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Stojanov IJ, Omari J, Akeel I, Sultan AS, Woo SB. Oral epithelial dysplasia with lymphocytic immune response: clinicopathological characterisation of 44 cases. Histopathology 2024; 85:40-50. [PMID: 38497348 DOI: 10.1111/his.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024]
Abstract
AIMS Oral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well-demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted. METHODS AND RESULTS Cases of solitary OED with LIR for which a clinical photograph was available were identified in the authors' institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well-demarcated hyperkeratotic plaques lacking diffuse white-and-red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous 'lichenoid' features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%). CONCLUSIONS Virtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well-demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.
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Affiliation(s)
- Ivan J Stojanov
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joud Omari
- Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Ibrahim Akeel
- Oral Diagnostic Sciences Department, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ahmed S Sultan
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sook-Bin Woo
- Harvard School of Dental Medicine, Boston, MA, USA
- Center for Oral Pathology, StrataDx, Lexington, MA, USA
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2
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Gondivkar SM, Yuwanati M, Sarode SC, Gadbail AR, Gondivkar R, Mohsin SF, Gaikwad R. Malignant transformation in oral submucous fibrosis: Tertiary level evidence: An umbrella review. Oral Dis 2024; 30:1818-1827. [PMID: 37650364 DOI: 10.1111/odi.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES An umbrella review is a systematic review of systematic reviews, which provides a tertiary level of evidence. This umbrella review of systematic reviews and meta-analysis (SR-MA) aimed to determine the proportion of oral cancer (OC) development in oral submucous fibrosis (OSF) patients. MATERIALS AND METHODS We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane and grey literature. Two reviewers independently screened abstracts and assessed for eligible papers. The methodological quality of SR-MA was evaluated using AMSTAR2, and we also checked the quality of evidence of the included papers. RESULTS Out of 454 papers identified in the primary search, 105 underwent eligibility screening. Inclusion criteria were met by four SR-MA. OC ratios ranged between 4.2% and 6% for OSF. Substantial heterogeneity was observed for this outcome in all four MA (I2 = 71.31% to 86.37%). None of the SRs assessed the quality of evidence, and half of them were judged to be of critically low methodological quality. CONCLUSION There is lack of quality of evidences and critically low methodological quality among SRs and MA leading to substantial heterogeneity. However, due to potentially malignant nature, OSF patients should be monitored carefully for early detection of OC.
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Affiliation(s)
- Shailesh M Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, India
| | - Monal Yuwanati
- Department of Oral Pathology & Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Amol R Gadbail
- Department of Dentistry, Shree Bhausaheb Hire Government Medical College and Hospital, Dhule, India
| | | | - Syed Fareed Mohsin
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Quassim University, Buraidah, Saudi Arabia
| | - Rahul Gaikwad
- Department of Community Dentistry and Oral Epidemiology, College of Dentistry, Quassim University, Buraidah, Saudi Arabia
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3
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González-Arriagada WA, Canedo-Marroquin G, Adorno-Farías D, Fernández-Ramires R. New insights into the role of the oral leukoplakia microenvironment in malignant transformation. FRONTIERS IN ORAL HEALTH 2024; 5:1363052. [PMID: 38450102 PMCID: PMC10914962 DOI: 10.3389/froh.2024.1363052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Oral leukoplakia is the most frequent and potentially malignant lesion of the oral cavity. Although dysplasia grading remains the main factor for risk assessment, challenges persist in determining the exact risk of transformation, and the literature has focused on studying alternative biomarkers. The interaction between dysplastic epithelial cells and the microenvironment starts early, and the communication is mainly mediated by lymphocytes, inflammatory factors, fibroblasts, and the extracellular matrix, leading to dysplastic progression. Leukoplakia-infiltrating leukocytes (LILs) and leukoplakia-associated fibroblasts (LAFs) play crucial roles in the dysplastic microenvironment. The immune response is related to intraepithelial T lymphocyte infiltration, mechanisms of immunosuppression coordinated by regulatory T cells, M2 macrophage polarization, and increased numbers of Langerhans cells; in contrast, fibroblastic and extracellular matrix factors are associated with increased numbers of pro-tumorigenic myofibroblasts, increased expression of metalloproteinases vs. decreased expression of TIMPs, and increased expression of chemokines and other inflammatory mediators. The microenvironment offers insights into the progression of leukoplakia to carcinoma, and understanding the complexity of the oral microenvironment in potentially malignant diseases aids in determining the risk of malignant transformation and proposing new therapeutic alternatives.
