Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases

Zohdy, Marwa; Cazzaniga, Simone; Nievergelt, Helga; Blum, Roger; Suter, Valérie G.A.; Feldmeyer, Laurence; Beltraminelli, Helmut

doi:10.3390/dermatopathology8020013

Cited by 4 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering the difference in the diagnosis of epithelial dysplasia between OLP and LLO lesions, in a study involving oral lichenoid diseases, Zohdy et al, 37 in 2021, found a signi cantly higher degree of epithelial dysplasia in LLO cases compared to OLP cases (p = 0.03). However, in our study, the presence of epithelial dysplasia and the degree of severity did not statistically differ between OLP and LLO lesions.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Controversy: Dysplasia in Oral Lichen Planus - A Comparative Study Based on WHO Criteria and the Binary System

Marques,

Lopes,

Gonçalves

et al. 2024

Preprint

View full text Add to dashboard Cite

Background To assess the presence and degree of epithelial dysplasia of epithelial dysplasia according to the World Health Organization (WHO) criteria and the binary system in oral lichen planus (OLP) and oral lichenoid lesions (OLL), and to compare the influence of individual architectural and cytological criteria on the assessment of the degree of epithelial dysplasia in these lesions. Methods Sixty-five biopsies from lesions diagnosed as OLP and OLL underwent evaluation by two oral pathologists to diagnose oral epithelial dysplasia. This assessment utilized both WHO criteria and the binary system, with consideration given to individual architectural and cytological criteria in the diagnostic process. Results All biopsies showed epithelial dysplasia, with the majority classified as mild epithelial dysplasia according to WHO criteria (73.8%) and low risk by the binary system (61.5%). There was a statistically significant association in the classification of epithelial dysplasia between WHO criteria and the binary system. No statistically significant differences were found in the association of the presence and degree of epithelial dysplasia with the diagnosis of OLP and LLO. Statistical analysis indicated that an increase in the number of mitotic figures was associated with the severity of epithelial dysplasia (moderate/severe) according to the WHO system. Drop-shaped projections of epithelial ridges, an increased number of mitotic figures, superficial mitoses, premature keratinization in single cells, abnormal variation in cell shape, and atypical mitotic figures were associated with the high risk by the binary system. Conclusion The presence of epithelial dysplasia is common in both oral lichen planus and oral lichenoid lesions, and the degree of epithelial dysplasia does not statistically differ between these lesions. The absence of epithelial dysplasia should not be considered a diagnostic criterion for classifying OLP. The binary system may provide a more precise assessment of epithelial dysplasia in OLP and LLO lesions.

show abstract

Section: Discussionmentioning

confidence: 99%

Exploring the Controversy: Dysplasia in Oral Lichen Planus - A Comparative Study Based on WHO Criteria and the Binary System

Marques,

Lopes,

Gonçalves

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The only previous study that evaluated inter-observer agreement of epithelial dysplasia in oral lichenoid diseases, according to the 2017 WHO criteria ( 6 ). These authors evaluated 84 cases of proliferative verrucous leukoplakia (PVL) and 28 cases of OLL and found a wide variability in the interpretation of epithelial dysplasia, with low inter-observer reliability among the four examiners ( 24 ). The Kappa was classified as very low in the two repeated evaluations among the examiners.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the assessment of epithelial dysplasia in oral lichen planus and oral lichenoid lesion: Inter and intra-observer variability of the WHO criteria and binary system

Marques,

Montovani,

Gonçalves

et al. 2024

J Clin Exp Dent

View full text Add to dashboard Cite

Background Assessment of oral epithelial dysplasia is the gold standard for investigating the risk of malignant progression. The World Health Organization (WHO) methods and the binary system have limitations. This study assess the inter- and intra-observer variability of the architectural and cytological criteria and the classification of the presence and degree of epithelial dysplasia in oral lichen planus (OLP) and oral lichenoid lesion (OLL), using both the 2017 WHO criteria and the binary system. Material and Methods The sample consisted of 65 biopsies from lesions classified as OLP and OLL according to the American Academy of Oral and Maxillofacial Pathology (AAOMP) criteria. The histological slides were reevaluated by two oral pathologists. Results The individual alterations with most inter-observer disagreement were atypical mitotic figures (43.1%), loss of cohesion between epithelial cells (38.5%) and drop shape rete ridges ridges (38.5%). Inter-observer agreement analysis did not show statistically significant agreement regarding the classification of epithelial dysplasia grade by WHO criteria, only regarding the binary system classification (k=0.257; p =0.035). Intra-observer agreement analysis by evaluator 1 showed that the classification of epithelial dysplasia grade according to both methods had statistically significant agreement (k=0.546; p =0.004, k=0.861; p <0.001). Considering evaluator 2, only the evaluation of the WHO system classification showed statistically significant agreement (k=0.593; p =0.010). Conclusions The evaluation of epithelial dysplasia is subjective and focal changes and inflammatory infiltrate, characteristic of OLP and OLL, can increase the degree of disagreement among evaluators. The binary system presents better inter-observer agreement, while the WHO system presents better intra-observer agreement. Key words: Oral lichen planus, oral lichenoid lesion, oral lichenoid disease, dysplasia, inter-observer variation.

