1
|
Ghosh SK, Man Y, Fraiwan A, Waters C, McKenzie C, Lu C, Pfau D, Kawsar H, Bhaskaran N, Pandiyan P, Jin G, Briggs F, Zender CC, Rezaee R, Panagakos F, Thuener JE, Wasman J, Tang A, Qari H, Wise-Draper T, McCormick TS, Madabhushi A, Gurkan UA, Weinberg A. Beta-defensin index: A functional biomarker for oral cancer detection. Cell Rep Med 2024; 5:101447. [PMID: 38442713 PMCID: PMC10983043 DOI: 10.1016/j.xcrm.2024.101447] [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: 06/28/2023] [Revised: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
There is an unmet clinical need for a non-invasive and cost-effective test for oral squamous cell carcinoma (OSCC) that informs clinicians when a biopsy is warranted. Human beta-defensin 3 (hBD-3), an epithelial cell-derived anti-microbial peptide, is pro-tumorigenic and overexpressed in early-stage OSCC compared to hBD-2. We validate this expression dichotomy in carcinoma in situ and OSCC lesions using immunofluorescence microscopy and flow cytometry. The proportion of hBD-3/hBD-2 levels in non-invasively collected lesional cells compared to contralateral normal cells, obtained by ELISA, generates the beta-defensin index (BDI). Proof-of-principle and blinded discovery studies demonstrate that BDI discriminates OSCC from benign lesions. A multi-center validation study shows sensitivity and specificity values of 98.2% (95% confidence interval [CI] 90.3-99.9) and 82.6% (95% CI 68.6-92.2), respectively. A proof-of-principle study shows that BDI is adaptable to a point-of-care assay using microfluidics. We propose that BDI may fulfill a major unmet need in low-socioeconomic countries where pathology services are lacking.
Collapse
Affiliation(s)
- Santosh K Ghosh
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | - Arwa Fraiwan
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | | | - Crist McKenzie
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Cheng Lu
- Center for Computational Imaging & Personalized Diagnostics, CWRU, Cleveland, OH, USA
| | - David Pfau
- School of Medicine, CWRU, Cleveland, OH, USA
| | - Hameem Kawsar
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Natarajan Bhaskaran
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Pushpa Pandiyan
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Ge Jin
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, USA
| | - Chad C Zender
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Rod Rezaee
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Fotinos Panagakos
- West Virginia University (WVU) School of Dentistry, Morgantown, WV, USA
| | - Jason E Thuener
- Department of Otolaryngology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Jay Wasman
- Department of Pathology, University Hospital of Cleveland, Cleveland, OH, USA
| | - Alice Tang
- Otolaryngology, Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hiba Qari
- Department of Diagnostic Sciences, WVU School of Dentistry, Morgantown, WV, USA
| | - Trisha Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA
| | - Aaron Weinberg
- Biological Sciences, Case School of Dental Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU), Cleveland, OH, USA.
| |
Collapse
|
2
|
Zdrojewski J, Nowak M, Nijakowski K, Jankowski J, Scribante A, Gallo S, Pascadopoli M, Surdacka A. Potential Immunohistochemical Biomarkers for Grading Oral Dysplasia: A Literature Review. Biomedicines 2024; 12:577. [PMID: 38540190 PMCID: PMC10967812 DOI: 10.3390/biomedicines12030577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 09/18/2024] Open
Abstract
Oral cancer is a prevalent global health issue, with significant morbidity and mortality rates. Despite available preventive measures, it remains one of the most common cancers, emphasising the need for improved diagnostic and prognostic tools. This review focuses on oral potentially malignant disorders (OPMDs), precursors to oral cancer, specifically emphasising oral epithelial dysplasia (OED). The World Health Organisation (WHO) provides a three-tier grading system for OED, and recent updates have expanded the criteria to enhance diagnostic precision. In the prognostic evaluation of OED, histological grading is presently regarded as the gold standard; however, its subjectivity and unreliability in anticipating malignant transformation or recurrence pose notable limitations. The primary objective is to investigate whether specific immunohistochemical biomarkers can enhance OED grading assessment according to the WHO classification. Biomarkers exhibit significant potential for comprehensive cancer risk evaluation, early detection, diagnosis, prognosis, and treatment optimisation. Technological advancements, including sequencing and nanotechnology, have expanded detection capabilities. Some analysed biomarkers are most frequently chosen, such as p53, Ki-67, cadherins/catenins, and other proteins used to differentiate OED grades. However, further research is needed to confirm these findings and discover new potential biomarkers for precise dysplasia grading and minimally invasive assessment of the risk of malignant transformation.
Collapse
Affiliation(s)
- Jakub Zdrojewski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (J.Z.); (M.N.); (A.S.)
| | - Monika Nowak
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (J.Z.); (M.N.); (A.S.)
| | - Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (J.Z.); (M.N.); (A.S.)
| | - Jakub Jankowski
- Student’s Scientific Group, Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland;
| | - Andrea Scribante
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.G.)
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simone Gallo
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.G.)
| | - Maurizio Pascadopoli
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.G.)
