{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:16:19Z","timestamp":1791220579267,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2003,6,23]],"date-time":"2003-06-23T00:00:00Z","timestamp":1056326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2003,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background.<\/jats:title><jats:p>The clinical utility of tolonium chloride rinse was compared with unaided visual examination alone in the diagnosis of oral carcinoma in patients previously treated for carcinoma of the upper aerodigestive tract.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>A total of 668 patients were enrolled in this multicenter study. At each site, an oral clinical visual examination was completed by one investigator followed by tolonium chloride rinse and examination by a second investigator blinded to the examination findings of the first investigator. If a lesion was considered suspicious (urgent biopsy required at the first visit), the lesion was biopsied after tolonium chloride rinsing. Patients with lesions characterized at the first visit as not suspicious (biopsy not urgent) or that stained with tolonium chloride were asked to return for a second visit. At the second visit, any residual lesion or lesions that retained tolonium chloride were biopsied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>A total of 96 biopsies was performed in 81 of the 668 patients (12.1%), of which 30 (31.3%) were diagnosed histologically as carcinoma\/carcinoma in situ (CIS) and the remainder as inflammation (31.3%), keratosis (26.6%), dysplasia (21.9%), ulcer (2.1%), other (3.1%), or no abnormality (1.0%). Of the 30 lesions with the diagnosis of carcinoma\/CIS, 12 (sensitivity 40.0%) were considered to be clinically suspicious (CS+), whereas 29 (sensitivity 96.7%) retained tolonium chloride (<jats:italic>p<\/jats:italic> = .0002). The predictive values of a positive test for clinical examination and tolonium chloride staining were similar (36.4% vs 32.6%; <jats:italic>p<\/jats:italic> = .5871), indicating that the greater sensitivity of tolonium chloride was not associated with an excessive number of unnecessary biopsies (false positives).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Tolonium chloride rinse is more sensitive than clinical examination alone in detecting lesions that might be found on biopsy to be carcinoma or CIS. The increased sensitivity is largely attributed to lesions that stain but were not detected clinically on visual examination. \u00a9 2003 Wiley Periodicals, Inc. Head Neck 25: 000\u2013000, 2003<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.10309","type":"journal-article","created":{"date-parts":[[2003,10,31]],"date-time":"2003-10-31T20:21:49Z","timestamp":1067631709000},"page":"911-921","source":"Crossref","is-referenced-by-count":72,"title":["The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer"],"prefix":"10.1002","volume":"25","author":[{"given":"Joel B.","family":"Epstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Feldman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowena J.","family":"Dolor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Porter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2003,6,23]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/59.6.1611"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0964-1955(92)90005-L"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/82.22.1773"},{"key":"e_1_2_6_5_2","first-page":"1565","article-title":"Third National Cancer Survey: an overview of available information","volume":"53","author":"Cutler SJ","year":"1974","journal-title":"J Natl Cancer Inst"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1741-2358.1984.tb00348.x"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.50.1.7"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19860215)57:4<843::AID-CNCR2820570426>3.0.CO;2-W"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1349-7006.1991.tb01743.x"},{"key":"e_1_2_6_10_2","first-page":"25","article-title":"Second cancers following cancer of the buccal cavity and pharynx in Connecticut 1935\u20131982","volume":"68","author":"Winn DM","year":"1985","journal-title":"Natl Cancer Inst Monogr"},{"key":"e_1_2_6_11_2","first-page":"253","article-title":"Second cancer following cancers of the buccal cavity and pharynx in Denmark 1943\u20131980","volume":"58","author":"Schou G","year":"1995","journal-title":"Natl Cancer Inst Monogr"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(91)90021-Z"},{"key":"e_1_2_6_13_2","first-page":"370","article-title":"Risk of multiple primary tumors following oral squamous\u2010cell carcinoma","volume":"56","author":"Jovanovic A","year":"1994","journal-title":"Int J Cancer"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(84)90154-3"},{"key":"e_1_2_6_15_2","volume-title":"Oral