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Uppal S, Kumar Shrivastava P, Khan A, Sharma A, Kumar Shrivastav A. Machine learning methods in predicting the risk of malignant transformation of oral potentially malignant disorders: A systematic review. Int J Med Inform 2024; 186:105421. [PMID: 38552265 DOI: 10.1016/j.ijmedinf.2024.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Oral Potentially Malignant Disorders (OPMDs) refer to a heterogenous group of clinical presentations with heightened rate of malignant transformation. Identification of risk levels in OPMDs is crucial to determine the need for active intervention in high-risk patients and routine follow-up in low-risk ones. Machine learning models has shown tremendous potential in several areas of dentistry that strongly suggest its application to estimate rate of malignant transformation of precancerous lesions. METHODS A comprehensive literature search was performed on Pubmed/MEDLINE, Web of Science, Scopus, Embase, Cochrane Library database to identify articles including machine learning models and algorithms to predict malignant transformation in OPMDs. Relevant bibliographic data, study characteristics, and outcomes were extracted for eligible studies. Quality of the included studies was assessed through the IJMEDI checklist. RESULTS Fifteen articles were found suitable for the review as per the PECOS criteria. Amongst all studies, highest sensitivity (100%) was recorded for U-net architecture, Peaks Random forest model, and Partial least squares discriminant analysis (PLSDA). Highest specificity (100%) was noted for PLSDA. Range of overall accuracy in risk prediction was between 95.4% and 74%. CONCLUSION Machine learning proved to be a viable tool in risk prediction, demonstrating heightened sensitivity, automation, and improved accuracy for predicting transformation of OPMDs. It presents an effective approach for incorporating multiple variables to monitor the progression of OPMDs and predict their malignant potential. However, its sensitivity to dataset characteristics necessitates the optimization of input parameters to maximize the efficiency of the classifiers.
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Affiliation(s)
- Simran Uppal
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
| | | | - Atiya Khan
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
| | - Aditi Sharma
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
| | - Ayush Kumar Shrivastav
- Computer Science and Engineering, Centre for Development of Advanced Computing, Noida, Uttar Pradesh, India.
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Kallarakkal TG, Zaini ZM, Ghani WMN, Karen-Ng LP, Siriwardena BSMS, Cheong SC, Tilakaratne WM. Calibration improves the agreement in grading oral epithelial dysplasia-Findings from a National Workshop in Malaysia. J Oral Pathol Med 2024; 53:53-60. [PMID: 38081145 DOI: 10.1111/jop.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems. METHODS A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems. RESULTS A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; Kw 0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise. CONCLUSION This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.
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Affiliation(s)
- Thomas George Kallarakkal
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zuraiza Mohamad Zaini
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Maria Nabillah Ghani
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Lee Peng Karen-Ng
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - B S M S Siriwardena
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Wang S, Rong R, Zhou Q, Yang DM, Zhang X, Zhan X, Bishop J, Chi Z, Wilhelm CJ, Zhang S, Pickering CR, Kris MG, Minna J, Xie Y, Xiao G. Deep learning of cell spatial organizations identifies clinically relevant insights in tissue images. Nat Commun 2023; 14:7872. [PMID: 38081823 PMCID: PMC10713592 DOI: 10.1038/s41467-023-43172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
Recent advancements in tissue imaging techniques have facilitated the visualization and identification of various cell types within physiological and pathological contexts. Despite the emergence of cell-cell interaction studies, there is a lack of methods for evaluating individual spatial interactions. In this study, we introduce Ceograph, a cell spatial organization-based graph convolutional network designed to analyze cell spatial organization (for example,. the cell spatial distribution, morphology, proximity, and interactions) derived from pathology images. Ceograph identifies key cell spatial organization features by accurately predicting their influence on patient clinical outcomes. In patients with oral potentially malignant disorders, our model highlights reduced structural concordance and increased closeness in epithelial substrata as driving features for an elevated risk of malignant transformation. In lung cancer patients, Ceograph detects elongated tumor nuclei and diminished stroma-stroma closeness as biomarkers for insensitivity to EGFR tyrosine kinase inhibitors. With its potential to predict various clinical outcomes, Ceograph offers a deeper understanding of biological processes and supports the development of personalized therapeutic strategies.
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Affiliation(s)
- Shidan Wang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Ruichen Rong
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qin Zhou
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donghan M Yang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xinyi Zhang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaowei Zhan
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhikai Chi
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Clare J Wilhelm
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Siyuan Zhang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Mark G Kris
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Minna
- Hamon Center for Therapeutic Oncology Research, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yang Xie
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
- Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA.
