Visually Enhanced Lesion Scope Versus Toluidine Blue Test for Early Diagnosis of Oral Cancer and Oral Potentially Malignant Disorders: A Prospective, Diagnostic Accuracy Comparison Study

Introduction: Early identification of dysplasia is crucial in managing oral potentially malignant disorders (OPMD). Adjunct techniques facilitate the oral examination (OE) to diagnose early oral squamous cell carcinoma (OSCC) and high-risk OPMDs. Our study aims to compare the efficacy of VELscope with Toluidine blue test (TBT) in the early detection of oral dysplasia (OD).
Materials and Methods: A total of 51 patients clinically diagnosed with OPMD and early oral cancer were subjected to VELscope examination and TBT followed by histopathological investigation. Lesions with loss of auto-fluorescence and royal blue staining were considered as positive for VELscope and TBT respectively. Sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV) were obtained for each test and combined tests.
Results: In 38 OPMDs, VELScope and TBT detected 12 and 10 cases as true positives and 4 and 9 cases as true negatives respectively. Out of 12 OSCCs, VELscope and TBT detected 10 and 9 cases as true positives respectively. The overall efficacies of VELscope and TBT in the diagnosis of both OPMDs and malignant lesions were as follows: 66.6% and 57.6% sensitivity, 22.2% and 50% specificity, 61% and 67.9% PPV, 26% and 39% NPV respectively. The sensitivity, specificity, PPV, and NPV of combined tests with the diagnosis of dysplasia and OSCC were 78.8%, 22.2%, 65%, and 36.4% respectively.
Conclusion: Combined tests have more sensitivity than individual tests. Concerning the individual tests, TBT results are more reliable than the VELscope test.