Evaluation of Efficiency of Dyes in Detection of Cancer Cells: An Original Research.

Introduction: The early detection of the cancer will dramatically improve the prognosis. There are many diagnostic aids that can be employed for screening. Hence, in our study, we aim to evaluate the efficiency of dyes in detection of cancer cells. Materials and
Methods: We piloted a prospective clinical study among 30 subjects to detect the efficiency of two dyes-Lugol's iodine and toluidine blue. They were grouped equally for potentially malignant and malignant lesions. The areas were analyzed for the diagnostic accuracy of the dyes using the histopathological examination and compared using chi square test deliberating P < 0.05 as significant.
Results: We observed that both the dyes showed a diagnostic accuracy of over 90% when used alone or in combination. Both the dyes had greater sensitivity while specificity was 20%.
Conclusion: The combination of these two dyes can be used as an efficient screening aid for the identification of the cancer cells. Copyright:

INTRODUCTION

Among the many cancers that affect the human body, majority if detected early are preventable. The oral cancer is one among such preventable cancers. The occurrence of the oral cancer is also on the raise in the southeast continents.[12] Many studies have concluded the significance of the early detection in the prevention of the various cancers. There are various methods of the detection of the potentially malignant lesions that are common in the oral cancers. The detection using the dyes has been practiced for the screening of the cervical cancers.[34] The dyes, Lugol's iodine and toluidine blue, are commonly used for the identification of the dysplastic cells that can be used in the screening of the oral cancers also.[56] Hence, in our study, we aim to evaluate the efficiency of these dyes in detection of cancer cells.

MATERIALS AND METHODS

We piloted a prospective clinical study among 30 subjects with oral clinical suspicious lesions. The ethics clearance was obtained for the study. The subjects were explained of the study and the written consent was taken for the study. We selected the subjects of both the genders between the age groups 35 and 60 years. The red and white lesions that were suspicious of the malignancy (N = 15) and the malignant lesions (N = 15) were selected. The lesional area was prepared with 1% acetic acid later rinsed with water. Following the protocols, the dyes, Lugol's iodine and toluidine blue, were applied. After 20 s, photos were taken and biopsies performed. Later, the lesional areas were biopsied and checked for the severity. The retention was checked for all the slides. The values were compared using the IBM SPSS ver 20 applying chi square test deliberating P < 0.05 as significant.

RESULTS

The potentially malignant lesions constituted lichen planus, leukoplakia, and oral sub mucous fibrosis and the malignant lesions were of oral squamous cell carcinoma that was of various levels of differentiation. Both the stains were retained in 28 of the lesional areas that were confirmed as dysplastic. In 100% and 20%, we observed the sensitivity and specificity, respectively. The positive and negative predictive values were 95% and 98%, respectively. The diagnostic accuracy for individual stain retained was 92% and when both were used was 94%. There was a significant variation in the retention of the Lugol's iodine for the various grades of malignant lesions, where it was retained better in well and moderately differentiated lesions better than the poor differentiated lesions [Table 1].

Table 1

Comparison of the various lesions for the staining

Diagnostic accuracy	Present	Absent	P
Lugol’s iodine + toluidine for potentially malignant lesions	13	2	0.05
Lugol’s iodine + toluidine for malignant lesions	12	3	0.064
Overall DA for both type of lesions	25	5	NS
Retention of Lugol’s iodine comparing the grading	5- well 4- moderate 3-poor	2-poor 1- moderate	0.05

DISCUSSION

The in-vivo staining helps in the separation of the abnormal tissue that might have been overlooked otherwise. There are various dyes for the identification of the cancerous lesions in the oral tissues. However, very few are safe and biocompatible.,[4567] The two dyes used in our study have been previously proved to be safe for the in-vivo staining in cervical cancers and hence were applied in our study for the oral cancer identification. The diagnostic accuracy of both the dyes for the potentially malignant or the malignant lesions was over 90%. This is in comparison with the studies of Nagaraju K et al.[6] Our study is one of the few studies to compare both the dyes for the various grades of differentiation and hence comparison with other studies was challenging. There were few limitations in our study like a small sample size and there were no controls to check how the dye stained normal and inflammatory tissues.[67]

CONCLUSION

Within the limitations of the study, the dyes, Lugol's iodine and toluidine blue, can be used efficiently for the identification of the cancers. Further studies with the larger sample size are suggested to corroborate our findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.