Non -invasive diagnostic tools in early detection of oral epithelial dysplasia

Objective: The incidence of oral cancer worldwide varies 2-18% and in India 0.1 to 13.5%. Early evaluation of oral precancerous lesions can have dramatic effect on oral cancer mortality rate. Among the premalignant stage, leukoplakia is the most commonly encountered clinical lesion and epithelial dysplasia is most important predictive factor. The objective of this paper is to compare the efficacy of exfoliative cytology, toluidine blue and chemiluminescent illumination (VIZILITE) to detect early dysplastic changes in leukoplakia. Study design: Study involved 50 patients of leukoplakia (homogeneous, speckled) in the age group of 20-72 years including males and females in the ratio of 7:3. All the diagnostic procedures were carried out on each patient followed by biopsy and data was subjected to statistical analysis. Results: Comparing the results of exfoliative cytology with toluidine blue in diagnosing dysplasia in leukoplakia, it showed 50% sensitivity and 83.3 % specificity. In comparison to chemiluminescent light examination, cytology showed 42.9% sensitivity and 79.3% specificity. Chemiluminescent light examination showed 60% sensitivity and 70% specificity compared to toluidine blue. Conclusions: Overall accuracy of exfoliative cytology was less than toluidine blue, whereas latter showed superior but comparable results to chemiluminescent illumination in detecting dysplasia. However role of chemiluminescent illumination should be further investigated in demarcating dysplatic lesions.