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Affiliation(s)
- Wilfredo Alejandro González-Arriagada
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
- IMPACT-Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Universidad de los Andes, Santiago, Chile
| | - Gisela Canedo-Marroquin
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
| | - Daniela Adorno-Farías
- School of Dentistry, Oral Medicine and Pathology Department, Universidad de Chile, Santiago, Chile
| | - Ricardo Fernández-Ramires
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
- Grupo Chileno de Cáncer Hereditario, Universidad de los Andes, Santiago, Chile
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4
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Hankinson P, Mahmood H, Walsh H, Speight PM, Khurram SA. Demystifying oral epithelial dysplasia: a histological guide. Pathology 2024; 56:11-23. [PMID: 38030478 DOI: 10.1016/j.pathol.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
Oral epithelial dysplasia is a histologically diagnosed potentially premalignant disorder of the oral mucosa, which carries a risk of malignant transformation to squamous cell carcinoma. The diagnosis and grading of oral epithelial dysplasia is challenging, with cases often referred to specialist oral and maxillofacial pathology centres for second opinion. Even still there is poor inter-examiner and intra-examiner agreement in a diagnosis. There are a total of 28 features of oral epithelial dysplasia listed in the 5th edition of World Health Organization classification of tumours of the head and neck. Each of these features is poorly defined and subjective in its interpretation. Moreover, how these features contribute to dysplasia grading and risk stratification is even less well defined. This article discusses each of the features of oral epithelial dysplasia with examples and provides an overview of the common mimics, including the normal histological features of the oral mucosa which may mimic atypia. This article also highlights the paucity of evidence defining these features while offering suggested definitions. Ideally, these definitions will be refined, and the most important features identified to simplify the diagnosis of oral epithelial dysplasia. Digital whole slide images of the figures in this paper can be found at: https://www.pathogenesis.co.uk/r/demystifying-dysplasia-histology-dataset.
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Affiliation(s)
- Paul Hankinson
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, England, UK
| | - Hanya Mahmood
- Academic Unit of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, England, UK
| | - Hannah Walsh
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, England, UK
| | - Paul M Speight
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, England, UK
| | - Syed Ali Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, England, UK.
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Kallarakkal TG, Zaini ZM, Ghani WMN, Karen-Ng LP, Siriwardena BSMS, Cheong SC, Tilakaratne WM. Calibration improves the agreement in grading oral epithelial dysplasia-Findings from a National Workshop in Malaysia. J Oral Pathol Med 2024; 53:53-60. [PMID: 38081145 DOI: 10.1111/jop.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems. METHODS A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems. RESULTS A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; Kw 0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise. CONCLUSION This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.
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Affiliation(s)
- Thomas George Kallarakkal
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zuraiza Mohamad Zaini
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Maria Nabillah Ghani
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Lee Peng Karen-Ng
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - B S M S Siriwardena
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Wolk R, Lingen MW. Proceedings of the North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Oral Cavity Dysplasia: Why Does Histologic Grading Continue to be Contentious? Head Neck Pathol 2023; 17:292-298. [PMID: 37184731 PMCID: PMC10293486 DOI: 10.1007/s12105-023-01544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the world's 6th most common malignancy. Oral cavity SCC (OCSCC) represents approximately one third of the HNSCC cases diagnosed annually in the United States. Despite therapeutic advances, OCSCC is frequently lethal, with a modest 5-year survival. Because OCSCC is often preceded by premalignant lesions, it is an ideal disease for screening initiatives. The conventional visual and tactile exam (CVTE), coupled with a tissue biopsy, remains the gold standard. However, CVTE alone cannot reliably differentiate between reactive/inflammatory and dysplastic lesions. Further, the histologic diagnosis of dysplasia is subjective in nature and a highly imperfect predictor of malignant transformation. This prognostic uncertainty creates a significant clinical management dilemma-watchful waiting with increased patient psychological and economic burdens versus unnecessary aggressive treatment. As such, the development and validation of novel diagnostic platforms such as Artificial Intelligence (AI) and prognostic molecular biomarkers may help address these critical unmet clinical needs.
