Sachdeva Kavita, Saji Tinnu Anna, Sachdeva Neeraj, Karun Harsh
Department of ENT, NSCB Medical College, Jabalpur, India.
NSCB Medical College, Jabalpur, India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2177-2183. doi: 10.1007/s12070-020-02070-x. Epub 2020 Aug 18.
In India cancer patients come at a very advanced stage with many of them being crossed the stage of resection. A wide range of non invasive techniques like toludine blue staining, methylene blue staining, Narrow band imaging have been developed for the early detection of malignant and premalignant lesions in the mucosa including oral cavity and gastrointestinal tract. However it is difficult for the clinicians to decide which diagnostic tool is most appropriate and useful for screening, resulting in failure to pick up the lesions at an early stage. Various online journals have been reviewed and no journal was found to support this point. This study here by describes Toludine blue and narrow-band imaging (NBI), diagnostic tools already proven independently as a useful screening method in many fields, and demonstrate its usefulness in the early detection of premalignant and malignant lesions of the oral cavity, as reported by previous studies in the otolaryngologic literature and compare both screening tools which has not been done till now. This study was done in a tertiary referral centre in middle India from March 2018 to August 2019 in order to evaluate the role of different screening tools (NBI and Toludine blue).44 patients with suspicious oral cavity lesions (premalignant and malignant) who had given consent for both NBI and toludine blue screening techniques were selected from the suspected (premalignant and malignant lesions) who had visited the OPD during the study period. Patients with proven malignancy were excluded from the study. A detailed history of the patient taken and standard Ear, nose, throat, oral cavity and neck examination of patient carried out. After subjecting the patients to screening tools like NBI and toludine blue, the efficacy of these techniques in helping us to take a representative biopsy was evaluated. In present study the sensitivity (to correctly identify all patients with disease), specificity (to correctly reject healthy patients without disease) of older technique toludine blue in detecting premalignant lesion was 66.6%, 87.8% while for NBI was 66.6%, 95%. For malignant lesion sensitivity and specificity of toludine blue was 94.3%, 100%, while the same for NBI was 100%, 88.8% respectively. Both NBI and toludine blue staining can be adopted for screening and the accurate detection of biopsy site and in the follow up of premalignant lesions to look for malignant transformation. Time tested is Toludine blue which is cheap and easily available. But being a better tool and having an upper hand in evaluating the lesions, NBI should be made available in all the secondary and tertiary care centres as a screening method.
在印度，癌症患者就诊时往往已处于非常晚期的阶段，其中许多人已过了可切除阶段。为了早期检测包括口腔和胃肠道在内的黏膜中的恶性和癌前病变，已经开发了多种非侵入性技术，如甲苯胺蓝染色、亚甲蓝染色、窄带成像。然而，临床医生很难决定哪种诊断工具最适合且对筛查有用，导致无法在早期发现病变。查阅了各种在线期刊，未发现有期刊支持这一观点。本研究描述了甲苯胺蓝和窄带成像（NBI），这两种诊断工具在许多领域已被独立证明是有用的筛查方法，并如耳鼻喉科文献中先前研究所报道的那样，证明其在口腔癌前和恶性病变早期检测中的有用性，并比较这两种筛查工具，此前尚未有人这样做过。本研究于2018年3月至2019年8月在印度中部的一家三级转诊中心进行，以评估不同筛查工具（NBI和甲苯胺蓝）的作用。从研究期间到门诊就诊的疑似（癌前和恶性病变）患者中，挑选了44例同意接受NBI和甲苯胺蓝筛查技术的口腔可疑病变（癌前和恶性）患者。已证实患有恶性肿瘤的患者被排除在研究之外。记录患者的详细病史，并对患者进行标准的耳、鼻、喉、口腔和颈部检查。在让患者接受NBI和甲苯胺蓝等筛查工具检查后，评估这些技术在帮助我们进行代表性活检方面的有效性。在本研究中，较老的技术甲苯胺蓝在检测癌前病变时的敏感性（正确识别所有患病患者）为66.6%，特异性（正确排除无病的健康患者）为87.8%，而NBI的敏感性为66.6%，特异性为95%。对于恶性病变，甲苯胺蓝的敏感性和特异性分别为94.3%、100%，而NBI的敏感性和特异性分别为100%、88.8%。NBI和甲苯胺蓝染色均可用于筛查、准确检测活检部位以及癌前病变的随访以寻找恶性转化。经时间检验的甲苯胺蓝价格便宜且容易获得。但作为一种更好的工具且在评估病变方面占优势，NBI应作为一种筛查方法在所有二级和三级医疗中心普及。
