
  • Reference20.Au J, Patel D, Campbell JH. Oral lichen planus. Oral Maxillofac Surg Clin North Am 2013; 25: 93-100.
  • Reference21. Epstein JB, Wan LS, Gorsky M, Zhang L. Oral lichen planus: Progress in understanding its malignant potential and the implications for clinical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 32-7.
  • Reference22. Kamath VV, Setlur K, Yerlagudda K. Oral Lichenoid Lesions - A Review and Update. Indian J Dermatol. 2015; 60(1): 102.
  • Reference23. Rice PJ, Hamburger J. Oral lichenoid drug eruptions: their recognation and management. Dent update 2002; 29: 442-447.
  • Reference24. Larsson A, Warfvinge G. Malignant transformation of oral lichen planus. Oral Oncol 2003; 39: 630-631.
  • Reference25. Aguirre Urizar JM. Letter to the editor: Oral Lichenoid Disease. A new classification proposal. Med Oral Patol Oral Cir Bucal 2008; 13: 224.
  • Reference26. Krutchkoff DJ, Eisenberg E. Lichenoid dysplasia: a distinct histopathologic entity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1985; 30: 308-15.
  • Reference27. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.
  • Reference28. Sperandio MS, Klinikowski MF, Brown AL, Shirlaw PJ, Challacombe SJ, Morgan PR, Warnakulasuriya S, Odell EW. Image-based DNA ploidy analyseie aids prediction of malignant transformation in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121: 643-50.
  • Reference29. Yang Q, Sun H, Zhang J, Liu S, Hexige S, Yu X, Wang X. Identification of the key genes implicated in the transformation of OLP to OSCC using RNA-sequencing. Oncol Rep 2017; 37: 2355-2365.
  • Reference30. Urbizo-Vélez J, Rodriguez Pérez I, Albrecht M, Bánóczy J. Comparative histopathological studies in oral lichen planus. Acta Morphol Hung. 1990; 38: 71-81.
  • Reference31. De Jong WF, Albrecht M, Bánóczy J, van der Waal I. Epithelial dysplasia in oral lichen planus. A preliminary report of a Dutch-Hungarian study of 100 cases. Int J Oral Surg. 1984; 13: 221-5.
  • Reference32. Onofre MA, Sposto MR, Navarro CM. Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carsinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 535-40.
  • Reference33. Epstein JB, Zahng L, Poh C, Nakamura H, Berean K, et al. Increased allelic loss in toluidine blue positive oral malignant lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95: 45-50.
  • Reference34. Guo Z, Yamaguchi K, Sanchez-Cespedes M, Westra WH, Koch WM, et al. Allelic losses in OraTest-directed biopsies of patients with prior upper aerodigestive tract malignancy. Clin Cancer Res 2001; 7: 1963-1968.
  • Reference35. Herlin P, Marnay J, Jacob JH, Ollivier JM, Mandard AM. A study of the mechanism of the toluidine blue dye test. Endoscopy 1983; 15: 4-7.Reference36.Shedd DP, Hukill PB, Bahn S. In vivo staining characteristics of oral cancer. Am J Surg 1965; 110: 631-634.
  • Reference37.Strong MS, Incze J, Vaughan CW. Field cancerization in the aerodigestive tract: its etiology, manifestation, and significance. J Otolaryngol 1984; 13: 1-6.
  • Reference38. Vercellino V, Gandolfo S, Camoletto D, Griffa B, Mori C. Toluidine blue (tolonium chloride) in the early diagnosis of dysplasias and carcinomas of the oral mucosa. Minerva Stomatol 1985; 34: 257-261.

Toluidine blue application to detect dysplasia and malignant changes in patients with oral lichenoid lesions

Year 2018, Volume: 1 Issue: 2, 42 - 51, 31.10.2018
https://doi.org/10.33204/mucosa.435522

Abstract

Background 

Oral lichen planus (OLP) is a chronic disease with immune-mediated pathogenesis which can be premalignant. Oral lichenoid dysplasia (OLD) is a precancerous process with lichenoid features which is frequently confused with OLP.

Objective

In this study, we aimed to investigate the efficacy of toluidine blue (TB) administration before biopsy to detect the dysplastic changes in patients who were clinically diagnosed with OLP.

Methods

Thirty consecutive patients with oral lichenoid lesions whose clinical findings were consistent with OLP were included in the study. Demographic and clinical characteristics of the patients studied were recorded and clinical photos were taken before and after the administration of TB. Areas to be biopsied were determined according to the results of the TB staining. Histopathologically, all the specimens were evaluated in terms of the diagnostic features of OLP and the presence of dysplastic findings. 

