A Comparative Study Using WHO and Binary Oral Epithelial Dysplasia Grading Systems in Leukoplakic Lesions Epithelial dysplasia grading in leukoplakic lesions
Journal of Dental School,
Vol. 42 No. 3 (2024),
27 July 2024
,
Page 107-110
https://doi.org/10.22037/jds.v42i3.45730
Abstract
Objectives This study aimed to compare the reproducibility and consistency of the World Health Organization (WHO) and Binary oral epithelial dysplasia grading systems when applied to leukoplakic lesions, the most common oral potentially malignant disorders (OPMDs).
Methods In this retrospective, cross-sectional study, clinical data and microscopic slides of 89 leukoplakia cases were reviewed. Two pathologists independently graded each sample using both WHO and Binary systems. Inter-observer agreement was evaluated using kappa statistics. The relationship between variables and the grade of dysplasia was analyzed using T-test and Chi-square test at p<0.05.
Results The mean age of cases was 53.93 ± 13.84 years, with a slight female predominance. The lesions were most commonly located on the tongue (38.2%) and buccal mucosa (37.08%). The inter-observer agreement was higher for the Binary system (kappa index= 0.62) compared to the WHO system (kappa index= 0.46). The highest agreement was observed for cellular features such as the increased number of cell nucleoli (0.74) and cell pleomorphism (0.73), while keratin pearls showed the lowest agreement (0.21).
Conclusion The Binary classification system demonstrated superior consistency and reproducibility compared to the WHO system due to fewer grading categories. However, its detailed numerical requirements and time-consuming nature may limit its widespread adoption, which is why the WHO system is more commonly used.
- WHO
- Binary
- Classification
- Grading
- Dysplasia
- Leukoplakia
- Oral cavity
How to Cite
References
Saldivia-Siracusa C, González-Arriagada WA. Difficulties in the Prognostic Study of Oral Leukoplakia: Standardisation Proposal of Follow-Up Parameters. Front Oral Health. 2021;2:614045.
de Freitas Silva BS, Batista DCR, de Souza Roriz CF, Silva LR, Normando AGC, Dos Santos Silva AR, et al. Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(7):4329-40.
de Azevedo AB, Dos Santos T, Lopes MA, Pires FR. Oral leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis: Analysis of 953 patients focusing on oral epithelial
dysplasia. J Oral Pathol Med. 2021;50(8):829-40.
Speight PM, Khurram SA, Kujan O. Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(6):612-27.
Tilakaratne WM, Jayasooriya PR, Jayasuriya NS, De Silva RK. Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges. Periodontol 2000. 2019;80(1):126-47.
Müller S. Oral epithelial dysplasia, atypical verrucous lesions and oral potentially malignant disorders: focus on histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(6):591-602.
Cerqueira JM, Pontes FS, Santos-Silva AR, Almeida OP, Costa RF, Fonseca FP, et al. Malignant transformation of oral leukoplakia: a multicentric retrospective study in Brazilian population. Med Oral Patol Oral Cir Bucal. 2021;26(3):e292-e8.
Iocca O, Sollecito TP, Alawi F, Weinstein GS, Newman JG, De Virgilio A, et al. Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype. Head Neck. 2020;42(3):539-55.
9. Shubhasini A R, Praveen B N, Hegde U, Uma K, Shubha G, Keerthi G, et al. Inter- and Intra-Observer Variability in Diagnosis of Oral Dysplasia. Asian Pac J Cancer Prev. 2017;18(12):3251-4.
Nankivell P, Williams H, Matthews P, Suortamo S, Snead D, McConkey C, Mehanna H. The binary oral dysplasia grading system: validity testing and suggested improvement. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(1):87-94.
Câmara PR, Dutra SN, Takahama Júnior A, Fontes K, Azevedo RS. A comparative study using WHO and binary oral epithelial dysplasia grading systems in actinic cheilitis. Oral Dis. 2016;22(6):523-9.
Krishnan L, Karpagaselvi K, Kumarswamy J, Sudheendra US, Santosh KV, Patil A. Inter- and intra-observer variability in three grading systems for oral epithelial dysplasia. J Oral Maxillofac Pathol. 2016;20(2):261-8.
Jayasooriya PR, Dayaratne K, Dissanayake UB, Warnakulasuriya S. Malignant transformation of oral leukoplakia: a follow-up study. Clin Oral Investig. 2020;24(12):4563-9.
Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med. 2016;45(3):155-66.
Kujan O, Oliver RJ, Khattab A, Roberts SA, Thakker N, Sloan P. Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation. Oral Oncol. 2006;42(10):987-93.
Kujan O, Khattab A, Oliver RJ, Roberts SA, Thakker N, Sloan P. Why oral histopathology suffers inter-observer variability on grading oral epithelial dysplasia: an attempt to understand the sources of variation. Oral Oncol. 2007;43(3):224-31.
Gupta S, Jawanda MK, Madhushankari GS. Current challenges and the diagnostic pitfalls in the grading of epithelial dysplasia in oral potentially malignant disorders: A review. J Oral Biol Craniofac Res. 2020;10(4):788-99.
- Abstract Viewed: 211 times
- PDF Downloaded: 135 times