Journal of Maxillofacial and Oral Surgery

, Volume 14, Issue 2, pp 188–200 | Cite as

Diagnostic Modalities for Squamous Cell Carcinoma: An Extensive Review of Literature-Considering Toluidine Blue as a Useful Adjunct

  • Naveen ChhabraEmail author
  • Shruti Chhabra
  • Nitin Sapra
Review Paper



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.


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.


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


Squamous cell carcinoma Diagnostic Modalities Toluidine Blue  Screening Test 


  1. 1.
    Enwonwu CO, Phillips RS, Ibrahim CD, Danfillo IS (2004) Nutrition and oral health in Africa. Int Dent J 54:344–351PubMedGoogle Scholar
  2. 2.
    Epstein JB, Zhang L, Rosin M (2002) Advances in the diagnosis of oral premalignant and malignant lesions. J Can Dent Assoc 68(10):617–621PubMedGoogle Scholar
  3. 3.
    Gray MGL, Burls A, Elley K (2000) The clinical effectiveness of toluidine blue dye as an adjunct to oral cancer screening in general dental practice. A West Midlands Development and Evaluation Service Report.
  4. 4.
    Johnson N, Franceschi S, Ferlay J, et al. (2005) Squamous cell carcinoma: tumours of the oral cavity and oropharynx (Chapter 4). In: Barnes L, Eveson JW, Reichart P, Sidransky D (eds) World Health Organization classification of tumours, pathology and genetics of head and neck tumours. Lyon: IARC publication. American Cancer Society. Facts and figures 2007.
  5. 5.
    Bettendorf O, Piffkò J, Bankfalvi A (2004) Prognostic and predictive factors in oral squamous cell cancer: important tools for planning individual therapy? Oral Oncol 40:110–119CrossRefPubMedGoogle Scholar
  6. 6.
    American Cancer Society. Facts and figures 2007.
  7. 7.
    Rosenberg D, Cretin S (1989) Use of meta-analysis to evaluate tolonium chloride in oral cancer screening. Oral Surg Oral Med Oral Pathol 67:621–627CrossRefPubMedGoogle Scholar
  8. 8.
    Mashberg A, Samit A (1995) Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA Cancer J Clin 45:328–351CrossRefPubMedGoogle Scholar
  9. 9.
    Epstein JB, Oakley C, Millner A et al (1997) 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 83:537–547CrossRefPubMedGoogle Scholar
  10. 10.
    Scuibba J (1999) Improving detection of precancerous and cancerous oral lesions. J Am Dent Assoc 130:1445–1457CrossRefGoogle Scholar
  11. 11.
    Epstein JB, Zhang L, Poh C et al (2003) Increased allelic loss in toluidine blue positive oral malignant lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:45–50Google Scholar
  12. 12.
    National Cancer Institute (2003) SEER cancer statistics review 1975–2003Google Scholar
  13. 13.
    Tsantoulis PK, Kastrinakis NG, Tourvas AD et al (2007) Advances in the biology of oral cancer. Oral Oncol 43:523–534CrossRefPubMedGoogle Scholar
  14. 14.
    Yeole BB, Ramanakumar AV, Sankaranarayanan R (2003) Survival from oral cancer in Mumbai (Bombay), India. Cancer Causes Control 14:945–952CrossRefPubMedGoogle Scholar
  15. 15.
    Acha A, Ruesga MT, Rodríguez MJ, Martínez de Pancorbo MA, Aguirre JM (2005) Applications of the oral scraped (exfoliative) cytology in oral cancer and precancer. Med Oral Patol Oral Cir Bucal 10:95–102PubMedGoogle Scholar
  16. 16.
    Moore SR, Johnson NW, Pierce AM, Wilson DF (2000) The epidemiology of mouth cancer: a review of global incidence. Oral Dis 6(2):65–74CrossRefPubMedGoogle Scholar
  17. 17.
