A chemiluminescent light system in combination with toluidine blue to assess suspicious oral lesions-clinical evaluation and review of the literature

The aim of the study was an evaluation of an acetic acid wash and chemiluminescent light system in combination with toluidine blue in order to detect visual identified, potentially malignant lesions. Forty-four patients with 50 oral lesions of primary uncertain visible dignity were included. Next to a clinical examination, a screening with ViziLiteA (R) (VL) as well as toluidine blue (TB; together ViziLiteA (R) Plus (VLP)) was conducted. Histopathology served as gold standard and sensitivity (SE), specificity (SP), positive as well as negative predictive value (PPV, NPV) was calculated descriptively. Additionally, a PubMed literature search using the key words ViziLite and chemiluminescence oral cancer was conducted. Histological diagnosis showed 40 lesions of reactive/inflammatory nature, moderate dysplasia (n = 3) and oral squamous cell carcinoma (OSCC n = 7). All OSCCs and one dysplasia were identified correct via clinical diagnosis (SE 90 %, SP 100 %, PPV 100 %, NPV 97.5 %). VL examination could show all malignancies with low specificity (SE 100 %, SP 30 %, PPV 26 %, NPV 100 %). TB and VLP were positive in all cases of cancer and in one case of inflammation (SE 80 %, SP 97.5 %, PPV 89 %, NPV 95 %). In the review, eight clinical trials with similar results were included. The adjunct of TB to VL reduces the number of false positives without increasing the rate of false negatives. Clinical evidence to justify the additional cost of the system for diagnosis of suspicious lesions is weak. However, for the potential role of VLP in detection of lesions not otherwise identified in the visual exam in general dental practice further studies are required.