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Updated: Jun 6, 2025
Author Spotlight: Unlocking the Mysteries of Oral Potential Malignancies
Published on: August 11, 2023
New IPCL Classification Using NBI for Early Detection of OPMDs Malignant Transformation
Yiming Xu1, Tianyu Zhang1, Dan Liu1
1State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
Objectives:
Introduce a new intrapapillary capillary loop (IPCL) classification using narrow-band imaging (NBI) to diagnose early malignant transformation in oral potentially malignant disorders (OPMDs).
Methods:
In the exploratory phase, NBI images from 241 patients with OPMDs and oral squamous cell carcinoma (OSCC) were assessed for three basic IPCL features-dilation, unevenness, and tortuosity-to identify patterns associated with OPMDs malignant transformation. Chi-square analysis and logistic regression differentiated these patterns between low-risk (no/mild dysplasia) and high-risk (moderate/severe dysplasia, invasive carcinoma) lesions, establishing a new classification system. In the validation phase, the system was applied to 90 patients with histopathological results confirming diagnostic accuracy.
Results:
Four distinct IPCL types were identified: normal, dilated, irregular, and chaotic, with increasing odds ratios for high-risk lesions. The ROC curve had an AUC of 0.913, with irregular and chaotic types providing the best diagnostic performance, achieving sensitivities and specificities of 84.2% and 88.4%, respectively. In the validation phase, the new classification achieved an overall diagnostic accuracy of 84.4% and substantial inter-observer consistency (κ = 0.694).
Conclusion:
The new IPCL classification effectively identifies high-risk oral lesions, enhancing the diagnostic utility of NBI for early detection of OPMDs malignant transformations.
