Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis

Yan, Flora; Reddy, Priyanka; Nguyen, Shaun A.; Angela, C.; Neville, Brad W.; Day, Terry A.

doi:10.1007/s00405-020-06036-1

Cited by 20 publications

(27 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies have largely focused on histology demonstrating at least severe dysplasia as a significant risk for transformation 25,28 . However, our data support that lesions demonstrating moderate dysplasia should be considered as high risk, and this is in agreement with the adoption of binary classification of oral dysplasia (low risk/high risk) to adequately perceive the risk of transformation while also improving reproducibility 29 . This may have implications for determining whether or not to treat moderately dysplastic lesions surgically.…”

Section: Discussionsupporting

confidence: 86%

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

et al. 2021

View full text Add to dashboard Cite

Background: Factors that increase the risk of malignant transformation of oral epithelial dysplasia (OED) are not completely elucidated. Methods: A retrospective chart review was performed assessing risk factors for transformation of OED, and cancer staging for transformed cases at Sunnybrook Health Sciences Centre. Results: Two-hundred four patients were diagnosed with OED, and 16.7% (34) underwent malignant transformation. Risk factors associated with transformation included: heavy tobacco smoking, excessive EtOH consumption, non-homogenous leukoplakia, size >200 mm 2 , moderate dysplasia or greater than moderate, progression of dysplasia grades, and immunosuppression.Transformed cases followed for a dysplastic lesion were associated with a stage-I cancer diagnosis, and cancer cases with no prior biopsy were associated with a stage-IV diagnosis.Conclusions: In addition to commonly cited risk factors, immunosuppression was associated with malignant transformation, including the use of topical steroids. Analyzing risk factors can help clinicians define risk of progression in patients with OED.

show abstract

Section: Discussionsupporting

confidence: 86%

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

et al. 2021

View full text Add to dashboard Cite

show abstract

“…2,4 At this point in time, the current study is one of the few to assess both the three-tiered WHO 2017 and binary grading systems as most previous studies compared the binary grading system against the 5-tiered WHO 2005 grading system. 15,16,20,[23][24][25] A study by de Vicente et al ( 2019) focusing on SOX2 gene expression in a cohort of 55 patients briefly described the correlation between OED grading and clinical outcome utilizing both the WHO 2017 and binary grading systems. 26 However, the paper did not address intra-and/or inter-rater agreement as well as the sensitivity and specificity of OED grading in predicting clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…2 In recent years, there has been increasing interest in a binary grading system consisting of "low-grade/low-risk" and "high-grade/highrisk" as it has been suggested that it has better prognostic utility and improves inter-rater variability. 4,14,15 Regardless of the classification system, the issue of inter-rater and inter-institutional variability persists rendering it difficult to generalize findings from studies on OED grading as lesions included in the same grade by different studies may not necessarily be similar. 2,4 A recent systematic review by de Freitas Silva et al (2021) highlighted the need for more data to provide much needed evidence on the clinical utility of OED grading systems.…”

Section: Introductionmentioning

confidence: 99%

The clinical utility of contemporary oral epithelial dysplasia grading systems

Sathasivam

Sloan

Thomson

et al. 2021

J Oral Pathology Medicine

View full text Add to dashboard Cite

Introduction: Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. While 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:One hundred thirty-one 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.

show abstract

“…Further, there was a statistically significant difference between the annual malignant transformation rates of mild and moderate+severe OED of 1.7% and 3.57%, respectively (Iocca et al, 2020). Another recent meta-analysis examined the predictive value of the binary OED grading system (Yan et al, 2020) and included 4 studies with 629 OED cases in the pooled analysis. High-grade OED had a sixfold increased risk for malignant transformation compared to lowgrade OED [odds ratio (OR) 6.14, 95% 1.18-15.38].…”

Section: Pred I C Tive Value Of Dys Pl a S Ia G R Adingmentioning

confidence: 99%

“…High-grade OED had a sixfold increased risk for malignant transformation compared to lowgrade OED [odds ratio (OR) 6.14, 95% 1.18-15.38]. Moreover, the malignant transformation proportion of low-grade and high-grade OED cases was 12.7% (95% CI −0.210 to 0.438) and 57.9% (95% CI 0.386-0.723), respectively (Yan et al, 2020). It is clear that, despite much negative comment in the literature, grading does differentiate lesions with different risks of transformation and identifies lesions with the greatest short-term risk.…”

Section: Pred I C Tive Value Of Dys Pl a S Ia G R Adingmentioning

confidence: 99%

Oral epithelial dysplasia: Recognition, grading and clinical significance

et al. 2021

View full text Add to dashboard Cite

The concept of epithelial dysplasia was introduced into oral pathology over 60 years ago, following the recognition that some oral lesions had the potential to progress to oral cancer, now recognised as oral potentially malignant disorders (OPMDs). Attempts to grade oral dysplasia systematically were introduced into the literature in 1969, using photographic standards as reference (Smith et al., 1969) and internationally agreed classifications were formulated later

show abstract

Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis

Cited by 20 publications

References 34 publications

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

The clinical utility of contemporary oral epithelial dysplasia grading systems

Oral epithelial dysplasia: Recognition, grading and clinical significance

Contact Info

Product

Resources

About