Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma
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RESEARCH ARTICLE
Open Access
Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma Hana’a Hezam Algadi1,2* , Amany Abd-Elhameed Abou-Bakr3, Omer Mohammed Jamali4,5 Louloua Mohamed Fathy1
and
Abstract Background: When the resected specimen is sent for intraoperative margin assessment, all margins are grossly checked, and selected margins undergo a frozen section (FS) examination. Therefore, there is a possibility of sampling error. This study evaluated the effectiveness of using toluidine blue (TB) as an intraoperative triage screening tool to detect positive mucosal margins of the resected specimens of oral squamous cell carcinoma (OSCC) and serve as a guide for FS sampling. Methods: Surgical samples of 30 consecutive patients with biopsy-proven OSCC were included in the study. A total of 140 mucosal margins were analyzed intraoperatively by TB and FS, the results were compared with the final histopathology. Results: Of the 140 examined mucosal tumor margins, 14 stained positives with TB, six were true-positives, eight were falsepositives, and there were no false-negatives, as confirmed by final histopathology of the same margins. The diagnostic performance measures were sensitivity 100.0%; specificity 94.0%; positive predictive value (PPV) 42.9%; negative predictive value (NPV) 100.0%; and accuracy 94.3% (95% CI: 89.0–97.5%). For FS, there were three true-positives, three false-negatives, and no false-positives. The diagnostic performance measures were sensitivity 50.0%; specificity 100.0%; PPV 100.0%; NPV 97.8%; and accuracy 97.9% (95% CI: 93.9–99.6%). Conclusion: TB is less specific but more sensitive than FS for detecting positive mucosal margins of resected OSCC. Screening the tumor mucosal margins with TB before FS sampling may help identify more tumor-bearing margins. Trial registration: This trial was registered at ClinicalTrials.gov. Registration number: NCT03554967. Registration date: June 13, 2018. Keywords: Toluidine blue, Frozen section, Tumor margins, Surgical margins, Oral Cancer, Oral squamous cell carcinoma
* Correspondence: [email protected] 1 Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Cairo University, Cairo, Egypt 2 Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Hodeidah University, Hodeidah, Yemen Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons lice
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