    Shafer WG, Hine MK, Levy BM (2008) Shafer’s textbook of oral pathology, 5th edn. Elsevier India, New DelhiGoogle Scholar
  18. 18.
    Su WW-Y, Yen AM-F, Chiu SY-H, Chen TH-H (2010) A community-based RCT for oral cancer screening with toluidine blue. J Dent Res 89(9):933–937CrossRefPubMedGoogle Scholar
  19. 19.
    Bouquot JE, Farthing PM, Speight PM (2006) The pathology of oral cancer and precancer revisited. Curr Diag Path 12:11–21CrossRefGoogle Scholar
  20. 20.
    Sciubba JJ (2002) Improving detection of precancerous and cancerous oral lesions. Computer assisted analysis of the oral brush biopsy. US Collaborative OralCDx Study Group. J Am Dent Assoc 133:272CrossRefGoogle Scholar
  21. 21.
    Bouquot JE, Suarez P, Vigneswaran N (2010) Oral precancer and early cancer detection in the dental office—review of new technologies. J Implant Adv Clin Dent 2:47–63Google Scholar
  22. 22.
    Hohlweg-Majert B, Deppe H, Metzger MC, Schumm S, Hoefler H, Kesting MR, Hölzle F, Wolff KD (2009) Sensitivity and specificity of oral brush biopsy. Cancer Invest 27(3):293–297CrossRefPubMedGoogle Scholar
  23. 23.
    Reddy SG, Kanala S, Chigurupat A, Kumar SR, Poosarla CS, Reddy BVR (2012) The sensitivity and specificity of computerized brush biopsy and scalpel biopsy in diagnosing oral premalignant lesions: a comparative study. J Oral Maxillofac Pathol 16(3):349–353CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Oral Brush Biopsy in the Early Detection of Oral Precancers and Cancers. Cytology in diagnosis oral lesions from PubMed NIH.Gov 2006Google Scholar
  25. 25.
    Babshet M, Nandimath K, Pervatikar SK, Naikmasur VG (2011) Efficacy of oral brush cytology in the evaluation of the oral premalignant, malignant lesions. J Cytol 28(4):165–172CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Kerr AR, Sirois DA, Epstein JB (2006) Clinical evaluation of chemiluminescent lighting: an adjunct for oral mucosal examinations. J Clin Dent 17:59–63PubMedGoogle Scholar
  27. 27.
    Pierre M, Lane PM, Whitehead TGP, Zeng H et al (2006) Simple device for the direct visualization of oral-cavity. J Biomed Optics 11:024–026Google Scholar
  28. 28.
    Oh ES, Laskin DM (2007) Efficacy of the ViziLite system in the identification of oral lesions. J Oral Maxillofac Surg 65:424–426CrossRefPubMedGoogle Scholar
  29. 29.
    Trullenque-Eriksson A, Muñoz-Corcuera M, Campo-Trapero J, Cano-Sánchez J, Bascones-Martínez A (2009) Analysis of new diagnostic methods in suspicious lesions of the oral mucosa. Med Oral Patol Oral Cir Bucal 14:210–216Google Scholar
  30. 30.
    Patton LL, Epstein JB, Kerr AR (2008) Adjunctive techniques for oral cancer examination and lesion diagnosis: a systematic review of the literature. J Am Dent Assoc 139:896–905CrossRefPubMedGoogle Scholar
  31. 31.
    Ram S, Siar CH (2005) Chemiluminescence as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions. Int J Oral Maxillofac Surg 34(5):521–527CrossRefPubMedGoogle Scholar
  32. 32.
    Sambandham T, Masthan KMK, Kumar MS, Jha A (2013) The application of Vizilite in oral cancer. J Clin Diagn Res 7(1):185–186PubMedCentralPubMedGoogle Scholar
  33. 33.
    Farah CS, McCullough MJ (2007) A pilot case control study on the efficacy of acetic acid wash and chemiluminescent illumination (ViziLite™) in the visualisation of oral mucosal white lesions. Oral Oncol 43:820–824CrossRefPubMedGoogle Scholar
  34. 34.
