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Chemi-luminescence
Symposia MORBIDITY AND MORTALITY CONFERENCE ON ANESTHESIA Presented on Thursday, September 30, 2004, 8:00 am—10:00 am Moderator: Stuart E. Lieblich, DMD, Avon, CT (no abstract provided)
SYMPOSIUM ON PATHOLOGY AND RECONSTRUCTION Presented on Thursday, September 30, 2004, 8:00 am—10:00 am Moderator: Joseph I. Helman, DMD, Ann Arbor, MI
Toluidine Blue Staining Hillel D. Ephros, DMD, MD, Paterson, NJ For many years, vital staining with Toluidine Blue (tolonium chloride) has been utilized successfully as an adjunct in the early detection of oral cancer. Its use elsewhere in the upper aerodigestive tract has also been documented. This acidophilic thiazine dye predictably stains squamous cell carcinoma even at its earliest stages when the patient is asymptomatic and mucosal changes may be subtle. There is little debate over the extraordinary sensitivity of this technique. The dye may also stain active inflammatory lesions and will be mechanically retained on the dorsum of the tongue, in dental plaque, and in mucosal ulcerations. As such, a significant percentage of false positives will be encountered unless an appropriate protocol is used. With such a protocol in place, the specificity of the technique rises to over 90 percent. Toluidine Blue is particularly useful in the evaluation and delineation of subtle oral mucosal changes and can serve as an adjunct in the routine screening of patients at risk. It may be used to guide a brush biopsy and does not disturb the computer enhanced cytological evaluation of these specimens. Moreover, by delineating affected mucosa, vital staining may bridge the gap between a positive brush biopsy by a generalist and definitive scalpel by the oral and maxillofacial surgeon. It has additional value for the surgeon as its use in the operating room may aid in visualizing clinical involvement and in establishing surgical margins. Concerns have been raised over possible mutagenicity and FDA approval of a tolonium chloride product is still pending. Nonetheless, this vital staining technique is used widely in Canada and throughout Europe and has a loyal following in this country. Toluidine Blue is a valuable tool, particularly in the hands of the oral and maxillofacial surgeon. It is complementary with brush biopsy techniques and is unparalleled in its ability to provide the clinician with clear and distinct information in a well-illuminated field. AAOMS • 2004
References Guo Z, et al: Clin Cancer Res 7:1963, 2001 Mashberg A: J Am Ddent Assoc 106:319, 1983 Onofre M, et al: Oral Surg Oral Med Oral Pathol 91:535, 2001
Chemi-Luminescence Sol Silverman Jr, DDS, San Francisco, CA The overall 5-year survival rate for oral cancer is a dismal 57%. In spite of improvements in surgery, radiation, and chemotherapy, the main explanation is the delay in diagnosis and suboptimal screening regimens. Chemiluminescence utilizing ViziLite may enhance the visualization of dysplastic and early malignant lesions that otherwise might be minimized or overlooked by either experienced or inexperienced clinicians. The technique consists of activating low energy, short wave length light that is absorbed by abnormal epithelium that has been dehydrated by 1% acetic acid rinse. These abnormal cells are reflected as a white mucosal surface color change (termed “acetowhite”) that enhances clinical identification. This screening technique has proven sensitive in identifying dysplastic and malignant changes in the stratified squamous epithelium of the uterine cervix (histologically similar to oral epithelium). ViziLite has been approved by the FDA as a device. References Wertlake PT, Francus K, et al: Effectiveness of the Papanicolaou smear and speculoscopy as compared with the Papanicolaou smear alone: A community-based clinical trial. Obstet Gynecol 90:421, 1997 Loiudice L, Abbiati R, et al: Improvement of Pap smear sensitivity using a visual adjunctive procedure: A cooperative Italian study on speculoscopy (GISPE). Eur J Cancer Prev 7:1, 1998 Keiles D, Wu NC, Silverman S, et al: Application of acetic acid rinse and chemiluminescent light source in visualization of oral epithelial abnormalities. (manuscript in preparation)