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (J.Z.); (M.N.); (A.S.)
| |
Collapse
|
3
|
Lubrano M, Bellahsen-Harrar Y, Berlemont S, Atallah S, Vaz E, Walter T, Badoual C. Diagnosis with confidence: deep learning for reliable classification of laryngeal dysplasia. Histopathology 2024; 84:343-355. [PMID: 37872676 DOI: 10.1111/his.15067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Diagnosis of head and neck (HN) squamous dysplasias and carcinomas is critical for patient care, cure, and follow-up. It can be challenging, especially for grading intraepithelial lesions. Despite recent simplification in the last WHO grading system, the inter- and intraobserver variability remains substantial, particularly for nonspecialized pathologists, exhibiting the need for new tools to support pathologists. METHODS In this study we investigated the potential of deep learning to assist the pathologist with automatic and reliable classification of HN lesions following the 2022 WHO classification system. We created, for the first time, a large-scale database of histological samples (>2000 slides) intended for developing an automatic diagnostic tool. We developed and trained a weakly supervised model performing classification from whole-slide images (WSI). We evaluated our model on both internal and external test sets and we defined and validated a new confidence score to assess the predictions that can be used to identify difficult cases. RESULTS Our model demonstrated high classification accuracy across all lesion types on both internal and external test sets (respectively average area under the curve [AUC]: 0.878 (95% confidence interval [CI]: [0.834-0.918]) and 0.886 (95% CI: [0.813-0.947])) and the confidence score allowed for accurate differentiation between reliable and uncertain predictions. CONCLUSION Our results demonstrate that the model, associated with confidence measurements, can help in the difficult task of classifying HN squamous lesions by limiting variability and detecting ambiguous cases, taking us one step closer to a wider adoption of AI-based assistive tools.
Collapse
Affiliation(s)
- Mélanie Lubrano
- Centre for Computational Biology (CBIO), Mines Paris, PSL University, Paris, France
- Keen Eye, Paris, France
- Tribun Health, Paris, France
| | - Yaëlle Bellahsen-Harrar
- Department of Pathology, APHP, Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Cité, Paris, France
| | | | - Sarah Atallah
- Sorbonne Université, Paris, France
- Head and Neck Surgery Department, Hôpital Tenon, Paris, France
| | | | - Thomas Walter
- Centre for Computational Biology (CBIO), Mines Paris, PSL University, Paris, France
- Institut Curie, PSL Université, Paris, France
- INSERM U900, Paris, France
| | - Cécile Badoual
- Department of Pathology, APHP, Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Cité, Paris, France
| |
Collapse
|
4
|
Marques LC, Montovani PDP, Gonçalves LS, Cunha KS, Junior AS, Conde DC. 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. J Clin Exp Dent 2024; 16:e62-e70. [PMID: 38314343 PMCID: PMC10837801 DOI: 10.4317/jced.61073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Letícia-Côgo Marques
- Ph.D. Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Pâmella-de Pinho Montovani
- M.Sc. Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Lúcio-Souza Gonçalves
- Ph.D. Postgraduation Program in Dentistry, Faculty of Dentistry, Universidade Estácio de Sá, Rio de Janeiro-RJ, Brazil
| | - Karin-Soares Cunha
- Ph.D. Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Arley-Silva Junior
- Ph.D. Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Danielle-Castex Conde
- Ph.D. Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| |
Collapse
|
5
|
Ribeiro MGM, Dolabella SS, Trento CL, Barros JDS, Freitas VS, Daltoé FP, Grando LJ, Machado MJ, Onofre FBDM, Onofre ASC. DNA-ICM as an adjuvant method applied on oral cytological specimens. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:714-721. [PMID: 38007692 DOI: 10.1016/j.oooo.2023.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate cytology diagnosis accuracy using adjuvant methods in clinical routine for oral cancer. STUDY DESIGN This prospective study was conducted on 98 patients with clinically potentially malignant or malignant oral cavity lesions. One oral lesion smear was taken from each patient using a cytobrush before biopsy and stored at PreservCyt Thinprep. Samples were cytologically analyzed, and DNA ploidy measurement was performed on the same slide. The diagnostic methods' accuracy was then calculated. RESULTS In clinical inspection, 61 patients had suspicious lesions for malignancy, whereas 37 had potentially malignant disorders. Cytology associated with DNA image cytometry presented a sensitivity of 81.2% and specificity of 90.9%. When analyzing lesions located in high-risk sites to oral malignancies individually, cytology associated with DNA image cytometry presented a sensitivity of 88.2%, specificity of 100.0%, accuracy of 90.0%, and Kappa value of 0.77 (CI 95%: 0.48-1.00). CONCLUSIONS Association between cytology and DNA image cytometry is an objective and non-invasive diagnostic method that demonstrated high sensitivity and specificity in diagnosing malignant epithelial squamous cell transformation in the oral cavity.
Collapse
Affiliation(s)
- Mariana Goveia Melo Ribeiro
- Federal University of Santa Catarina, Department of Clinical Analysis, Florianópolis, Santa Catarina, Brazil.
| | | | | | - Juliana da Silva Barros
- State University of Feira de Santana, Oral Cancer Center-NUCAO, Feira de Santana, Bahia, Brazil
| | - Valéria Souza Freitas
- State University of Feira de Santana, Oral Cancer Center-NUCAO, Feira de Santana, Bahia, Brazil
| | - Felipe Perozzo Daltoé
- Federal University of Santa Catarina, Department of Dentistry, Florianópolis, Santa Catarina, Brazil
| | - Liliane Janete Grando
- Federal University of Santa Catarina, Department of Dentistry, Florianópolis, Santa Catarina, Brazil
| | - Marcos José Machado
- Federal University of Santa Catarina, Department of Clinical Analysis, Florianópolis, Santa Catarina, Brazil
| | | | | |
Collapse
|
6
|
Dehan LM, Lewis JS, Mehrad M, Ely KA. Patterns of Major Frozen Section Interpretation Error: An In-Depth Analysis From a Complex Academic Surgical Pathology Practice. Am J Clin Pathol 2023; 160:247-254. [PMID: 37141256 DOI: 10.1093/ajcp/aqad040] [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: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To establish baseline error rates due to misinterpretation and to identify scenarios in which major errors were most common and potentially preventable. METHODS Our database was queried over a 3-year period for major discrepancies due to misinterpretation. These were stratified by histomorphologic setting, service, availability/type of prior material, and years of experience and subspecialization of the interpreting pathologist. RESULTS The overall discordance rate between frozen section (FS) and final diagnoses was 2.9% (199/6,910). Seventy-two errors were due to interpretation, of which 34 (47.2%) were major. Major error rates were highest on the gastrointestinal and thoracic services. Of major discrepancies, 82.4% were rendered in subdisciplines outside those of the FS pathologist. Pathologists with fewer than 10 years' experience made more errors than those with more experience (55.9% vs 23.5%, P = .006). Major error rates were greater for cases without previous material compared to those with a prior glass slide (47.1% vs 17.6%, P = .009). Common histomorphologic scenarios in which disagreements were made involved discriminating mesothelial cells from carcinoma (20.6%) and accurately recognizing squamous carcinoma/severe dysplasia (17.6%). CONCLUSIONS To improve performance and decrease future misdiagnoses, monitoring discordances should be a continuous component of surgical pathology quality assurance programs.