    De Veld DC, Witjes MJ, Sterenborg HJ, Roodenburg JL (2005) The status of in vivo autofluorescence spectroscopy and imaging for oral oncology. Oral Oncol 41:117–131CrossRefPubMedGoogle Scholar
  35. 35.
    Roblyer D, Richards-Kortum R, Sokolov K et al (2008) Multispectral optical imaging device for in vivo detection of oral neoplasia. J Biomed Opt 13(2):024019CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Skala MC, Riching KM, Gendron-Fitzpatrick A, Eickhoff J, Eliceiri KW, White JG, Ramanujam N (2007) In vivo multiphoton microscopy of NADH and FAD redox states, fluorescence lifetimes, and cellular morphology in precancerous epithelia. PNAS 104:19494–19499CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Roblyer D, Kurachi C, Stepanek V, Williams MD, El-Naggar AK, Lee JJ, Gillenwater AM, Richards-Kortum R (2009) Objective detection and delineation of oral neoplasia using autofluorescence imaging. Cancer Prev Res (Phila Pa) 2:423–431CrossRefGoogle Scholar
  38. 38.
    Poh CF, Williams PM, Zhang L, Rosin MP (2006) Heads up!—A call for dentists to screen for oral cancer. J Can Dent Assoc 72(5):413–416PubMedGoogle Scholar
  39. 39.
    Westra WH, Sidransky D (2006) Fluorescence visualization in oral neoplasia: shedding light on an old problem. Clin Cancer Res 12(22):6594–6597CrossRefPubMedGoogle Scholar
  40. 40.
    Laronde DM, Poh CF, Williams PM et al (2007) A magic wand for the community dental office? Observations from the British Columbia Oral Cancer Prevention Program. J Can Dent Assoc 73(7):607–609PubMedGoogle Scholar
  41. 41.
    Rosin MP, Poh CF, Guillard M, Williams PM, Zhang L, MacAulay C (2007) Visualization and other emerging technologies as change makers for oral cancer prevention. Ann NY Acad Sci 1098:167–183CrossRefPubMedGoogle Scholar
  42. 42.
    Williams PM, Poh CF, Hovan AJ, Ng S, Rosin MP (2008) Evaluation of a suspicious oral mucosal lesion. J Can Dent Assoc 74(3):275–280PubMedGoogle Scholar
  43. 43.
    Rosin MP, Poh CF, Elwood JM et al (2008) New hope for an oral cancer solution: together we can make a difference. J Can Dent Assoc 74(3):261–266PubMedCentralPubMedGoogle Scholar
  44. 44.
    Shin D, Vigneswaran N, Gillenwate A, Richards-Kortum R (2010) Advances in fluorescence imaging techniques to detect oral cancer and its precursors. Future Oncol 6(7):1143–1154CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Poh CF, Ng SP, Williams PM et al (2007) Direct fluorescence visualization of clinically occult high-risk oral premalignant disease using a simple hand-held device. Head Neck 29(1):71–76CrossRefPubMedGoogle Scholar
  46. 46.
    Kois JC, Truelove E (2006) Detecting oral cancer: a new technique and case reports. Dent Today 25(10):94, 96–97Google Scholar
  47. 47.
    Dwyer MO, Day A, Padgett M, Ogden GR, Mclaren S, Goodman CR (2008) Detection of mucosal abnormalities in patients with oral cancer using photodynamic technique: a pilot study. Br J Oral Maxillofac Surg 46(1):6–10CrossRefGoogle Scholar
  48. 48.
    Sridharan G, Shankar AA (2012) Toludine blue: a review of its chemistry and clinical utility. J Oral Maxillofac Pathol 6:251–255CrossRefGoogle Scholar
  49. 49.
    Lingen MW, Kalmar JR, Karrison T, Speight PM (2008) Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 44:10–22CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Epstein JB, Scully C, Spinelli J (1992) Toluidine blue and Lugol’s iodine application in the assessment of oral malignant disease and lesions at risk of malignancy. J Oral Pathol Med 21:160–163CrossRefPubMedGoogle Scholar