Results

The mean age of the 30 patients (21 females, 9 males) included in the study was 51.03 (26-70 years) and the median value of disease duration was 12.00 ± 67.23 months (2-360 months). Six patients (20.0%) had positive staining after application of TB. Histopathological examination revealed OLP findings in 17 patients (56.7%), OLP and dysplasia findings in nine patients (30.0%) and lichenoid dysplasia in four patients (13.3%). Dysplasia was detected in all of the lesions (six patients) which were stained blue with TB. The relationship between staining and dysplasia was significant (p<0.05). OLP and dysplasia were observed in four of these six patients (66.7%), and lichenoid dysplasia was observed in the other two (33.3%). The relationship between presence of dysplasia and presence of mitosis was found statistically significant in patients with histopathological dysplasia (p<0.05). When the presence of mitosis was evaluated in biopsies taken from the stained lesions, a statistically significant relation was found (p<0.05).

Conclusions

In our study, it was observed that dysplasia was detected in all stained areas after the application of TB to clinically classical OLP patients, but there was no staining in some patients despite the presence of dysplasia. Therefore, the sensitivity of the application was 46%, specificity was 100%, positive predictive value was 100% and negative predictive value was 70.8%. TB application is a specific test to detect the dysplasia; however because of the low sensitivity in oral lichenoid lesions, another method is needed to increase the sensitivity.