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Affiliation(s)
- Rachelle Wolk
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA.
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Embaló B, Miguel AFP, Konrath AC, Modolo F, Rivero ERC. Evaluation of two classification systems for oral epithelial dysplasia. Oral Dis 2023; 29:100-104. [PMID: 33813775 DOI: 10.1111/odi.13867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Bubacar Embaló
- Postgraduate Program in Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Andressa Fernanda Paza Miguel
- Postgraduate Program in Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Andrea Cristina Konrath
- Department of Informatics and Statistics, Technological Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Filipe Modolo
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
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Li C, Zhang Q, Sun K, Jia H, Shen X, Tang G, Liu W, Shi L. Autofluorescence imaging as a noninvasive tool of risk stratification for malignant transformation of oral leukoplakia: A follow-up cohort study. Oral Oncol 2022; 130:105941. [DOI: 10.1016/j.oraloncology.2022.105941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 01/30/2023]
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Nevanpää TT, Terävä AE, Laine HK, Rautava J. Malignant transformation of oral epithelial dysplasia in Southwest Finland. Sci Rep 2022; 12:8261. [PMID: 35585112 PMCID: PMC9117212 DOI: 10.1038/s41598-022-12441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
Oral epithelial dysplasia (OED) is considered a risk for oral squamous cell carcinoma (OSCC). A meta-analysis estimated a mean malignant transformation rate of 12.1% (95% CI 8.1-17.9). The main target of this study was to define how many OED patients develop OSCC in the hospital district of Southwest Finland. A total of 571 patients diagnosed with OED were identified. Their potential subsequent diagnosis of OSCC was derived from the Finnish Cancer Registry. The risk of OSCC development in OED patients was compared with that of the general population without OED. During a mean follow-up of 5.5 (range 0.1-29.0) years 10.9% of OED patients developed OSCC. OED patients had a 44.7-fold higher risk (95% CI 34.4-56.7) of developing OSCC than the general population. The risk was at its highest within two years of OED diagnosis. OED patients in Southwest Finland have a significantly increased risk of developing OSCC relative to the general population, especially within the first two years of dysplasia diagnosis.
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Affiliation(s)
- Toni T Nevanpää
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Antti E Terävä
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna K Laine
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland.
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland.
| | - Jaana Rautava
- Oral Pathology and Oral Radiology, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 41, 00014, Helsinki, Finland
- Department of Pathology, Medicum, Faculty of Medicine, University of Helsinki and HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
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The implications of gene mutations in salivary DNA for noninvasive diagnosis of head and neck cancer with a focus on oral cancer. Oral Oncol 2022; 130:105924. [PMID: 35594773 DOI: 10.1016/j.oraloncology.2022.105924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/16/2022]
Abstract
DNA-based liquid biopsy as a diagnostic strategy of head and neck squamous cell carcinoma (HNSCC) has emergingly gained momentum. In this letter, we identified 6 studies contained 274 patients with HNSCC focused on gene mutations in salivary DNA. We observe that the incidence of DNA mutations with at least one gene mutated ranges from 63% to 95.9%, and the most frequently examined gene mutations are TP53, CDKN2A, PIK3CA, FAT1, and NOTCH1. Meanwhile, studies have demonstrated that saliva had a greater sensitivity and much higher quantitative values than plasma in both tumor DNA count and variant allele frequency. Interestingly, more tumor-derived mutations were detected in salivary DNA among patients with tumors arising in oral cavity compared to in oropharynx, larynx, and hypopharynx. Collectively, it is feasibility to identify somatic mutations in driver genes using saliva samples to noninvasively diagnose HNSCC, especially in oral cavity cancer and even at early stages of the disease. Larger well-designed studies are needed to consolidate the evidence.
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11
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Khoury ZH, Sultan M, Sultan AS. Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis. Int J Surg Pathol 2022; 30:499-511. [PMID: 34994584 DOI: 10.1177/10668969211070171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^2 statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.