  51. 51.
    Lopez ML, del Valle MO, Cueto A (1994) Knowledge of the European code against cancer in sixth–form pupils and teachers in Asturias (Spain). Eur J Cancer Prev 3:207–213CrossRefPubMedGoogle Scholar
  52. 52.
    Gandolfo S, Pentenero M, Broccoletti R, Pagano M, Carrozzo M, Scully C (2006) Toluidine blue uptake in potentially malignant oral lesions in vivo: clinical and histological assessment. Oral Oncol 42(1):89–95CrossRefPubMedGoogle Scholar
  53. 53.
    Patton LL (2003) The effectiveness of community-based visual screening and utility of adjunctive diagnostic aids in the early detection of oral cancer. Oral Oncol 39:708–723CrossRefPubMedGoogle Scholar
  54. 54.
    Missmann M, Jank Siegfried J, Laimer K, Gassner R (2006) 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 102:741–743CrossRefPubMedGoogle Scholar
  55. 55.
    Mashberg A (1983) Final evaluation of tolonium chloride rinse for screening of highrisk patients with asymptomatic squamous carcinoma. J Am Dent Assoc 106:319–323CrossRefPubMedGoogle Scholar
  56. 56.
    Martin LC, Kerawala CJ, Reed M (1998) The application of toluidine blue as a diagnostic adjunct in the detection of epithelial dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:444–446CrossRefPubMedGoogle Scholar
  57. 57.
    Rodriguez PC, Lapiedra RC, Gomez GE, Martinez SL, Warnakulasuriya S (2011) The use of toludine blue in the detection of premalignant and malignant oral lesions. J Oral Pathol Med 40:300–304CrossRefGoogle Scholar
  58. 58.
    Guo Z, Yamaguchi K, Sanchez-Cespedes M et al (2001) Allelic losses in Ora Test-directed biopsies of patients with prior upper aerodigestive tract malignancies. Clin Cancer Res 7:1963–1968Google Scholar
  59. 59.
    Epstein JB, Feldman R, Dolor RJ, Porter SR (2003) The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer. Head Neck 25:911–921CrossRefPubMedGoogle Scholar
  60. 60.
    Zhang L, Williams M, Poh CF et al (2005) Toluidine blue staining identifies high-risk primary oral premalignant lesions with poor outcome. Cancer Res 65:8017–8021PubMedGoogle Scholar
  61. 61.
    Miller RL, Simms BW, Gould AR (1988) Toluidine blue staining for detection of oral premalignant lesions and carcinomas. J Oral Pathol Med 17:73–78CrossRefGoogle Scholar
  62. 62.
    Mashberg A (1980) Reevaluation of toluidine blue application as a diagnostic adjunct in the detection of asymptomatic oral squamous cell carcinoma: a continuing prospective study of oral cancer III. Cancer 46:758–763CrossRefPubMedGoogle Scholar
  63. 63.
    Hegde CM, Kamath PN, Sridharan S, Dannana NK, Raju RM (2006) Supravital staining: its role in detecting early malignancies. Indian J Otolaryngol Head Neck Surg 58:31–34Google Scholar
  64. 64.
    Epstein JB, Guneri P (2009) The adjunctive role of toluidine blue in detection of oral premalignant and malignant lesions. Curr Opin Otolaryngol Head Neck Surg 17:79–87Google Scholar
  65. 65.
    Onofre MA, Sposto MR, Navarro CM (2001) Reliability of Toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:535–540Google Scholar
  66. 66.
    The Oral Cancer Foundation. Early Detection, Diagnosis and Staging. The Oral Cancer Foundation site. Available at:
  67. 67.
    Patton LL, Elter JR, Southerland JH, Strauss RP (2005) Knowledge of oral cancer risk factors and diagnostic concepts among North Carolina dentists. J Am Dent Assoc 136:602–610Google Scholar
