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A New Approach for Diagnosing Oral Epithelial Dysplasia: A Proposal for a Novel Histopathological Scoring System
Govindarajan Priyadharshini1, Pratibha Ramani1, Wanninayake Mudiyanselage Tilakaratne2
1Department of Oral and Maxillofacial Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
Background:
Oral epithelial dysplasia (OED) encompasses a range of architectural and cytological changes in epithelial tissue due to genetic alterations. Traditional grading methods for OED often suffer from subjectivity and lack numerical precision.
Objective:
This study aimed to develop a new scoring system to objectively grade OED based on architectural and cytological features.
Materials And Methods:
We analyzed 150 cases of OED from our institutional database. A scoring sheet was created to record the presence (score of 1) or absence (score of 0) of specific dysplastic features. Scores were categorized into three ranges: 1-4, 5-8, and 9-16. This new system was validated against the World Health Organization (WHO) Grading System and Binary System, with interobserver variability assessed using kappa statistical analysis.
Results:
Scores ranged from 1 to 4 for mild dysplasia, from 5 to 8 for moderate dysplasia, and from 9 to 16 for severe dysplasia (P < 0.001). The new system aligned closely with the WHO grading: 92% of cases with mild dysplasia scored 1-4, 74% of moderate dysplasia cases scored 5-8, and 92% of severe dysplasia cases scored 9-16 (P = <0.001). Two cases initially classified as mild and moderate dysplasia by WHO progressed to malignancy within 6-8 months and scored 12 and 9, respectively, in our system. The new system demonstrated fair interobserver agreement, with kappa scores ranging from 0.24 to 0.317.
Discussion:
This novel scoring system addresses limitations of existing grading methods, such as subjectivity and variability. It offers a more objective approach to diagnosing and managing OED, potentially improving the early detection and prevention of oral squamous cell carcinoma.
