Diagnostic value of oral “beefy red” patch in vitamin B12 deficiency

Figures & data

Figure 1 Flow diagram of the study.

Figure 2 Different oral manifestations of B12 deficiency and other conditions.

Notes: (A and B) Linear or band-like “beefy red” patches on the lingual dorsum in B12 deficiency, (C) confluent erythema on the lingual dorsum and a depapillated area in erythematous candidiasis, (D) circinate, irregular erythema on the dorsum of the tongue surrounded by a slightly elevated keratotic band in geographic tongue.

Table 1 Oral manifestations of B12 deficiency and conditions with similar features

Disease	Oral manifestations
B12 deficiency	Diffuse and bright erythema (“beefy red” patch) with linear, band-like, or irregular shape on any part of the oral mucosa. On the dorsum of the tongue, it presents as an inflamed area initially and gradually progresses to atrophic mucosa.^Citation16,Citation19,Citation20
Erythematous candidiasis	Diffuse and confluent erythema mainly on the lingual dorsum, presenting as a red depapillated area or on the denture-bearing mucosa.^Citation23
Geographic tongue	Circinate, irregular erythema mainly on the anterior two-thirds of the dorsal and lateral surfaces of the tongue; the lesion is surrounded by a slightly elevated keratotic band or line.^Citation24

Table 2 Oral diseases in the control group patients

Oral diseases	Number
Burning mouth syndrome	50
Oral candidiasis alone	6
Recurrent aphthous stomatitis	4
Geographic tongue	4
Unidentified	2
Total	66

Table 3 Demographic data of the subjects

	Patient group (n = 70)	Control group (n = 65)	P-value
Age (years)* (mean ± SD)	61.7 ± 12.6	58.7 ± 10.6	0.06*
Gender#
Male	30 (42.9%)	25 (37.9%)	0.55#
Female	40 (57.1%)	41 (62.1%)

Notes:

* The independent samples t-test was used for the analysis of quantitative data;

# the chi-square test was used for the analysis of enumeration data.

Table 4 Values of various clinical and serum indices for diagnosis of B12 deficiency

	Vitamin B12 deficiency		Validity			Reliability
	Positive (n = 70)	Negative (n = 66)	Sensitivity	Specificity	r	Kappa value	Consistency (95% CI)
“Beefy red” lesions	61	2	87.1%	97.0%	0.84	0.86	91.9% (87.3%–96.5%)
MCV >100 fL	30	0	40.0%	100%	0.40	0.42	70.6% (62.9%–78.3%)
Cobalamin <200 pg/mL	59	4	84.3%	93.9%	0.78	0.78	89.0% (83.8%–94.3%)
Cobalamin <350 pg/mL	67	16	95.7%	75.8%	0.72	0.72	86.0% (80.2%–91.8%)
B200 – “beefy red”	53	1	75.7%	98.5%	0.74	0.74	86.8% (81.1%–92.5%)
B350 – “beefy red”	59	2	84.3%	97.0%	0.81	0.81	90.4% (85.5%–95.4%)

Notes: r, Youden index; B200 - “beefy red”: combination of cobalamin <200 pg/mL with “beefy red” lesions; B350 - “beefy red”: combination of cobalamin <350 pg/mL with “beefy red” lesions.

Abbreviation: MCV, mean corpuscular volume.

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