  68. 68.
    Siddiqui IA, Farooq MU, Siddiqui RA, RAfi SMT (2006) Role of toluidine blue in early detection of oral cancer. Pak J Med Sci 22:184–187Google Scholar
  69. 69.
    Chen YW, Lin JS, Wu CH, Lui MT, Kao SY, Fong Y (2007) Application of in vivo stain of methylene blue as a diagnostic aid in the early detection and screening of oral squamous cell carcinoma and precancer lesions. J Chin Med Assoc 70(11):497–503Google Scholar
  70. 70.
    Canto MI, Setrakian S, Willis JE, Chak A, Petras RE, Sivak MV (2001) Methylene blue staining of dysplastic and nondysplastic Barrett’s esophagus: an in vivo and ex vivo study. Endoscopy 33:391–400CrossRefPubMedGoogle Scholar
  71. 71.
    Canto MI, Setrakian S, Willis J, Chak A, Petras R, Powe NR, Sivak MV Jr (2000) Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus. Gastrointest Endosc 51:560–568CrossRefPubMedGoogle Scholar
  72. 72.
    Canto MI, Setrakian S, Petras RE, Blades E, Chak A, Sivak MV Jr (1996) Methylene blue selectively stains intestinal metaplasia in Barrett’s esophagus. Gastrointest Endosc 44:1–7CrossRefPubMedGoogle Scholar
  73. 73.
    Suzuki S, Murakami H, Suzuki H, Sakakibara N, Endo M, Nakayama K (1979) An endoscopic staining method for detection and operation of early gastric cancer. Int Adv Surg Oncol 2:223–241PubMedGoogle Scholar
  74. 74.
    Mufti GR, Shah PJ, Parkinson MC, Riddle PR (1990) Diagnosis of clinically occult bladder cancer by in vivo staining with methylene blue. Br J Urol 65:173–175CrossRefPubMedGoogle Scholar
  75. 75.
    Gill WB, Huffman JL, Lyon ES, Bagley DH, Schoenberg HW, Straus FH 2nd (1984) Selective surface staining of bladder tumors by intravesical methylene blue with enhanced endoscopic identification. Cancer 53:2724–2727CrossRefPubMedGoogle Scholar
  76. 76.
    Riaz A, Shreedhar B, Kamboj M, Riaz SN (2013) Methylene blue as an early diagnostic marker for oral precancer and cancer. Springer Plus 2:95CrossRefPubMedCentralPubMedGoogle Scholar
  77. 77.
    Neville BW, Day TA (2002) Oral cancer and precancerous lesion. CA Cancer J Clin 52:195–215CrossRefPubMedGoogle Scholar
  78. 78.
    Kusukawa J, Suefuji Y, Ryu F, Noguchi R, Iwamoto O, Kameyama T (2009) Dissemination of cancer cells into circulation occurs by incisional biopsy of oral squamous cell carcinoma. J Oral Pathol Med 29:303–307CrossRefGoogle Scholar
  79. 79.
    Dyavanagoudar S, Kale A, Bhatt K, Hallikerimath S (2008) Reverse transcriptase polymerase chain reaction study to evaluate dissemination of cancer cells into circulation after incision biopsy in oral squamous cell carcinoma. Indian J Dent Res 19(4):315–319Google Scholar
  80. 80.
    Peters LJ (1975) A study of the influence of various diagnostic and therapeutic procedures applied to a murine squamous carcinoma on its metastatic behaviour. Br J Cancer 32:355–372CrossRefPubMedCentralPubMedGoogle Scholar
  81. 81.
    Safour IM, Wood NK, Tsiklakis K, Doemling DB, Joseph G (1984) Incisional biopsy and seeding in hamster cheek pouch carcinoma. J Dent Res 63:1116–1120CrossRefPubMedGoogle Scholar
  82. 82.
    Ohtake K, Shingaki S, Nakajima T (1990) Effects of incision and irradiation on regional lymph node metastasis in carcinoma of the hamster tongue. Oral Surg Oral Med Oral Pathol 70:62–69CrossRefPubMedGoogle Scholar
  83. 83.
    Eriksson O, Hagmar B, Ryd W (1984) Effects of fine-needle aspiration and other biopsy procedures on tumor dissemination in mice. Cancer 54:73–78CrossRefPubMedGoogle Scholar