References

  • Reference1. Al-Hashimi I, Schifter M, Lockhard PB, Brennan M, Bruce AJ et al. Oral lichen planus and lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 1-12.
  • Reference2. Chandrakala J, Vidya M, Hemavathy S, Srinath S, Suresh T, Yadav TS. Estimation of silver nucleolar organizer regions in oral lichen planus, oral lichenoid reactions and oral lichenoid dysplasia. J Oral Maxillofac Pathol. 2017;21(3):454.
  • Reference3. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol 2002; 46: 207-14.
  • Reference4. Ismail SB, Kumar SKS, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2007; 49: 89-106.
  • Reference5. Mignogna MD, Fedele S, Lo Russo L, Mignogna C, de Rosa G, Porter SR. Field cancerization in oral lichen planus. EJSO 2007; 33: 383-389.
  • Reference6. Gonzalez-Moles MA, Scully C, Gil-Montoya JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Diseases 2008; 14: 229-243.
  • Reference7. Gonzalez-Moles MA, Gil-Montoya JA, Ruiz-Avila I, Bravo M. Is oral cancer incidence among patients with oral lichen planus/oral lichenoid lesions underestimated? J Oral Pathol Med 2017; 46: 148-153.
  • Reference8. van der Meij EH, Schepman KP, van der Waal I. The posibble premalignant character of oral lichen planus and oral lichenoid lesions: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 164-71.
  • Reference9. Chieco P, Pagnoni M, Romagnoli E, Melchiorri C. A rapid and simple staining method, using toluidine blue, for analysing mitotic figures in tissue sections. Histochem J 1993; 25: 569-577.
  • Reference10.Patton LL, Elter JR, Southerland JH, Strauss RP. Knowledge of oral cancer risk factors and diagnostic concepts among North Carolina dentists. JADA 2005; 136: 602-610.
  • Reference11. Gandolfo S, Pentenero M, Brocoletti R, Pagano M, Carrozzo, et al. Toluidine blue uptake in potentially malignant oral lesions in vivo: Clinical and histological assessment. Oral Oncol 2006; 42: 89-95.
  • Reference12. Mashberg A. Final evaluation of tolonium chloride rinse for screening of high-risk patients with asymptomatic squamous carcinoma. JADA 1983; 106: 319-323.
  • Reference13.McIntyre G.T, Oliver R.J. Update on precancerous lesions. Dent Update 1999; 26: 382-386.
  • Reference14.Missmann M, Jank Siegfried J, Laimer K, Gassner R. A reason for the use of toluidine blue staining in the presurgical management of patients with oral squamous cell carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 741-743.
  • Reference15.Siddiqui IA, Farooq MU, Siddiqui RA, Rafi SMT. Role of toluidine blue in early detection of oral cancer. Pak J Med Sci 2006; 22: 184-187.
  • Reference16. Xue J-L, Fan MW, Wang S-Z, Chen X-M, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med 2005; 34: 467-72.
  • Reference17. Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: a retrospective study of 690 British patients. Oral Dis 2006; 12: 263-468.
  • Reference18. Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS, Elsaadany BA, Ahmed EM. Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095 patient data. Oral Oncol 2017; 68: 92-102.
  • Reference19. Scully C, Eisen D, Carrozzo M. Management of oral lichen planus. Am J Clin Dermatol 2000; 1: 287-306.
  • Reference20.Au J, Patel D, Campbell JH. Oral lichen planus. Oral Maxillofac Surg Clin North Am 2013; 25: 93-100.
  • Reference21. Epstein JB, Wan LS, Gorsky M, Zhang L. Oral lichen planus: Progress in understanding its malignant potential and the implications for clinical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 32-7.
  • Reference22. Kamath VV, Setlur K, Yerlagudda K. Oral Lichenoid Lesions - A Review and Update. Indian J Dermatol. 2015; 60(1): 102.
  • Reference23. Rice PJ, Hamburger J. Oral lichenoid drug eruptions: their recognation and management. Dent update 2002; 29: 442-447.
  • Reference24. Larsson A, Warfvinge G. Malignant transformation of oral lichen planus. Oral Oncol 2003; 39: 630-631.
  • Reference25. Aguirre Urizar JM. Letter to the editor: Oral Lichenoid Disease. A new classification proposal. Med Oral Patol Oral Cir Bucal 2008; 13: 224.
  • Reference26. Krutchkoff DJ, Eisenberg E. Lichenoid dysplasia: a distinct histopathologic entity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1985; 30: 308-15.
  • Reference27. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.
  • Reference28. Sperandio MS, Klinikowski MF, Brown AL, Shirlaw PJ, Challacombe SJ, Morgan PR, Warnakulasuriya S, Odell EW. Image-based DNA ploidy analyseie aids prediction of malignant transformation in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121: 643-50.
  • Reference29. Yang Q, Sun H, Zhang J, Liu S, Hexige S, Yu X, Wang X. Identification of the key genes implicated in the transformation of OLP to OSCC using RNA-sequencing. Oncol Rep 2017; 37: 2355-2365.
  • Reference30. Urbizo-Vélez J, Rodriguez Pérez I, Albrecht M, Bánóczy J. Comparative histopathological studies in oral lichen planus. Acta Morphol Hung. 1990; 38: 71-81.
  • Reference31. De Jong WF, Albrecht M, Bánóczy J, van der Waal I. Epithelial dysplasia in oral lichen planus. A preliminary report of a Dutch-Hungarian study of 100 cases. Int J Oral Surg. 1984; 13: 221-5.
  • Reference32. Onofre MA, Sposto MR, Navarro CM. Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carsinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 535-40.
  • Reference33. Epstein JB, Zahng L, Poh C, Nakamura H, Berean K, et al. Increased allelic loss in toluidine blue positive oral malignant lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95: 45-50.
  • Reference34. Guo Z, Yamaguchi K, Sanchez-Cespedes M, Westra WH, Koch WM, et al. Allelic losses in OraTest-directed biopsies of patients with prior upper aerodigestive tract malignancy. Clin Cancer Res 2001; 7: 1963-1968.
  • Reference35. Herlin P, Marnay J, Jacob JH, Ollivier JM, Mandard AM. A study of the mechanism of the toluidine blue dye test. Endoscopy 1983; 15: 4-7.Reference36.Shedd DP, Hukill PB, Bahn S. In vivo staining characteristics of oral cancer. Am J Surg 1965; 110: 631-634.
  • Reference37.Strong MS, Incze J, Vaughan CW. Field cancerization in the aerodigestive tract: its etiology, manifestation, and significance. J Otolaryngol 1984; 13: 1-6.
  • Reference38. Vercellino V, Gandolfo S, Camoletto D, Griffa B, Mori C. Toluidine blue (tolonium chloride) in the early diagnosis of dysplasias and carcinomas of the oral mucosa. Minerva Stomatol 1985; 34: 257-261.
There are 37 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Banu Taskin 0000-0002-9651-9258

Bengu Gerceker Turk

Gulsen Kandiloglu This is me

Can Ceylan

Pelin Guneri

Sibel Alper This is me

Tugrul Dereli This is me

Publication Date October 31, 2018
Published in Issue Year 2018 Volume: 1 Issue: 2

Cite

Vancouver Taskin B, Gerceker Turk B, Kandiloglu G, Ceylan C, Guneri P, Alper S, Dereli T. Toluidine blue application to detect dysplasia and malignant changes in patients with oral lichenoid lesions. Mucosa. 2018;1(2):42-51.