cancer","author":"Silverman S","year":"1998"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19860115)57:2<391::AID-CNCR2820570235>3.0.CO;2-Q"},{"key":"e_1_2_6_17_2","volume-title":"Oral cancer and precancer","author":"Pindborg JJ","year":"1980"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0964-1955(93)90022-7"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1996.tb00191.x"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1368-8375(99)00092-5"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1949.02900350013003"},{"key":"e_1_2_6_22_2","first-page":"96","article-title":"A study of the acute and chronic toxicity to toluidine blue and related phenazine and thiazine dyes","volume":"9","author":"Haley TJ","year":"1951","journal-title":"Stanford Med Bull"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1218(92)90241-Q"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(92)90299-6"},{"key":"e_1_2_6_25_2","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/S0002-9378(16)35183-3","article-title":"A clinical staining test for the in vivo delineation of dysplasia and carcinoma in situ","volume":"86","author":"Richart RM","year":"1963","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1964.0190"},{"key":"e_1_2_6_27_2","first-page":"7","article-title":"Toluidine blue staining in the endoscopic diagnosis of carcinoma of the bronchus","volume":"4","author":"Tarkkanen J","year":"1972","journal-title":"Ann Clin Res"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1018355"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(88)71335-8"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)90309-1"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(92)70578-1"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930040505"},{"key":"e_1_2_6_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19800815)46:4<758::AID-CNCR2820460420>3.0.CO;2-8"},{"key":"e_1_2_6_34_2","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1001\/jama.1981.03310480024019","article-title":"Tolonium (toluidine blue) rinse\u2014A screening method for recognition of squamous carcinoma: a continuing study of oral cancer IV","volume":"245","author":"Mashberg A","year":"1981","journal-title":"JAMA"},{"key":"e_1_2_6_35_2","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1983.0063"},{"key":"e_1_2_6_36_2","first-page":"111","article-title":"Toluidine blue rinse: potential for benign lesions in early detection of oral neoplasms","volume":"41","author":"Moyer GN","year":"1986","journal-title":"J Oral Med"},{"key":"e_1_2_6_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(89)90286-7"},{"key":"e_1_2_6_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1996.tb00201.x"},{"key":"e_1_2_6_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1079-2104(97)90117-7"},{"key":"e_1_2_6_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1079-2104(98)90071-3"},{"key":"e_1_2_6_41_2","first-page":"860","article-title":"An assessment of toluidine blue for the diagnosis of lip lesions","volume":"106","author":"Pizer ME","year":"1997","journal-title":"VA Med"},{"key":"e_1_2_6_42_2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.45.6.328"},{"key":"e_1_2_6_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1996.01890170051010"},{"key":"e_1_2_6_44_2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S0901-5027(00)80121-6","article-title":"The role of vital tissue staining in the marginal control of oral squamous cell carcinoma","volume":"29","author":"Kerawala CJ","year":"2000","journal-title":"Int J Oral Maxillofac Surg"},{"key":"e_1_2_6_45_2","doi-asserted-by":"publisher","DOI":"10.1067\/moe.2001.112949"},{"key":"e_1_2_6_46_2","first-page":"1963","article-title":"Allelic losses in Oratest\u2010directed biopsies of patients with prior upper aerodigestive tract malignancy","volume":"7","author":"Guo Z","year":"2001","journal-title":"Clin Cancer Res"},{"key":"e_1_2_6_47_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1992.tb00094.x"},{"key":"e_1_2_6_48_2","first-page":"404","article-title":"Toluidine blue: its significance and application in dentistry","volume":"37","author":"Kaugars GE","year":"1989","journal-title":"Gen Dent"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhed.10309","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.10309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T19:38:28Z","timestamp":1700249908000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.10309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,6,23]]},"references-count":47,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2003,11]]}},"alternative-id":["10.1002\/hed.10309"],"URL":"https:\/\/doi.org\/10.1002\/hed.10309","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,6,23]]}}}