Toluidine blue staining in the diagnosis of endometrial pathologies: a preliminary study before chromohysteroscopy

• Published in: European journal of obstetrics & gynecology and reproductive biology 2012-02, Vol.160 (2), p.191-195
• Main Authors: Ozturk, Mustafa, Ercan, Cihangir Mutlu, Dede, Murat, Yenen, Mufit Cemal, Demiriz, Murat, Baser, Iskender
• Format: Article
• Language: English
• Subjects: Adult; Aged; Chromohysteroscopy; Coloring Agents - chemistry; Cross-Sectional Studies; Diagnosis of endometrial cancer; Endometrial Hyperplasia - diagnosis; Endometrial Hyperplasia - pathology; Endometrial Neoplasms - diagnosis; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrium - pathology; Endometrium - surgery; Endometrium staining; Female; Frozen section procedure; Frozen Sections; Hospitals, Military; Humans; Hysteroscopy; Leiomyoma - diagnosis; Leiomyoma - pathology; Middle Aged; Obstetrics and Gynecology; Precancerous Conditions - diagnosis; Precancerous Conditions - pathology; Predictive Value of Tests; Preoperative Period; Sensitivity and Specificity; Tolonium Chloride - chemistry; Toluidine blue dye
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2011.10.013

Abstract Objective To assess the efficacy of toluidine blue (TBlue) staining in the detection of endometrial premalignant or malignant lesions in uterine specimens obtained from hysterectomies. We hoped that the results of this preliminary study would help us in our future studies which may be on chromohysteroscopy. Study design We developed an endometrium staining technique in which TBlue solution was used as a vital dye. The study enrolled 50 patients. Of these, 20 patients known to have a premalign or malign lesion of the uterus constituted the study group and 30 patients were recruited as the control group who were operated for leiomyoma of the uterus. Immediately after hysterectomy, all specimens were dyed with TBlue solution and a frozen section procedure was performed on the positively stained areas. The pre- and post-operative histopathological diagnoses of the participants were compared and the reliability of the new method was calculated. Results The sensitivity of TBlue staining in the determination of endometrial pathologies was 100% (95%, CI 0.83–1) with a specificity of 90% (95%, CI 0.74–0.96). As a diagnostic test, the positive predictive value (PPV) was 87% with a negative predictive value (NPV) of 100%. The positive likelihood ratio (+LR) was 10 (95%, CI 3.41–29.2). Conclusions Our preliminary results demonstrated that TBlue staining of endometrium is a reliable and highly sensitive technique that may be used in the frozen section examination of uterine specimens if a malignancy is suspected. Moreover, TBlue staining of endometrium may prove useful in hysteroscopy, although the technique, interpretation, and indications require further studies.