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Affiliation(s)
- Zaid H Khoury
- Meharry Medical College, School of Dentistry, Department of Oral Diagnostic Sciences & Research, Nashville, TN, USA
| | - Mohamed Sultan
- Western Vascular Institute, University College Hospital, Galway, Ireland
| | - Ahmed S Sultan
- 12265University of Maryland School of Dentistry, Baltimore, MD, USA.,12265University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA
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12
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Sathasivam HP, Sloan P, Thomson PJ, Robinson M. The clinical utility of contemporary oral epithelial dysplasia grading systems. J Oral Pathol Med 2021; 51:180-187. [PMID: 34797585 DOI: 10.1111/jop.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. METHODS Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. RESULTS 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. CONCLUSION This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).
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Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Peter J Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Max Robinson
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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13
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Dorman SJ, Kudenov MW, Lytle AJ, Griffith EH, Huseth AS. Computer vision for detecting field-evolved lepidopteran resistance to Bt maize. PEST MANAGEMENT SCIENCE 2021; 77:5236-5245. [PMID: 34310008 DOI: 10.1002/ps.6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Resistance evolution of lepidopteran pests to Bacillus thuringiensis (Bt) toxins produced in maize and cotton is a significant issue worldwide. Effective toxin stewardship requires reliable detection of field-evolved resistance to enable the implementation of mitigation strategies. Currently, visual estimates of maize injury are used to document changing susceptibility. In this study, we evaluated an existing maize injury monitoring protocol used to estimate Bt resistance levels in Helicoverpa zea (Lepidoptera: Noctuidae). RESULTS We detected high interobserver variability across multiple injury metrics, suggesting that the precision and accuracy of maize injury detection could be improved. To do this, we developed a computer vision-based algorithm to measure H. zea injury. Algorithm estimates were more accurate and precise than a sample of human observers. Moreover, observer estimates tended to overpredict H. zea injury, which may increase the false-positive rate, leading to prophylactic insecticide application and unnecessary regulatory action. CONCLUSIONS Automated detection and tracking of lepidopteran resistance evolution to Bt toxins are critical for genetically engineered crop stewardship to prevent the use of additional insecticides to combat resistant pests. Advantages of this computerized screening are: (i) standardized Bt injury metrics in space and time, (ii) preservation of digital data for cross-referencing when thresholds are reached, and (iii) the ability to increase sample sizes significantly. This technological solution represents a significant step toward improving confidence in resistance monitoring efforts among researchers, regulators and the agricultural biotechnology industry.
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Affiliation(s)
- Seth J Dorman
- Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, USA
| | - Michael W Kudenov
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
| | - Amanda J Lytle
- Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, USA
| | - Emily H Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Anders S Huseth
- Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, USA
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Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021; 27:1947-1976. [PMID: 34418233 DOI: 10.1111/odi.13993] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
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Affiliation(s)
- Edward Odell
- King's College London and Head and Neck Pathology Guy's Hospital, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King's College London and The WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Chief Histopathologist, AMLo Biosciences, Newcastle upon Tyne, UK
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15
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McCarthy C, Fedele S, Ottensmeier C, Shaw RJ. Early-Phase Interventional Trials in Oral Cancer Prevention. Cancers (Basel) 2021; 13:cancers13153845. [PMID: 34359746 PMCID: PMC8345124 DOI: 10.3390/cancers13153845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Oral cancer is a devastating disease with increasing incidence worldwide. Oral epithelial dysplasia (OED) is a potentially malignant disorder and patients with OED are at increased risk of developing oral cancer. Current strategies for management of OED include surgery or close observation and both fail to address the underlying pathogenesis of the disease. There is an urgent need for evidence-based medical treatments for OED to prevent oral cancer development in this cohort. Chemoprevention trials to date have not delivered therapeutic agents for routine clinical practice. Historically, there has been significant heterogeneity in the design of oral cancer chemoprevention trials, with most failing to selectively recruit patients with biopsy-proven OED, which limits the usefulness of the findings in the OED population. The present paper aims to review the current evidence and the methodology of early-phase trials in oral cancer chemoprevention. Novel strategies in oral cancer chemoprevention will also be discussed. Abstract The increasing breadth of molecular targets, promise of immune-targeted therapies and repurposed agents have heightened interest in cancer prevention. While, to date, testing of oral cancer chemoprevention strategies has failed to deliver therapeutic agents for routine clinical practice, there remains an urgent need for further clinical research to overcome this hurdle. Patients at the greatest risk of disease stand to benefit the most from inclusion in clinical trials; therefore, there is a need to carefully define this population using validated clinical and molecular markers. Safety, tolerability and the efficacy of interventions is assessed through carefully selected endpoints. These endpoints may include pharmacodynamic, clinical, histological and on-target molecular modifications as an individual or as a composite endpoint. Early-phase trials provide an area of opportunity to explore novel and repurposed agents in the setting of oral cancer chemoprevention, eventually leading to phase III trials with clinical endpoints such as transformation and clinical outcome; these studies are large, lengthy and expensive and should be reserved for the most promising of agents. This paper will explore current evidence in oral cancer chemoprevention, drug repurposing, selection of appropriate endpoints for early-phase trials and novel therapeutic angles in oral cancer chemoprevention.