Collapse
Affiliation(s)
- Lauren M Dehan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Kim A Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| |
Collapse
|
7
|
Zhang X, Gleber-Netto FO, Wang S, Jin KW, Yang DM, Gillenwater AM, Myers JN, Ferrarotto R, Pickering CR, Xiao G. A Deep Learning Onion Peeling Approach to Measure Oral Epithelium Layer Number. Cancers (Basel) 2023; 15:3891. [PMID: 37568707 PMCID: PMC10416878 DOI: 10.3390/cancers15153891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/13/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC), specifically in the oral cavity (oral squamous cell carcinoma, OSCC), is a common, complex cancer that significantly affects patients' quality of life. Early diagnosis typically improves prognoses yet relies on pathologist examination of histology images that exhibit high inter- and intra-observer variation. The advent of deep learning has automated this analysis, notably with object segmentation. However, techniques for automated oral dysplasia diagnosis have been limited to shape or cell stain information, without addressing the diagnostic potential in counting the number of cell layers in the oral epithelium. Our study attempts to address this gap by combining the existing U-Net and HD-Staining architectures for segmenting the oral epithelium and introducing a novel algorithm that we call Onion Peeling for counting the epithelium layer number. Experimental results show a close correlation between our algorithmic and expert manual layer counts, demonstrating the feasibility of automated layer counting. We also show the clinical relevance of oral epithelial layer number to grading oral dysplasia severity through survival analysis. Overall, our study shows that automated counting of oral epithelium layers can represent a potential addition to the digital pathology toolbox. Model generalizability and accuracy could be improved further with a larger training dataset.
Collapse
Affiliation(s)
- Xinyi Zhang
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (S.W.); (D.M.Y.)
| | - Frederico O. Gleber-Netto
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (A.M.G.); (J.N.M.)
| | - Shidan Wang
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (S.W.); (D.M.Y.)
| | - Kevin W. Jin
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (S.W.); (D.M.Y.)
| | - Donghan M. Yang
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (S.W.); (D.M.Y.)
| | - Ann M. Gillenwater
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (A.M.G.); (J.N.M.)
| | - Jeffrey N. Myers
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (A.M.G.); (J.N.M.)
| | - Renata Ferrarotto
- Department of Thoracic Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | | | - Guanghua Xiao
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA (S.W.); (D.M.Y.)
- Department of Bioinformatics, The University of Texas Southwestern Medical Center, Dallas, TX 76104, USA
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX 76104, USA
| |
Collapse
|
8
|
Wolk R, Lingen MW. Proceedings of the North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Oral Cavity Dysplasia: Why Does Histologic Grading Continue to be Contentious? Head Neck Pathol 2023; 17:292-298. [PMID: 37184731 PMCID: PMC10293486 DOI: 10.1007/s12105-023-01544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the world's 6th most common malignancy. Oral cavity SCC (OCSCC) represents approximately one third of the HNSCC cases diagnosed annually in the United States. Despite therapeutic advances, OCSCC is frequently lethal, with a modest 5-year survival. Because OCSCC is often preceded by premalignant lesions, it is an ideal disease for screening initiatives. The conventional visual and tactile exam (CVTE), coupled with a tissue biopsy, remains the gold standard. However, CVTE alone cannot reliably differentiate between reactive/inflammatory and dysplastic lesions. Further, the histologic diagnosis of dysplasia is subjective in nature and a highly imperfect predictor of malignant transformation. This prognostic uncertainty creates a significant clinical management dilemma-watchful waiting with increased patient psychological and economic burdens versus unnecessary aggressive treatment. As such, the development and validation of novel diagnostic platforms such as Artificial Intelligence (AI) and prognostic molecular biomarkers may help address these critical unmet clinical needs.
Collapse
Affiliation(s)
- Rachelle Wolk
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA.
