Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility

Fleskens, Stijn A. J. H. M.; Slootweg, Piet J.

doi:10.1186/1758-3284-1-11

Cited by 100 publications

(86 citation statements)

References 60 publications

(84 reference statements)

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“…4,6,16,23 Gale et al 16 concluded that the results of a long-term follow-up study of 1268 patients once again justify the proposal of the Ljubljana classification. It entails dividing the morphological criteria into two basic groups: benign (squamous hyperplasia and basal/ parabasal hyperplasia) and potentially malignant (atypical hyperplasia).…”

Section: Discussionmentioning

confidence: 99%

“…4,18,19 In the 'high-risk' group, the three-grade system additionally distinguishes mild and moderate dysplasia from severe dysplasia, carcinoma in situ, and squamous cell carcinoma (World Health Organization); it also distinguishes SIN 1 and 2 from SIN 3 and squamous cell carcinoma (Squamous Intraepithelial Neoplasia), and it differentiates (atypical hyperplasia) dysplasia from carcinoma in situ and squamous cell carcinoma (Ljubljana). This further differentiation was made because in daily practice normal histology, inflammation, and hyperplasia (green segment in Table 2) are generally considered to require no periodic observation.…”

Section: Methodsmentioning

confidence: 99%

“…It is subjective and has been shown to lack intra-and inter-observer reproducibility, which may have significant therapeutic implications. [3][4][5][6][7] To minimize both morbidity and mortality, it is highly important to detect the lesions at risk for malignancy in its earliest stage. [8][9][10] Unfortunately, there is no universally accepted histopathological classification system.…”

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confidence: 99%

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Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation

et al. 2011

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The objective of this study is to measure interobserver variability in the classification of laryngeal mucosal premalignant lesions by reassessing the histopathology of previously diagnosed cases and to determine the possible therapeutic consequences of disagreement among observers. Histopathological assessment of 110 laryngeal mucosal premalignant lesions was done by three pathologists. Each slide had to be classified according to the World Health Organization, Squamous Intraepithelial Neoplasia, and the Ljubljana Squamous Intraepithelial Lesions systems. After the independent assessment, a joint meeting took place. To assess the relation between histopathological grading and subsequent clinical management, we created a two-and a three-grade system besides one comprising all options. For all analyses, the SAS/STAT statistical software was used. The highest unweighted j-values concerning the all-options system are observed for the Squamous Intraepithelial Neoplasia classification (0.28, 95% confidence interval 0.23-0.33), followed by the World Health Organization and Ljubljana classifications. For the two-grade system the Ljubljana classification shows the highest unweighted j-values (0.50, 95%, 0.39-0.61), followed by the World Health Organization and Squamous Intraepithelial Neoplasia classifications. For the three-grade system, the unweighted j-values are similar. The implementation of weighted j-values led to higher scores within all three classification systems, although these did not exceed 0.55 (moderate agreement). Given the high level of consensus, simultaneous pathological assessment may be said to provide added value in comparison with independent assessment. In the current study, no clear tendency is observed in favor of any one classification system. The proposed three-grade system could be an improved histopathological tool because it is easier to correlate with clinical decision making and because it yields better unweighted j-values and proportions of concordance than the all-options system. Furthermore, clinical management could benefit from assessment by more than one pathologist in suspected cases of dysplasia or carcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation

et al. 2011

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“…SCC develops in 6% to 20% of dysplastic lesions but dysplasia grading is not an accurate predictor. Most OPMD remain unchanged or regress (2) and dysplasia grading has been criticized as subjective, poorly reproducible, and inadequate for clinical management (3)(4)(5). There is a need for better predictive markers of transformation to guide treatment (6).…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Dysplasia Grading and DNA Ploidy in Malignant Transformation of Oral Potentially Malignant Disorders

