Understanding interobserver variability of pathologists to improve oral epithelial dysplasia grading

Abstract

ObjectiveThis study aimed to understand reasons for interobserver variability in the grading of oral epithelial dysplasia (OED) through a survey of pathologists to provide insight for improvements in the reliability and reproducibility of OED diagnoses.MethodsThe study design included quantitative and qualitative methodology. A pre‐validated 31‐item questionnaire was distributed to general, head and neck, and oral and maxillofacial histopathology specialists worldwide.ResultsA total of 132 pathologists participated and completed the questionnaire. Over two‐thirds used the three‐tier grading system for OED, while about a third used both binary and three‐tier systems. Regular reporters of OED preferred the three‐tier system and grading architectural features. Continuing education significantly aided recognition of architectural and cytological changes. Irregular epithelial stratification and drop‐shaped rete ridges had the lowest prognostic value and recognition scores, while loss of epithelial cell cohesion had the highest. Most participants used clinical information and often sought a second opinion when grading OED.ConclusionOur study has found that frequency of OED reporting and attendance of CME/CPD can play an important role in grading OED. Variations in the prognostic value of individual histological features and the use of clinical information may further contribute to interobserver variability.