| |
Collapse
|
9
|
Kitahara ABP, Michels AC, Luiz ST, Nagashima S, Camargo Martins AP, de Azevedo MLV, Azevedo Alanis LR, Couto Souza PH, Ignácio SA, de Noronha L, Bettega PVC, Tyski MCA, Quispe EMP, Mozzer I, Souto GR, Aguiar MCF, Modolo F, Scariot R, Jham BC, Hardy AMTG, Johann ACBR. Immunohistochemical detection of NANOG in oral leukoplakia. Oral Dis 2023; 29:376-379. [PMID: 33915012 DOI: 10.1111/odi.13891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 02/05/2023]
Affiliation(s)
| | | | - Suelen Teixeira Luiz
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Seigo Nagashima
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Ana Paula Camargo Martins
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | | | - Luciana Reis Azevedo Alanis
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Paulo Henrique Couto Souza
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Sérgio Aparecido Ignácio
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Lucia de Noronha
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | | | - Maria Carolina Albini Tyski
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Edinson Manuel Pérez Quispe
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Izabela Mozzer
- Pontifícia Universidade Católica do Paraná. Imaculada Conceição, 1155, Prado Velho, Curitiba-PR, 80215-901, Brazil
| | - Giovanna Ribeiro Souto
- Pontifícia Universidade Católica de Minas Gerais. Avenida Dom José Gaspar, 500. Bairro Coração Eucaristico, Belo Horizonte, Minas Gerais, GEP, 30535-901
| | - Maria Cássia Ferreira Aguiar
- Universidade Federal de Minas Gerais, Avenida Presidente Antonio Carlos 6627 - Pampulha, Belo Horizonte - MG, 31270-901, Brazil
| | - Filipe Modolo
- Universidade Federal de Santa Catarina, Eng. Agronômico Andrei Cristian Ferreira, s/n - Trindade, Florianópolis - SC, 88040-900, Brazil
| | - Rafaela Scariot
- Universidade Federal do Paraná. Avenida Pref. Lothário Meissner, 632, Jardim Botanico, Curitiba-PR, 80210-170, Brazil
| | | | | | | |
Collapse
|
10
|
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
| |
Collapse
|
11
|
Akafzadeh N, Baghaei F, Derakhshan S, Moradzadeh Khiavi M, Kharazifard M, Aminishakib P. Combination of Binary System with Ki67 Immunohistochemical Staining: a Reliable Grading Method for Oral Epithelial Dysplasia. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2022; 23:377-382. [PMID: 36588968 PMCID: PMC9789337 DOI: 10.30476/dentjods.2021.91032.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/12/2021] [Accepted: 08/29/2021] [Indexed: 01/03/2023]
Abstract
Statement of the Problem Oral epithelial dysplasia (OED) is a common potentially malignant lesion of oral cavity that should be managed to prevent likely malignant transformation. Purpose Here, we present a combination of binary grading system with complementary immunohistochemical (IHC) staining for Ki67 biomarker to provide a reproducible OED grading system. Materials and Method In this cross-sectional study, seventy out of one hundred OED specimens, which were accompanied by IHC stained microscopic slides for Ki67 antigen were evaluated by four independent oral pathologists. Both three-tier and binary grading systems based on WHO microscopic criteria were employed , blindly in a four-step method with at least two-week interval between each observation. Intra- and inter-observational reliability was assessed using Kappa statistical analysis. Results OED diagnosis based on binary system showed significant intra-observer reliability comparing to three-tier system without biomarker. Moreover, OED diagnosis based on binary system using Ki67 biomarker showed significant inter-observer reliability comparing to diagnosis in three tier system and based on binary system without Ki67 biomarker showed significant inter-observer reliability comparing to diagnosis based on three-tier system without Ki67. Conclusion Here, we found that application of IHC staining for Ki67 biomarker in binary system might provide a more reliable grading method for oral pathologist form different educational background.
Collapse
Affiliation(s)
- Negar Akafzadeh
- Postgraduate Student of Pediatric Dentistry, Dept. of Pediatric Dentistry, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fereshteh Baghaei
- Retired Professor, Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Derakhshan
- Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Monir Moradzadeh Khiavi
- Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamadjavad Kharazifard
- Researcher, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouyan Aminishakib
- Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Behl I, Calado G, Vishwakarma A, Traynor D, Flint S, Galvin S, Healy CM, Pimentel ML, Malkin A, Byrne HJ, Lyng FM. Classification of cytological samples from oral potentially malignant lesions through Raman spectroscopy: A pilot study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 266:120437. [PMID: 34627019 DOI: 10.1016/j.saa.2021.120437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
The potential of Raman microspectroscopy of exfoliated cells has been demonstrated for oral cancer diagnosis. In this study, brush biopsies were collected from the buccal mucosa/tongue of healthy donors (n = 31) and from oral mucosal dysplastic lesions (n = 31 patients). Raman spectra were acquired and subjected to partial least squares-discriminant analysis (PLS-DA). The patient samples could be differentiated from healthy donor samples with 96% sensitivity and 95% specificity. Furthermore, PLS-DA models were developed based on cytopathological and histopathological assessment. Low and high grade dysplasia could be discriminated with 64% sensitivity and 65% specificity based on cytopathological assessment, while 81% sensitivity and 86% specificity could be achieved when histopathological assessment was within six months of the brush biopsy sampling. Therefore, this explorative study has successfully demonstrated that Raman spectroscopy may have a role in monitoring patients with dysplasia and may reduce the need for multiple biopsies.
Collapse
Affiliation(s)
- Isha Behl
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland.
| | - Genecy Calado
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Anika Vishwakarma
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Damien Traynor
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Stephen Flint
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Sheila Galvin
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Claire M Healy
- Oral Medicine Unit, Dublin Dental University Hospital, Trinity College Dublin, Ireland
| | - Marina Leite Pimentel
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Alison Malkin
- School of Biological and Health Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| | - Hugh J Byrne
- FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland
| | - Fiona M Lyng
- Centre for Radiation and Environmental Science, FOCAS Research Institute, Technological University Dublin, City Campus, Dublin, Ireland; School of Physics & Clinical & Optometric Sciences, Technological University Dublin, City Campus, Dublin, Ireland
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Samuelson MI, Chen SJ, Boukhar SA, Schnieders EM, Walhof ML, Bellizzi AM, Robinson RA, Rajan K D A. Rapid Validation of Whole-Slide Imaging for Primary Histopathology Diagnosis. Am J Clin Pathol 2021; 155:638-648. [PMID: 33511392 PMCID: PMC7929400 DOI: 10.1093/ajcp/aqaa280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The ongoing global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitates adaptations in the practice of surgical pathology at scale. Primary diagnosis by whole-slide imaging (WSI) is a key component that would aid departments in providing uninterrupted histopathology diagnosis and maintaining revenue streams from disruption. We sought to perform rapid validation of the use of WSI in primary diagnosis meeting recommendations of the College of American Pathologists guidelines. METHODS Glass slides from clinically reported cases from 5 participating pathologists with a preset washout period were digitally scanned and reviewed in settings identical to typical reporting. Cases were classified as concordant or with minor or major disagreement with the original diagnosis. Randomized subsampling was performed, and mean concordance rates were calculated. RESULTS In total, 171 cases were included and distributed equally among participants. For the group as a whole, the mean concordance rate in sampled cases (n = 90) was 83.6% counting all discrepancies and 94.6% counting only major disagreements. The mean pathologist concordance rate in sampled cases (n = 18) ranged from 90.49% to 97%. CONCLUSIONS We describe a novel double-blinded method for rapid validation of WSI for primary diagnosis. Our findings highlight the occurrence of a range of diagnostic reproducibility when deploying digital methods.