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Zhang X, Gleber‐Netto FO, Wang S, Martins‐Chaves RR, Gomez RS, Vigneswaran N, Sarkar A, William WN, Papadimitrakopoulou V, Williams M, Bell D, Palsgrove D, Bishop J, Heymach JV, Gillenwater AM, Myers JN, Ferrarotto R, Lippman SM, Pickering CR, Xiao G. Deep learning-based pathology image analysis predicts cancer progression risk in patients with oral leukoplakia. Cancer Med 2023; 12:7508-7518. [PMID: 36721313 PMCID: PMC10067069 DOI: 10.1002/cam4.5478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/15/2022] [Accepted: 11/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oral leukoplakia (OL) is associated with an increased risk for oral cancer (OC) development. Prediction of OL cancer progression may contribute to decreased OC morbidity and mortality by favoring early intervention. Current OL progression risk assessment approaches face large interobserver variability and is weakly prognostic. We hypothesized that convolutional neural networks (CNN)-based histology image analyses could accelerate the discovery of better OC progression risk models. METHODS Our CNN-based oral mucosa risk stratification model (OMRS) was trained to classify a set of nondysplastic oral mucosa (OM) and a set of OC H&E slides. As a result, the OMRS model could identify abnormal morphological features of the oral epithelium. By applying this model to OL slides, we hypothesized that the extent of OC-like features identified in the OL epithelium would correlate with its progression risk. The OMRS model scored and categorized the OL cohort (n = 62) into high- and low-risk groups. RESULTS OL patients classified as high-risk (n = 31) were 3.98 (95% CI 1.36-11.7) times more likely to develop OC than low-risk ones (n = 31). Time-to-progression significantly differed between high- and low-risk groups (p = 0.003). The 5-year OC development probability was 21.3% for low-risk and 52.5% for high-risk patients. The predictive power of the OMRS model was sustained even after adjustment for age, OL site, and OL dysplasia grading (HR = 4.52, 1.5-13.7). CONCLUSION The ORMS model successfully identified OL patients with a high risk of OC development and can potentially benefit OC early diagnosis and prevention policies.
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Affiliation(s)
- Xinyi Zhang
- Quantitative Biomedical Research Center, Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Shidan Wang
- Quantitative Biomedical Research Center, Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical SciencesThe University of Texas Health Science Center at Houston School of DentistryHoustonTexasUSA
| | - Arunangshu Sarkar
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - William N. William
- Department of Thoracic‐Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Hospital BPA Beneficência Portuguesa de São PauloSao PaoloBrazil
| | - Vassiliki Papadimitrakopoulou
- Department of Thoracic‐Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Global Product DevelopmentOncology, Pfizer, Inc.New YorkNew YorkUSA
| | - Michelle Williams
- Department of Anatomical PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Diana Bell
- Department of Anatomical PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of PathologyCity of HopeDuarteCaliforniaUSA
| | - Doreen Palsgrove
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Justin Bishop
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - John V. Heymach
- Department of Thoracic‐Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ann M. Gillenwater
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jeffrey N. Myers
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Renata Ferrarotto
- Department of Thoracic‐Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Scott M. Lippman
- Department of Thoracic‐Head & Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Curtis Rg Pickering
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of BioinformaticsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Embaló B, Miguel AFP, Konrath AC, Modolo F, Rivero ERC. Evaluation of two classification systems for oral epithelial dysplasia. Oral Dis 2023; 29:100-104. [PMID: 33813775 DOI: 10.1111/odi.13867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Bubacar Embaló
- Postgraduate Program in Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Andressa Fernanda Paza Miguel
- Postgraduate Program in Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Andrea Cristina Konrath
- Department of Informatics and Statistics, Technological Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Filipe Modolo
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
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Chiang TE, Lin YC, Wu CT, Wu ST, Chen YW. Association between socioeconomic status and severity of oral epithelial dysplasia using a Taiwanese Nationwide Oral Mucosal Screening Program: a retrospective analysis. BMC Oral Health 2022; 22:56. [PMID: 35246076 PMCID: PMC8895639 DOI: 10.1186/s12903-022-02084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The study aimed to investigate the association between socioeconomic status and severity of oral epithelial dysplasia (OED) using current data from the Taiwanese Nationwide Oral Mucosal Screening Program (TNOMSP). METHODS This retrospective analysis was conducted in the Department of Oral and Maxillofacial Surgery at a general hospital in Taipei, Taiwan. A total of 134 participants were analysed from a previous study database of 150 patients. The inclusion criteria included age > 20 years and a history of either tobacco or betel nut use. Background information, including para-habits such as betel and tobacco use, was analysed using the Pearson chi-square (χ2) test; furthermore, the correlation of background information with OED severity was investigated using logistic regression (mild or moderate/severe). RESULTS High school education level (P < 0.001), poor self-awareness (P = 0.002), current betel use (P < 0.001), and tobacco use (P = 0.003) were highly correlated with moderate- and severe OED (P < 0.05). The odds ratio (OR) of education status above senior high school was 0.03 (95% confidence interval [CI] 0.01-0.15, P < 0.001), while that of junior high school was 1. Current betel chewing (OR 6.57 [95% CI 1.17-37.0], P = 0.033) was significantly associated with OED severity compared with never or ex-use of betel. CONCLUSIONS We found a strong correlation between the severity of OED and current betel use and low education status. The current study revealed that the socioeconomic status, poor self-awareness, and para-habit history of the patients with OED should be evaluated to identify high-risk individuals using TNOMSP.