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Affiliation(s)
- Caroline McCarthy
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool L3 9TA, UK
- Correspondence: ; Tel.: +44-7904-363-109
| | - Stefano Fedele
- Eastman Dental Institute, University College London, 21 University Street, London WC1E 6DE, UK;
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, Maple House Suite A 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Christian Ottensmeier
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
| | - Richard J. Shaw
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
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16
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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; 25:4329-4340. [PMID: 34050426 DOI: 10.1007/s00784-021-04008-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems. MATERIAL AND METHODS A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED). RESULTS The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I2 = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I2 = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64). CONCLUSIONS Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation. CLINICAL RELEVANCE The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.
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17
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Koyuncu CF, Lu C, Bera K, Zhang Z, Xu J, Toro P, Corredor G, Chute D, Fu P, Thorstad WL, Faraji F, Bishop JA, Mehrad M, Castro PD, Sikora AG, Thompson LD, Chernock RD, Lang Kuhs KA, Luo J, Sandulache V, Adelstein DJ, Koyfman S, Lewis JS, Madabhushi A. Computerized tumor multinucleation index (MuNI) is prognostic in p16+ oropharyngeal carcinoma. J Clin Invest 2021; 131:145488. [PMID: 33651718 DOI: 10.1172/jci145488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDPatients with p16+ oropharyngeal squamous cell carcinoma (OPSCC) are potentially cured with definitive treatment. However, there are currently no reliable biomarkers of treatment failure for p16+ OPSCC. Pathologist-based visual assessment of tumor cell multinucleation (MN) has been shown to be independently prognostic of disease-free survival (DFS) in p16+ OPSCC. However, its quantification is time intensive, subjective, and at risk of interobserver variability.METHODSWe present a deep-learning-based metric, the multinucleation index (MuNI), for prognostication in p16+ OPSCC. This approach quantifies tumor MN from digitally scanned H&E-stained slides. Representative H&E-stained whole-slide images from 1094 patients with previously untreated p16+ OPSCC were acquired from 6 institutions for optimization and validation of the MuNI.RESULTSThe MuNI was prognostic for DFS, overall survival (OS), or distant metastasis-free survival (DMFS) in p16+ OPSCC, with HRs of 1.78 (95% CI: 1.37-2.30), 1.94 (1.44-2.60), and 1.88 (1.43-2.47), respectively, independent of age, smoking status, treatment type, or tumor and lymph node (T/N) categories in multivariable analyses. The MuNI was also prognostic for DFS, OS, and DMFS in patients with stage I and stage III OPSCC, separately.CONCLUSIONMuNI holds promise as a low-cost, tissue-nondestructive, H&E stain-based digital biomarker test for counseling, treatment, and surveillance of patients with p16+ OPSCC. These data support further confirmation of the MuNI in prospective trials.FUNDINGNational Cancer Institute (NCI), NIH; National Institute for Biomedical Imaging and Bioengineering, NIH; National Center for Research Resources, NIH; VA Merit Review Award from the US Department of VA Biomedical Laboratory Research and Development Service; US Department of Defense (DOD) Breast Cancer Research Program Breakthrough Level 1 Award; DOD Prostate Cancer Idea Development Award; DOD Lung Cancer Investigator-Initiated Translational Research Award; DOD Peer-Reviewed Cancer Research Program; Ohio Third Frontier Technology Validation Fund; Wallace H. Coulter Foundation Program in the Department of Biomedical Engineering; Clinical and Translational Science Award (CTSA) program, Case Western Reserve University; NCI Cancer Center Support Grant, NIH; Career Development Award from the US Department of VA Clinical Sciences Research and Development Program; Dan L. Duncan Comprehensive Cancer Center Support Grant, NIH; and Computational Genomic Epidemiology of Cancer Program, Case Comprehensive Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the US Department of VA, the DOD, or the US Government.