Collapse
Affiliation(s)
- Megan I Samuelson
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| | - Stephanie J Chen
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| | - Sarag A Boukhar
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| | - Eric M Schnieders
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mackenzie L Walhof
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| | - Robert A Robinson
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| | - Anand Rajan K D
- Department of Pathology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
17
|
Bavle RM, Paremala K, Venugopal R, Rudramuni AS, Khan N, Hosthor SS. Grading of Oral Leukoplakia: Can It be Improvised Using Immunohistochemical Markers p63 and CD31. Contemp Clin Dent 2021; 12:37-43. [PMID: 33967536 PMCID: PMC8092094 DOI: 10.4103/ccd.ccd_493_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Oral squamous cell carcinoma is usually preceded by potentially malignant disorders (PMDs), the most common being oral leukoplakia. A conservative management protocol is followed for milder dysplastic cases, while severe dysplastic lesions are surgically excised. Several classification systems have been developed based mainly on histopathological features with a lot of inter-observer variations. The present study was done to assess the use of immunohistochemical (IHC) markers in grading leukoplakic lesions in addition to histopathological grading. Aims and Objectives To grade leukoplakia using different grading systems and assess if IHC markers can aid in categorizing leukoplakia. Materials and Methods Thirty-five cases of leukoplakia were graded using Ljubljana, 2005 World Health Organization (WHO), and Binary System followed by IHC staining with p63 and CD31. Results and Statistics Variation was noted in 12 cases while using WHO, 11 using Ljubljana, and 7 using Binary System and was significant on Cohen-Kappa statistics, with the least significant variation noted on Binary System. p63 staining assisted to group doubtful cases and even identify variation in cases graded positively on histopathology. In total, 17 cases stained one-third (mild/low), while 15 cases stained one-half or more (higher grade) epithelial thickness. A weak correlation was observed between all grading systems and p63 on Kendall's Tau-b analysis and the weak correlation was significant for the WHO and binary grading systems. Analyzing p63 and CD31 using Kruskal-Wallis test, an increase in mean vessel density (MVD) was noted for mild/moderate cases but decreased for severe cases. Conclusion Addressing histological categorization of PMDs assisted by IHC markers to understand the biological behavior of the tissues is currently essential with studies on more markers to assist in the management protocol.
Collapse
Affiliation(s)
- Radhika Manoj Bavle
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - K Paremala
- Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Reshma Venugopal
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - Amulya S Rudramuni
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| | - Nawal Khan
- Sher-i-Kashmir Institute of Medical Sciences, Community Medicine (Dental Unit), Srinagar, Jammu and Kashmir, India
| | - Sreenitha S Hosthor
- Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental College and Hospital, Sir MVIT Campus, Bengaluru, Karnataka, India
| |
Collapse
|
18
|
Detection of deletions in 1q25, 1p36 and 1pTEL and chromosome 17 aneuploidy in oral epithelial dysplasia and oral squamous cell carcinoma by fluorescence in situ hybridization (FISH). Oral Oncol 2021; 116:105221. [PMID: 33610067 DOI: 10.1016/j.oraloncology.2021.105221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/07/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify chromosome deletions in 1q25, 1p36 and 1pTEL, and chromosome 17 ploidy status in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS Samples from 57 OED and 63 OSCC were selected. FISH was performed using centromeric probes 17 and n LSIR 1p36/LSI 1q25 Dual Color Probe. RESULTS In OED, deletions were found only in 1pTEL region (29.8%). In OSCC, there was a higher frequency of deletion in 1pTEL (79.4%), followed by 1p36 (73.0%), and 1q25 (20.6%). Advanced TNM clinical stages (III/IV) showed all the deletions studied; at early clinical stages (I/II) of OSCC, deletions were observed only in 1pTEL. The frequency of deletion in 1p36 was 17.0 times higher in OSCC at advanced clinical stages (PR: 17.00). The median number of cell nuclei with chromosome 17 aneuploidy was higher in OSCC than in OED (P < 0.001). Early clinical stages of OSCC showed lower median number nuclei with aneuploidy when compared to advanced tumors (P < 0.05). Tumors harboring deletions in 1p36, 1q25 and 1pTEL revealed higher median numbers of trisomic/polysomic nuclei when compared to lesions exhibiting no abnormalities in chromosome 1 (P < 0.05). CONCLUSION A higher prevalence of chromosomal abnormalities was found in OSCC than in OED, while in OSCC, higher abnormalities were present in lesions with higher TNM staging. 1pTEL deletion and monosomy of chromosome 17 are possible markers for progression of OED to OSCC. 1p36 deletion and trisomy/polysomy of chromosome 17 could be markers of worse prognosis of OSCC.