show abstract

“…The only previous study that evaluated inter-observer agreement of epithelial dysplasia in oral lichenoid diseases, according to the 2017 WHO criteria (6), was conducted by Zohdy et al (24) in 2021. These authors evaluated 84 cases of proliferative verrucous leukoplakia (PVL) and 28 cases of OLL and found a wide variability in the interpretation of epithelial dysplasia, with low inter-observer reliability among the four examiners (24). The Kappa was classi ed as very low, measuring 0.05 and 0.11, respectively, in the two repeated evaluations among the examiners.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding intra-observer agreement, the study by Zohdy et al (24) conducted in oral lichenoid diseases reported a slight improvement in intra-observer reliability during the evaluation of the epithelial dysplasia grading by the WHO system (6), which varied among examiners (κ = 0.34, κ = 0.36, κ = 0.52, and κ = 0.65) (moderate to substantial agreement).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it has been questioned in the literature whether the Kappa statistic, used to measure reproducibility in a dichotomous decision model in pathology, is the most appropriate (27), as it is believed that these verbal descriptors of reproducibility can be arbitrary (15). However, it is still the most widely used in the majority studies to date (20)(21)(22)24).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Challenges in the assessment of epithelial dysplasia in oral lichen planus and oral lichenoid lesion: Inter and intra-observer variability of the WHO criteria and binary system

Marques

Santos

Gonçalves

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Assessment of oral epithelial dysplasia is the gold standard for investigating the risk of malignant progression. The World Health Organization (WHO) methods and the binary system have limitations. In oral lichen planus (OLP) and in oral lichenoid lesion (OLL), the evaluation of epithelial dysplasia presents an additional difficulty due to the presence of epithelial alterations generated by the inflammatory process. This study aimed to assess the inter- and intra-observer variability of the architectural and cytological criteria and the classification of the presence and degree of epithelial dysplasia in OLP and OLL, using both the 2017 WHO criteria and the binary system. Methods The sample consisted of 65 biopsies from lesions classified as OLP and OLL according to the criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP) (excluding the absence of epithelial dysplasia for OLP). The histological slides were reevaluated by two oral pathologists. Results The individual alterations that showed the most inter-observer disagreement were atypical mitotic figures (43.1%), loss of cohesion between epithelial cells (38.5%), and drop shape rete ridges ridges (38.5%). Inter-observer agreement analysis did not show statistically significant agreement regarding the classification of epithelial dysplasia grade by WHO criteria, however, there was statistically significant agreement regarding the binary system classification (k = 0.257; p = 0.035). Intra-observer agreement analysis by evaluator 1 showed that the classification of epithelial dysplasia grade according to both methods had statistically significant agreement (k = 0.546; p = 0.004, k = 0.861; p < 0.001). Considering evaluator 2, only the evaluation of the WHO system classification showed statistically significant agreement (k = 0.593; p = 0.010). Conclusions The evaluation of epithelial dysplasia is subjective and influenced by each evaluator's individual experience. Subtle and focal changes and inflammatory infiltrate, characteristic of OLP and OLL, can increase the degree of disagreement among evaluators. The binary system presents better inter-observer agreement, while the WHO system presents better intra-observer agreement.

show abstract

Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases

Cited by 4 publications

References 16 publications

Exploring the Controversy: Dysplasia in Oral Lichen Planus - A Comparative Study Based on WHO Criteria and the Binary System

Exploring the Controversy: Dysplasia in Oral Lichen Planus - A Comparative Study Based on WHO Criteria and the Binary System

Challenges in the assessment of epithelial dysplasia in oral lichen planus and oral lichenoid lesion: Inter and intra-observer variability of the WHO criteria and binary system

Challenges in the assessment of epithelial dysplasia in oral lichen planus and oral lichenoid lesion: Inter and intra-observer variability of the WHO criteria and binary system

Contact Info

Product

Resources

About