Sperandio

Brown

Lock

et al. 2013

Cancer Prevention Research

101

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Dysplasia grading is widely used to assess risk of transformation in oral potentially malignant disorders despite limited data on predictive value. DNA ploidy analysis has been proposed as an alternative. This study examines the prognostic value for both tests used in a routine diagnostic setting to inform clinical management. A retrospective study of conventional dysplasia grading was conducted on 1,401 patients. DNA ploidy analysis was conducted on a subset of 273 patients and results correlated with clinical information, pathologic diagnosis, and outcome over 5 to 15 years.Malignant transformation occurred in 32 of 273 patients (12%) and, of these, 20 (63%) of preexisting index lesions were aneuploid. Of 241 patients not developing carcinoma, only 39 (16%) of index lesions were aneuploid. Epithelial dysplasia correlated with DNA ploidy status (P < 0.001). The overall positive predictive value for malignant transformation by DNA aneuploidy was 38.5% (sensitivity 65.2% and specificity 75%) and by severe dysplasia grade 39.5% (sensitivity 30% and specificity 98%). DNA diploid and tetraploid status had negative predictive value of 90% to 96%. Combining DNA ploidy analysis with dysplasia grading gives a higher predictive value than either technique alone.Each of three traditional dysplasia grades predicts a significantly different risk of carcinoma development and time to transformation. DNA ploidy analysis had equivalent predictive value and also detected additional risk lesions in the absence of dysplasia. Cancer Prev Res; 6(8); 822-31. Ó2013 AACR.

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“…4,5,6,7 Hyperkeratotic lesions without dysplasia can also show malignant transformation. 8 The ability of current clinical and histological methods to predict premalignant lesions that will undergo malignant transformation is limited, and it is important to develop other methods for predicting the malignant potential of lesions so that they can be treated appropriately.…”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Ghrelin Expression In Oral Leukoplakia And Oral Squamous Cell Carcinoma: An Immunohistochemical Study

Fikirli¹,

Özeç²,

Eğılmez³

et al. 2017

EÜ Dişhek Fak Derg

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ÖZET AMAÇ: Biobelirteçler normal dokuda, prekanseröz lezyonlarda ve kanserli dokuda farklı miktarlarda bulunabilen proteinler veya genlerdir, biobelirteçlerin değerlendirilmesi daha etkin bir şekilde malign transformasyon öngörüsü yapılmasını sağlayabilir. Bu çalışmanın amacı normal oral epitel, oral lökoplaki ve oral skuamoz hücreli karsinomada (OSHK) ghrelin seviyelerinin araştırılarak karşılaştırılmasıdır. YÖNTEM: Patoloji bölümü arşivinden elde edilen toplam 55 adet daha önce tanısı konulmuş normal oral mukoza (n = 15), oral lökoplaki (n = 18) ve OSHK (n = 22) bloklarından deparafinize edilerek elde edilen preparatlar özel antikorlar kullanılarak immünhistokimyasal olarak boyanmış ve ghrelin seviyeleri değerlendirilmiştir. İmmünhistokimyasal boyamada ghrelin mevcudiyeti mikroskop altında 100 hücre değerlendirilerek sayısallaştırılmıştır. Ghrelin pozitif hücrelerde kahverengi sitoplazmik boyama görülmüştür. BULGULAR: Normal oral mukozada hücrelerinin % 64'ünde, oral lökoplaki hücrelerinin % 66'sında ghrelin pozitif boyama görülürken, OSHK'da bu boyama yalnızca hücrelerin % 8'inde olmuştur. Diğer gruplar ile karşılaştırıldığı zaman OSHK grubunda ghrelin pozitif boyalı hücre miktarının istatistiksel olarak anlamlı şekilde az olduğu görülmüştür (P < 0.05). SONUÇ: Normal oral mukoza ve oral lökoplaki ile karşılaştırıldığı zaman OSHK grubunda ghrelin seviyesinin daha az olduğu tespit edilmiştir. Oral lökoplaki ve normal oral mukoza gruplarının ghrelinin seviyelerinin benzer olduğu belirlenmiştir. Oral karsinogenezis ile birlikte oluşan ghrelin seviyesinde ki değişikliklerin artmış malign potansiyelin belirlenmesinde bir biobelirteç olabileceği düşünülmektedir.

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Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility

Cited by 100 publications

References 60 publications

Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation

Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation

Predictive Value of Dysplasia Grading and DNA Ploidy in Malignant Transformation of Oral Potentially Malignant Disorders

The Evaluation of Ghrelin Expression In Oral Leukoplakia And Oral Squamous Cell Carcinoma: An Immunohistochemical Study

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