Collapse
|
19
|
Thompson LDR, Fitzpatrick SG, Müller S, Eisenberg E, Upadhyaya JD, Lingen MW, Vigneswaran N, Woo SB, Bhattacharyya I, Bilodeau EA, Carlos R, Islam MN, Leon ME, Lewis JS, Magliocca KR, Mani H, Mehrad M, Purgina B, Richardson M, Wenig BM, Cohen DM. Proliferative Verrucous Leukoplakia: An Expert Consensus Guideline for Standardized Assessment and Reporting. Head Neck Pathol 2021; 15:572-587. [PMID: 33415517 PMCID: PMC8134585 DOI: 10.1007/s12105-020-01262-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022]
Abstract
The many diverse terms used to describe the wide spectrum of changes seen in proliferative verrucous leukoplakia (PVL) have resulted in disparate clinical management. The objective of this study was to produce an expert consensus guideline for standardized assessment and reporting by pathologists diagnosing PVL related lesions. 299 biopsies from 84 PVL patients from six institutions were selected from patients who had multifocal oral leukoplakic lesions identified over several years (a minimum follow-up period of 36 months). The lesions demonstrated the spectrum of histologic features described in PVL, and in some cases, patients developed oral cavity squamous cell carcinoma (SCC). An expert working group of oral and maxillofacial and head and neck pathologists reviewed microscopic features in a rigorous fashion, in combination with review of clinical photographs when available. The working group then selected 43 single slide biopsy cases for whole slide digital imaging (WSI) review by members of the consensus conference. The digital images were then reviewed in two surveys separated by a washout period of at least 90 days. Five non-PVL histologic mimics were included as controls. Cases were re-evaluated during a consensus conference with 19 members reporting on the cases. The best inter-observer diagnostic agreement relative to PVL lesions were classified as "corrugated ortho(para)hyperkeratotic lesion, not reactive" and "SCC" (chi-square p = 0.015). There was less than moderate agreement (kappa < 0.60) for lesions in the "Bulky hyperkeratotic epithelial proliferation, not reactive" category. There was ≥ moderate agreement (> 0.41 kappa) for 35 of 48 cases. This expert consensus guideline has been developed with support and endorsement from the leadership of the American Academy of Oral and Maxillofacial Pathology and the North American Society of Head and Neck Pathologists to recommend the use of standardized histopathologic criteria and descriptive terminology to indicate three categories of lesions within PVL: (1) "corrugated ortho(para)hyperkeratotic lesion, not reactive;" (2) "bulky hyperkeratotic epithelial proliferation, not reactive;" and (3) "suspicious for," or "squamous cell carcinoma." Classification of PVL lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research and potentially guide clinical management.
Collapse
Affiliation(s)
- Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue Woodland Hills, CA 91364 Woodland Hills, USA
| | - Sarah G. Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Susan Müller
- Atlanta Oral Pathology, Emory University School of Medicine, Decatur, GA USA
| | - Ellen Eisenberg
- Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT USA
| | - Jasbir D. Upadhyaya
- Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL USA
| | - Mark W. Lingen
- Department of Pathology, University of Chicago Medicine, Chicago, IL USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston, Houston, TX USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Elizabeth A. Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Roman Carlos
- Centro Clínico de Cabeza y Cuello, Patología División, Guatemala City, Guatemala
| | - Mohammed N. Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Marino E. Leon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - James S. Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kelly R. Magliocca
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Haresh Mani
- Department of Pathology, Inova Fairfax Hospital, Falls Church, VA USA
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Bibianna Purgina
- Department of Pathology, University of Ottawa, Ottawa, Ontario Canada
| | - Mary Richardson
- Department of Pathology, MUSC Health-University Medical Center, Charleston, SC USA
| | - Bruce M. Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL USA
| | - Donald M. Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| |
Collapse
|
20
|
Diniz PB, Sena-Filho M, Graner KM, Mariz BA, Reis LA, Almeida OP, Jorge J. Comparison of the whole slide imaging and conventional light microscopy in the grading of oral epithelial dysplasia: a multi-institutional study. Med Oral Patol Oral Cir Bucal 2021; 26:e8-e13. [PMID: 33247580 PMCID: PMC7806346 DOI: 10.4317/medoral.23854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background Whole Slide Imaging (WSI) is an alternative method to light microscopy (LM). However, few studies have compared the diagnostic agreement between WSI and LM, especially to grade oral epithelial dysplasia (OED). The purpose of this study was to evaluate the variability in grading OED by the World Health Organization grading system, using WSI and conventional LM, and to investigate whether the access to clinical information, and psychologic or physical states of the pathologists could interfere with the diagnosis.
Material and Methods eleven experienced pathologists from seven Brazilian universities independently evaluated twenty-five OED cases. The analyses were performed in duplicate for each method, with an interval of at least 30 days, and the time consumed in each analysis was measured. Physical and psychologic states were evaluated by blood pressure levels, heart rate and two questionnaires: State-Trait Anxiety Inventory and Perceived Stress Scale. Clinical information was provided after the second evaluation using WSI and the pathologist could change their diagnostic decision or not.
Results LM showed a higher inter-examiner agreement (k=0.53) than WSI (k=0.45) and a smaller time consumed by the pathologists (mean of 65.53 seconds compared to 91.02 seconds in WSI). In the first analysis using conventional microscopy, there was a positive correlation between kappa values and anxiety (r=0.47, p=0.02), and stress (r=0.64, p<0.01), and an inverse correlation with heart rate (r=-0.48, p=0.02). In the digital analysis, there was also a positive correlation between kappa values and anxiety (r=0.75, p<0.001). After clinical information was given, there was a slight change in 11.3% of the cases, and a great discrepancy in 1.1% of the cases, mainly increasing the OED grade.
Conclusions both microscopy systems had similar results, although LM had slightly higher kappa values, and WSI was more time consuming. Key words:Pathology, microscopy, diagnosis, leukoplakia oral, anxiety.
