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. 2012 Nov;18(8):728-33. doi: 10.1111/j.1601-0825.2012.01935.x. Epub 2012 Apr 24.


Background: The value of chairside adjunctive tests in the detection of oral potentially malignant disorders (OPMDs) remains uncertain.

Objectives: To determine the effectiveness of toluidine blue in detecting leukoplakia and erythroplakia and its accuracy in identifying cases with oral epithelial dysplasia.

Materials and methods: Ninety-two patients attending two oral medicine clinics in London, presenting with white and red patches of the oral mucosa, were investigated by the application of toluidine blue. Eighty-two patients were clinically diagnosed as OPMDs and 10 were frictional keratoses. A surgical biopsy was performed to assess epithelial dysplasia.

Results: Of 64 oral leukoplakias, 34 (53.1%) were positive for toluidine blue and among nine erythroplakias seven stained positive. Of 41 oral dysplasia cases, a little more than half of the lesions (n = 23) were stain positive, an estimated sensitivity of 56.1%. TBlue test had a higher sensitivity for detecting higher-grade dysplastic lesions (5/8 moderate dysplasia, sensitivity 62.5%; 5/7 severe dysplasia; sensitivity 71.4%) compared with lower grades of dysplasia, but the differences were not significant (P = 0.60).

Conclusions: We report here the utility of TBlue for the detection of oral leukoplakia and erythroplakia. The test has the potential to detect OPMDs and yielded a sensitivity of 56.1% and specificity of 56.9% to detect oral epithelial dysplasia.

Publication types

  • Comparative Study

MeSH terms

  • Acetic Acid
  • Alcohol Drinking
  • Biopsy
  • Coloring Agents*
  • Cytodiagnosis / methods
  • Epithelium / pathology
  • Erythroplasia / diagnosis
  • Female
  • Humans
  • Leukoplakia, Oral / diagnosis
  • Male
  • Mouth Mucosa / pathology
  • Mouth Neoplasms / diagnosis*
  • Precancerous Conditions / diagnosis*
  • Sensitivity and Specificity
  • Smoking
  • Tolonium Chloride*


  • Coloring Agents
  • Tolonium Chloride
  • Acetic Acid