The influence of toluidine blue staining on decision-making for the selection of biopsy sites in oral disorders.

Purpose: The aim of this study is to evaluate the influence of toluidine blue (TB) staining on decision-making processes for the identification of biopsy sites in oral lesions. Materials and methods: Original and TB-stained images of oral mucosal lesions that required histopathological examination were accessed through archives. Twenty dental specialists were asked to select and mark their choice of biopsy sites on both original and TB-stained images using a standard circle selection tool of software. The X and Y coordinates of the center points of selections were calculated by a custom-made image processing algorithm in Matlab. In order to assess the dispersity of the selected centers from the mean center, the distances of the selected points from this average point were calculated using Euclidean distance. Data was analysed using Wilcoxon test. Results: The study involved original and TB-stained images of 5 suspicious lesions. The histological diagnoses of oral lesions were reported as bening for 3 cases and malignant for 2 cases. 20 dental specialists marked their choice of biopsy site on a total of 200 images. The results revealed that the biopsy selections varied significantly between original and TB-stained images in certain cases. In 60% of cases, specialists showed statistically significant agreement in biopsy site selection on TB-stained images compared to original images (p <0.05). Conclusion: While the study did not evaluate the accuracy of site selection against a gold standard, the observed consensus among specialists suggests the potential utility of TB staining in enhancing the consistency and objectivity of biopsy site selection for suspicious oral lesions.