Collapse
Affiliation(s)
- P-B Diniz
- Department of Oral Diagnosis, Piracicaba Dental School University of Campinas (UNICAMP) 901, Limeira Av., Areião, Piracicaba, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
21
|
Adam A, Hadi Abd Rahman A, Samsiah Sani N, Abdi Alkareem Alyessari Z, Jumaadzan Zaleha Mamat N, Hasan B. Epithelial Layer Estimation Using Curvatures and Textural Features for Dysplastic Tissue Detection. COMPUTERS, MATERIALS & CONTINUA 2021; 67:761-777. [DOI: 10.32604/cmc.2021.014599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/14/2020] [Indexed: 09/02/2023]
|
22
|
Ranganathan K, Kavitha L, Sharada P, Bavle RM, Rao RS, Pattanshetty SM, Hazarey VK, Madhura MG, Nagaraj T, Lingappa A, Warnakulasuriya S. Intra‐observer and inter‐observer variability in two grading systems for oral epithelial dysplasia: A multi‐centre study in India. J Oral Pathol Med 2020; 49:948-955. [DOI: 10.1111/jop.13056] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/02/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Kannan Ranganathan
- Department of Oral and Maxillofacial Pathology Ragas Dental College and Hospital Chennai India
- The Tamil Nadu Dr. MGR Medical University Chennai India
| | - Loganathan Kavitha
- Department of Oral and Maxillofacial Pathology Ragas Dental College and Hospital Chennai India
- The Tamil Nadu Dr. MGR Medical University Chennai India
| | - Prakash Sharada
- Department of Oral and Maxillo Facial Pathology AECS Maaruti College of Dental Sciences Bengaluru India
| | - Radhika M. Bavle
- Department of Oral and Maxillofacial Pathology Krishnadevaraya College of Dental Sciences Bengaluru India
| | - Roopa S. Rao
- Department of Oral Pathology Faculty of Dental Sciences Ramaiah University of Applied Sciences Bangaluru India
| | | | | | | | - Tejavathi Nagaraj
- Sri Rajiv Gandhi College of Dental sciences & Hospital Bengaluru India
| | | | - Saman Warnakulasuriya
- Faculty of Dentistry Oral & Craniofacial Sciences King's College LondonWHO Collaborating Centre for Oral Cancer London UK
| |
Collapse
|
23
|
MAGE-A expression in oral and laryngeal leukoplakia predicts malignant transformation. Mod Pathol 2019; 32:1068-1081. [PMID: 30936424 DOI: 10.1038/s41379-019-0253-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/17/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
Leukoplakia is a potential precursor of oral as well as laryngeal squamous cell carcinoma. Risk assessment of malignant transformation based on the grade of dysplasia of leukoplakia often does not lead to reliable results. However, oral squamous cell carcinoma, laryngeal squamous cell carcinoma, and leukoplakia express single or multiple members of the melanoma-associated antigens A (MAGE-A) family, while MAGE-A are absent in healthy mucosal tissue. The present study aimed at determining if there is an association between the expression of MAGE-A in leukoplakia and malignant transformation to oral or laryngeal squamous cell carcinoma. Paraffin-embedded tissues of 205 oral and laryngeal leukoplakia, 90 corresponding tumors, and 40 healthy oral mucosal samples were included in the study. The grade of dysplasia of the leukoplakia samples was determined histopathologically. The leukoplakia samples were divided into lesions that transformed to oral and laryngeal squamous cell carcinoma (n = 91) and lesions that did not (n = 114) during a 5 years follow-up. The expression of MAGE-A3/6 and MAGE-A4 was analyzed by real-time RT-PCR. The expression of MAGE-A 1-4, 6, and 12 was determined by immunohistochemistry. A total of 59.3% of the transforming leukoplakia expressed at least one of the examined antigens as opposed to an expression rate of 3.5% of all non-transforming leukoplakia. There was no MAGE-A expression in healthy oral mucosa. The risk of malignant transformation was statistically significantly associated with MAGE-A expression in immunohistochemistry (p < 0.001) and real-time RT-PCR (MAGE-A3/6, p = 0.001; MAGE-A4, p = 0.002) analyses. There was no significant association between MAGE-A expression and the grade of dysplasia ("low-grade", D0/D1; "high-grade", D2/D3) in immunohistochemistry (p = 0.412) and real-time RT-PCR (MAGE-A3/6, p = 0.667; MAGE-A4, p = 0.756). It seems that the analysis of the MAGE-A expression profile may support the identification of leukoplakia at risk for malignant transformation. Therefore, efforts should be made to establish this analysis as a routine procedure in addition to conventional histopathology.
Collapse
|
24
|
Upadhyaya JD, Fitzpatrick SG, Cohen DM, Bilodeau EA, Bhattacharyya I, Lewis JS, Lai J, Wright JM, Bishop JA, Leon ME, Islam MN, Seethala R, Padilla RJ, Carlos R, Müller S, Thompson LDR. Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study. Head Neck Pathol 2019; 14:156-165. [PMID: 30972634 PMCID: PMC7021885 DOI: 10.1007/s12105-019-01035-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023]
Abstract
The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons' responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.
Collapse
Affiliation(s)
- Jasbir D. Upadhyaya
- Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Alton, IL 62002 USA
| | - Sarah G. Fitzpatrick
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Donald M. Cohen
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Elizabeth A. Bilodeau
- grid.21925.3d0000 0004 1936 9000Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Indraneel Bhattacharyya
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - James S. Lewis
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jinping Lai
- grid.15276.370000 0004 1936 8091Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - John M. Wright
- grid.264763.20000 0001 2112 019XDepartment of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX USA
| | - Justin A. Bishop
- grid.267313.20000 0000 9482 7121Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Marino E. Leon
- grid.15276.370000 0004 1936 8091Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - Mohammed N. Islam
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Raja Seethala
- grid.21925.3d0000 0004 1936 9000Department of Pathology, University of Pittsburgh, Pittsburgh, PA USA
| | - Ricardo J. Padilla
- grid.10698.360000000122483208Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Roman Carlos
- Pathology Division, Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Susan Müller
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta Oral Pathology, Decatur, GA USA
| | - Lester D. R. Thompson
- grid.417224.60000 0004 0445 0789Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA USA
| |
Collapse
|
25
|
Safadi RA, Abdullah NI, Alaaraj RF, Bader DH, Divakar DD, Hamasha AA, Sughayer MA. Clinical and histopathologic prognostic implications of the expression of cytokeratins 8, 10, 13, 14, 16, 18 and 19 in oral and oropharyngeal squamous cell carcinoma. Arch Oral Biol 2019; 99:1-8. [PMID: 30579132 DOI: 10.1016/j.archoralbio.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Rima A Safadi
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan; In sabbatical leave to College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences Riyadh, Saudi Arabia.
