Oral epithelial dysplasia grading: Comparing the binary system to the traditional 3-tier system, an actuarial study with malignant transformation as outcome

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Sperandio, Marcelo ; Warnakulasuriya, Saman ; Soares, Andresa Borges ; Passador-Santos, Fabricio ; Mariano, Fernanda Viviane ; Passos Lima, Carmen Silvia ; Scarini, Joao Figueira ; Lopes Dominguete, Matheus Henrique ; Moraes, Paulo de Camargo ; Martins Montalli, Victor Angelo ; Hellmeister, Luiza ; de Araujo, Vera Cavalcanti

• Document type: Journal article
• Source: JOURNAL OF ORAL PATHOLOGY & MEDICINE; v. N/A, p. 8-pg., 2022-10-13.

Abstract

Background Establishing the risk of malignant transformation (MT) in oral leukoplakia is usually based on grading oral epithelial dysplasia (OED) on biopsy tissue, for which two systems are proposed: a 3-tier and a binary system. Only very few actuarial studies have tested the accuracy of such methods in predicting MT, especially for the binary system. This study aimed to assess the accuracy of the two grading systems in predicting MT in a cohort of oral leukoplakia (OL) from Brazil, with follow-up data. Methods The sample comprised 878 individuals diagnosed with OL from 2005 to 2018. Follow-up data were obtained both locally and from the regional cancer registry. All lesions were graded using both the 3-tier and the binary systems. Kaplan-Meier curves (Log-rank Mantel-Cox) were used to assess risk and kappa to assess interobserver agreement. Results Thirty-five individuals underwent MT (4%). Both systems demonstrated prognostic value, though the 3-tier system proved superior, with OR 9.23 (3.42-23.69), PPV 0.152, NPV 0.98, compared to binary OR 3.49 (1.79-6.79), PPV 0.079, NPV 0.976. Interobserver agreement was also superior in the 3-tier system (0.47, p < 0.05) compared to the binary system (0.139, p = 0.39). Combining the two systems enhanced prognostic values (OR 14.28, PPV 0.217, NPV 0.981). Conclusion The 3-tier system presented superior prognostic value to the binary system. Combining both systems to double-grade intermediate lesions might enhance risk assessment. (AU)

• FAPESP's process: 17/06579-1 - Predictive value of DNA ploidy combined with malignant transformation biomarkers in oral potentially malignant diseases
• Grantee: Marcelo Sperandio
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/07304-0 - Study of genetic and metabolic changes of pleomorphic adenoma and carcinoma ex pleomorphic adenoma by exome, gene expression and immunohistochemistry
• Grantee: Fernanda Viviane Mariano Brum Corrêa
• Support Opportunities: Research Grants - Young Investigators Grants