Assessing the accuracy of autofluorescence, chemiluminescence and toluidine blue as diagnostic tools for oral potentially malignant disorders--a clinicopathological evaluation

Clin Oral Investig. 2015 Dec;19(9):2267-72. doi: 10.1007/s00784-015-1457-9. Epub 2015 Mar 26.


Objectives: Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders.

Materials and methods: A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia.

Results: Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively.

Conclusion: While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity.

Clinical relevance: These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.

Keywords: Adjunctive tests; Diagnosis; Epithelial dysplasia; Leukoplakia; Oral cancer; Oral potentially malignant disorders.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Diagnosis, Differential
  • Early Detection of Cancer / methods*
  • Female
  • Fluorescence
  • Humans
  • London
  • Luminescence
  • Male
  • Middle Aged
  • Mouth Neoplasms / diagnosis*
  • Mouth Neoplasms / pathology
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / pathology
  • Risk Factors
  • Sensitivity and Specificity
  • Tolonium Chloride


  • Tolonium Chloride