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Affiliation(s)
- Can F Koyuncu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland, Ohio, USA
| | - Cheng Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zelin Zhang
- Nanjing University of Information Science and Technology, Nanjing, China
| | - Jun Xu
- Nanjing University of Information Science and Technology, Nanjing, China
| | - Paula Toro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - German Corredor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland, Ohio, USA
| | | | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Wade L Thorstad
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Justin A Bishop
- University of Texas (UT) Southwestern Medical Center, Dallas, Texas, USA
| | - Mitra Mehrad
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia D Castro
- Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G Sikora
- Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,ENT Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - R D Chernock
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Jingqin Luo
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Vlad Sandulache
- Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,ENT Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | | | - James S Lewis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.,Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland, Ohio, USA
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18
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Idrees M, Farah CS, Khurram SA, Firth N, Soluk-Tekkesin M, Kujan O. Observer agreement in the diagnosis of oral lichen planus using the proposed criteria of the American Academy of Oral and Maxillofacial Pathology. J Oral Pathol Med 2021; 50:520-527. [PMID: 33730381 DOI: 10.1111/jop.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined malignant transformation potential. There have been many attempts at providing a specific definition of OLP without conclusive outcomes. A new set of diagnostic criteria was proposed in 2016 by the American Academy of Oral and Maxillofacial Pathology (AAOMP) in an endeavour to resolve this issue, and this has not yet been evaluated. This study aimed to assess the utility of AAOMP proposed criteria for the diagnosis of OLP. METHODS Five pathologists blindly assessed a cohort of 215 digital whole slide images (WSI) obtained from haematoxylin and eosin-stained microscopic slides. Forty-six WSI were included twice to assess the intra-observer agreement. Included cases were diagnosed clinically as either OLP or oral lichenoid reaction. Each pathologist was asked to utilize the AAOMP histopathological criteria while assessing slides. The variations in diagnoses were assessed by unweighted kappa statistics. RESULTS The level of intra-observer agreement was very good (0.801 to 0.899). The level of inter-observer agreement among the observers varied from good (0.658) to very good (0.842) when the responses were categorized as evident/compatible OLP versus no OLP and was good (0.62 to 0.725) when the responses were categorized as evident OLP, versus compatible OLP, versus no OLP. The clinico-pathological correlation was 87.6%. CONCLUSION A reliable level of agreement can be achieved by pathologists for the diagnosis of OLP using the AAOMP criteria for differentiation between lichenoid and other conditions. There are still limitations in discriminating OLP from oral lichenoid lesions microscopically.
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Affiliation(s)
- Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia.,Australian Clinical Labs, Subiaco, WA, Australia
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Norman Firth
- Clinipath Pathology, Osborne Park, WA, Australia
| | - Merva Soluk-Tekkesin
- Department of Tumor Pathology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
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19
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Zohdy M, Cazzaniga S, Nievergelt H, Blum R, Suter VGA, Feldmeyer L, Beltraminelli H. Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases. Dermatopathology (Basel) 2021; 8:84-88. [PMID: 33915710 PMCID: PMC8167714 DOI: 10.3390/dermatopathology8020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.
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Affiliation(s)
- Marwa Zohdy
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Department of Dermatology, Andrology and STDs, Mansoura University Hospitals, Mansoura University, Mansoura 35516, Egypt
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Centro Studi GISED, 24121 Bergamo, Italy
| | - Helga Nievergelt
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
| | - Roland Blum
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
| | - Valérie G. A. Suter
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
- Correspondence:
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (M.Z.); (S.C.); (H.N.); (R.B.); (H.B.)
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20
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Kujan O, Mello FW, Warnakulasuriya S. Malignant transformation of oral submucous fibrosis: A systematic review and meta‐analysis. Oral Dis 2020; 27:1936-1946. [DOI: 10.1111/odi.13727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Omar Kujan
- UWA Dental School The University of Western Australia Perth WA Australia
| | - Fernanda Weber Mello
- Department of Dentistry Health Sciences Center Federal University of Santa Catarina Santa Catarina Brazil
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King’s College London, and the WHO Collaborating Centre for Oral Cancer London UK
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