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Affiliation(s)
- Tien-En Chiang
- Division of Oral and Maxillofacial Surgery, Tri-Service General Hospital, No. 325, Cheng-Kung Rd., Sec. 2, Neihu District, Taipei City, 11490, Taiwan, ROC
- School of Dentistry, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, ROC
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Chi-Tsung Wu
- Division of Oral and Maxillofacial Surgery, Tri-Service General Hospital, No. 325, Cheng-Kung Rd., Sec. 2, Neihu District, Taipei City, 11490, Taiwan, ROC
- School of Dentistry, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, ROC
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, ROC
| | - Yuan-Wu Chen
- Division of Oral and Maxillofacial Surgery, Tri-Service General Hospital, No. 325, Cheng-Kung Rd., Sec. 2, Neihu District, Taipei City, 11490, Taiwan, ROC.
- School of Dentistry, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, ROC.
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Khoury ZH, Sultan M, Sultan AS. Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis. Int J Surg Pathol 2022; 30:499-511. [PMID: 34994584 DOI: 10.1177/10668969211070171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^2 statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.
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Affiliation(s)
- Zaid H Khoury
- Meharry Medical College, School of Dentistry, Department of Oral Diagnostic Sciences & Research, Nashville, TN, USA
| | - Mohamed Sultan
- Western Vascular Institute, University College Hospital, Galway, Ireland
| | - Ahmed S Sultan
- 12265University of Maryland School of Dentistry, Baltimore, MD, USA.,12265University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA
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Sathasivam HP, Sloan P, Thomson PJ, Robinson M. The clinical utility of contemporary oral epithelial dysplasia grading systems. J Oral Pathol Med 2021; 51:180-187. [PMID: 34797585 DOI: 10.1111/jop.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. METHODS Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. RESULTS 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. CONCLUSION This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).
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Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Philip Sloan
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,AMLo Biosciences, Newcastle upon Tyne, UK
| | - Peter J Thomson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Max Robinson
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Kierce J, Shi Y, Klieb H, Blanas N, Xu W, Magalhaes M. Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia. Head Neck 2021; 43:3552-3561. [PMID: 34472151 DOI: 10.1002/hed.26851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Factors that increase the risk of malignant transformation of oral epithelial dysplasia (OED) are not completely elucidated. METHODS A retrospective chart review was performed assessing risk factors for transformation of OED, and cancer staging for transformed cases at Sunnybrook Health Sciences Centre. RESULTS Two-hundred four patients were diagnosed with OED, and 16.7% (34) underwent malignant transformation. Risk factors associated with transformation included: heavy tobacco smoking, excessive EtOH consumption, non-homogenous leukoplakia, size >200 mm2 , moderate dysplasia or greater than moderate, progression of dysplasia grades, and immunosuppression. Transformed cases followed for a dysplastic lesion were associated with a stage-I cancer diagnosis, and cancer cases with no prior biopsy were associated with a stage-IV diagnosis. CONCLUSIONS In addition to commonly cited risk factors, immunosuppression was associated with malignant transformation, including the use of topical steroids. Analyzing risk factors can help clinicians define risk of progression in patients with OED.
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Affiliation(s)
- Justin Kierce
- Oral & Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yuliang Shi
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Hagen Klieb
- Sunnybrook Health Sciences Centre, Department of Dental and Maxillofacial Sciences, Toronto, Ontario, Canada
| | - Nick Blanas
- Sunnybrook Health Sciences Centre, Department of Dental and Maxillofacial Sciences, Toronto, Ontario, Canada.,Oral & Maxillofacial Surgery, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marco Magalhaes
- Sunnybrook Health Sciences Centre, Department of Dental and Maxillofacial Sciences, Toronto, Ontario, Canada.,Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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10
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Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021; 27:1947-1976. [PMID: 34418233 DOI: 10.1111/odi.13993] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
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Affiliation(s)
- Edward Odell
- King's College London and Head and Neck Pathology Guy's Hospital, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King's College London and The WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Chief Histopathologist, AMLo Biosciences, Newcastle upon Tyne, UK
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11
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Gilvetti C, Soneji C, Bisase B, Barrett AW. Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit. Oral Oncol 2021; 121:105462. [PMID: 34303087 DOI: 10.1016/j.oraloncology.2021.105462] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). MATERIALS & METHODS A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). RESULTS Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). CONCLUSION Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
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Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Chandni Soneji
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew William Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
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Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4329-4340. [PMID: 34050426 DOI: 10.1007/s00784-021-04008-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems. MATERIAL AND METHODS A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED). RESULTS The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I2 = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I2 = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64). CONCLUSIONS Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation. CLINICAL RELEVANCE The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.
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