  84. 84.
    Kusukawa J, Kameyama T (1995) Clinical evaluation of excisional biopsy for stage I and II squamous cell carcinoma of the oral cavity. J Jpn Soc Cancer Ther 30:1817–1827Google Scholar
  85. 85.
    Kusukawa J, Nakamura Y, Kameyama T (1998) Evaluation of excisional biopsy for stage I and II squamous cell carcinoma of the oral cavity. Int J Clin Oncol 3:311–316CrossRefGoogle Scholar
  86. 86.
    Cai WM, Zhang HX, Hu YH, Gu XZ (1983) Influence of biopsy on the prognosis of nasopharyngeal carcinoma—a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients. Int J Radiol Oncol Biol Phys 9:1439–1444CrossRefGoogle Scholar
  87. 87.
    Gandolfo S, Carbone M, Carrozzo M, Scamuzzi S (1993) Biopsy technics in oral oncology: excisional or incisional biopsy? A crical review of the literature and the authors’ personal contribution. Minerva Stomatol 42:69–75PubMedGoogle Scholar
  88. 88.
    Ramani P, Thomas G, Ahmed S (2005) Use of Rt-PCR in detecting disseminated cancer cells after incisional biopsy among oral squamous cell carcinoma patients. J Cancer Res Ther 1:92–97CrossRefPubMedGoogle Scholar
  89. 89.
    Frydrych AM, Parsons R, Threlfall T, Austin N, Davies GR, Booth D (2010) Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study. Aust Dent J 55:378–384CrossRefPubMedGoogle Scholar
  90. 90.
    Hellman K, Hilgard P, Eccles S (1980) Metastasis: clinical and experimental aspects. Martinus Nijhoff, The Hague, pp 50–54CrossRefGoogle Scholar
  91. 91.
    Warnakulasuriya KA, Johnson NW (1996) Sensitivity and specificity of OraScan toludine blue mouthrinse in the detection of oral cancer and precancer. J Oral Pathol Med 25:97–103CrossRefPubMedGoogle Scholar
  92. 92.
    Gupta A, Singh M, Ibrahim R, Mehrotra R (2007) Utility of toluidine blue staining and brush biopsy in precancerous and cancerous oral lesions. Acta Cytol 51(5):788–794CrossRefPubMedGoogle Scholar
  93. 93.
    Wiersma AC, van der Waal I (1990) Toluidine blue staining for detection of oral squamous carcinoma. Ned Tijdschr Tandheelkd 97(10):431–432PubMedGoogle Scholar
  94. 94.
    Silverman S Jr, Migliorati C, Barbosa J (1984) Toluidine blue staining in the detection of oral precancerous and malignant lesions. Oral Surg Oral Med Oral Pathol 57(4):379–382CrossRefPubMedGoogle Scholar
  95. 95.
    Awan Kh, Yang Y, Morgan P, Warnakulasuriya S (2012) Utility of toluidine blue as a diagnostic adjunct in the detection of potentially malignant disorders of the oral cavity—a clinical and histological assessment. Oral Dis 18(8):728–733CrossRefPubMedGoogle Scholar
  96. 96.
    Vahidy NA. Zaidi SHM, Jafarey NA (1972) Toluidine blue test for detection of carcinoma of the oral cavity: an evaluation. J Surg Oncol 434Google Scholar
  97. 97.
    Allegra E, Lombardo N, Puzzo L, Garozzo A (2009) The usefulness of toluidine staining as a diagnostic tool for precancerous and cancerous oropharyngeal and oral cavity lesions. Acta Otorhinolaryngol Ital 29(4):187–190PubMedCentralPubMedGoogle Scholar
  98. 98.
    Upadhyay J, Rao NN, Upadhyay RB, Agarwal P (2011) Reliability of toluidine blue vital staining in detection of potentially malignant oral lesions—time to reconsider. Asian Pacific J Cancer Prev 12:1757–1760Google Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2014

Authors and Affiliations

  1. 1.Department of OMFSD.A.V Dental College and M.M General HospitalYamunanagarIndia

Personalised recommendations