Brush Biopsy Techniques Carl Allen, DDS, MSD, Columbus, OH Mortality rates from oral cancer in the United States have remained fairly constant, in the 50% range, for 1
SYMPOSIUM ON PATHOLOGY AND RECONSTRUCTION Presented on Thursday, September 30, 2004, 8:00 am—10:00 am Moderator: Joseph I. Helman, DMD, Ann Arbor, MI
Toluidine Blue Staining Hillel D. Ephros, DMD, MD, Paterson, NJ For many years, vital staining with Toluidine Blue (tolonium chloride) has been utilized successfully as an adjunct in the early detection of oral cancer. Its use elsewhere in the upper aerodigestive tract has also been documented. This acidophilic thiazine dye predictably stains squamous cell carcinoma even at its earliest stages when the patient is asymptomatic and mucosal changes may be subtle. There is little debate over the extraordinary sensitivity of this technique. The dye may also stain active inflammatory lesions and will be mechanically retained on the dorsum of the tongue, in dental plaque, and in mucosal ulcerations. As such, a significant percentage of false positives will be encountered unless an appropriate protocol is used. With such a protocol in place, the specificity of the technique rises to over 90 percent. Toluidine Blue is particularly useful in the evaluation and delineation of subtle oral mucosal changes and can serve as an adjunct in the routine screening of patients at risk. It may be used to guide a brush biopsy and does not disturb the computer enhanced cytological evaluation of these specimens. Moreover, by delineating affected mucosa, vital staining may bridge the gap between a positive brush biopsy by a generalist and definitive scalpel by the oral and maxillofacial surgeon. It has additional value for the surgeon as its use in the operating room may aid in visualizing clinical involvement and in establishing surgical margins. Concerns have been raised over possible mutagenicity and FDA approval of a tolonium chloride product is still pending. Nonetheless, this vital staining technique is used widely in Canada and throughout Europe and has a loyal following in this country. Toluidine Blue is a valuable tool, particularly in the hands of the oral and maxillofacial surgeon. It is complementary with brush biopsy techniques and is unparalleled in its ability to provide the clinician with clear and distinct information in a well-illuminated field. AAOMS • 2004
References Guo Z, et al: Clin Cancer Res 7:1963, 2001 Mashberg A: J Am Ddent Assoc 106:319, 1983 Onofre M, et al: Oral Surg Oral Med Oral Pathol 91:535, 2001
Chemi-Luminescence Sol Silverman Jr, DDS, San Francisco, CA The overall 5-year survival rate for oral cancer is a dismal 57%. In spite of improvements in surgery, radiation, and chemotherapy, the main explanation is the delay in diagnosis and suboptimal screening regimens. Chemiluminescence utilizing ViziLite may enhance the visualization of dysplastic and early malignant lesions that otherwise might be minimized or overlooked by either experienced or inexperienced clinicians. The technique consists of activating low energy, short wave length light that is absorbed by abnormal epithelium that has been dehydrated by 1% acetic acid rinse. These abnormal cells are reflected as a white mucosal surface color change (termed “acetowhite”) that enhances clinical identification. This screening technique has proven sensitive in identifying dysplastic and malignant changes in the stratified squamous epithelium of the uterine cervix (histologically similar to oral epithelium). ViziLite has been approved by the FDA as a device. References Wertlake PT, Francus K, et al: Effectiveness of the Papanicolaou smear and speculoscopy as compared with the Papanicolaou smear alone: A community-based clinical trial. Obstet Gynecol 90:421, 1997 Loiudice L, Abbiati R, et al: Improvement of Pap smear sensitivity using a visual adjunctive procedure: A cooperative Italian study on speculoscopy (GISPE). Eur J Cancer Prev 7:1, 1998 Keiles D, Wu NC, Silverman S, et al: Application of acetic acid rinse and chemiluminescent light source in visualization of oral epithelial abnormalities. (manuscript in preparation)
Brush Biopsy Techniques Carl Allen, DDS, MSD, Columbus, OH Mortality rates from oral cancer in the United States have remained fairly constant, in the 50% range, for 1