| | | | | | | | - Darshan D Divakar
- College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Abed A Hamasha
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan; In sabbatical leave to College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences Riyadh, Saudi Arabia
| | | |
Collapse
|
26
|
Farah CS, Pollaers K, Frydrych A. Management of Premalignant Disease of the Oral Mucosa. HEAD AND NECK CANCER CLINICS 2019. [DOI: 10.1007/978-981-13-2931-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
27
|
Li YN, Lu R, Zhang J, Zhou G. Inter-and intra-observer agreement on the judgment of toluidine blue staining for screening of oral potentially malignant disorders and oral cancer. Clin Oral Investig 2018; 23:1709-1714. [PMID: 30155573 DOI: 10.1007/s00784-018-2595-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Toluidine blue staining (TBS) is used for screening of oral potentially malignant disorders (OPMDs) and oral cancer. Nevertheless, the judgment of TBS is based on the observer's personal experience and largely considered subjective. The aim of this study was to evaluate the inter- and intra-observer agreement on the judgment of TBS for screening of OPMDs and oral cancer. MATERIALS AND METHODS Two hundred randomly ordered TBS images of OPMDs and oral cancer were judged twice independently by four clinicians and four graduated students majored in oral medicine, with an interval of 3 months. Inter- and intra-observer agreement was evaluated by the Cohen's kappa (κ) coefficient. The correlation between κ-value and individual experience was assessed by Spearman's correlation coefficient. RESULTS For the two sets of observation, good overall inter-observer agreement was found in the study (κ = 0.620 and 0.667). Sub-group analysis yielded good inter-observer agreement both for clinicians (κ = 0.613 and 0.611) and students (κ = 0.610 and 0.665). Pairwise inter-observer agreement was presented to be moderate to excellent between clinician and clinician (κ = 0.41~0.87, 0.43~0.81), moderate to excellent between student and student (κ = 0.43~0.71, 0.53~0.82), and poor to excellent between clinician and student (κ = 0.25~0.81, 0.35~0.87). Good to excellent intra-observer agreement (κ = 0.69~0.85) was presented for eight observers. However, no correlation was illustrated between years of experience and inter- or intra-observer agreement. CONCLUSION Judgment of TBS has a good overall inter-observer agreement and good to excellent intra-observer agreement, which guarantees its utilization and popularity in detecting OPMDs and oral cancer. CLINICAL RELEVANCE To our knowledge, this is the first study to investigate the inter- and intra-observer agreement of TBS judgment. The present results revealed a good inter-observer agreement and good to excellent intra-observer agreement, which provide a beneficial supplement to the knowledge of TBS technique.
Collapse
Affiliation(s)
- Ya-Nan Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Rui Lu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China
| | - Jing Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China
| | - Gang Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China.
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China.
| |
Collapse
|
28
|
Luiz ST, Modolo F, Mozzer I, dos Santos EC, Nagashima S, Camargo Martins AP, de Azevedo MLV, Azevedo Alanis LR, Hardy AMTG, de Moraes RS, Aguiar MCF, Ignácio SA, Jham BC, Noronha L, Johann ACBR. Immunoexpression of SOX-2 in oral leukoplakia. Oral Dis 2018; 24:1449-1457. [DOI: 10.1111/odi.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/22/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023]
Affiliation(s)
| | - Filipe Modolo
- Universidade Federal de Santa Catarina; Florianópolis Brasil
| | - Izabela Mozzer
- Pontifícia Universidade Católica do Paraná; Curitiba Brasil
| | | | | | | | | | | | | | | | - Maria Cássia Ferreira Aguiar
- Departamento de Patologia Bucal, Av. Antônio Carlos; Universidade Federal de Minas Gerais; Belo Horizonte Brasil
| | | | | | - Lucia Noronha
- Pontifícia Universidade Católica do Paraná; Curitiba Brasil
| | | |
Collapse
|
29
|
Cho KJ, Song JS. Recent Changes of Classification for Squamous Intraepithelial Lesions of the Head and Neck. Arch Pathol Lab Med 2018; 142:829-832. [PMID: 29775074 DOI: 10.5858/arpa.2017-0438-ra] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Interpretation of atypical squamous lesions of the head and neck has always been a nettlesome task for pathologists. Moreover, many different grading systems for squamous intraepithelial lesions have been proposed in past decades. The recent World Health Organization 2017 classification presents 2 types of 2-tier systems for laryngeal and oral precursor lesions. OBJECTIVE - To review the recent changes in classification and the clinical significance for squamous intraepithelial lesions of the head and neck. DATA SOURCES - Personal experience and data from the literature. CONCLUSIONS - The 2-tier grading system for laryngeal dysplasia, presented by World Health Organization in 2017, is expected to improve diagnostic reproducibility and clinical implication. However, the diagnostic criteria for low-grade dysplasia do not distinguish it clearly from basal cell hyperplasia. The World Health Organization 2017 classification of oral epithelial dysplasia remains unclear, and complicated and variable grading systems still make head and neck intraepithelial lesions difficult to interpret.
Collapse
Affiliation(s)
| | - Joon Seon Song
- From the Department of Pathology, University of Ulsan College Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
30
|
Intraoral Potentially Malignant Disorders in a Brazilian Oral Pathology Service: Epidemiological, Clinical, and Histopathological Findings. JOURNAL OF ONCOLOGY 2018; 2018:2325808. [PMID: 29686705 PMCID: PMC5852874 DOI: 10.1155/2018/2325808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 12/12/2022]
Abstract
The aim of this study was to investigate the characteristics of individuals with intraoral potentially malignant disorders (IOPMD) in an oral pathology service in Brazil. Cases were screened based on clinical diagnosis of leukoplakia (LKP), erythroleukoplakia (ELKP), and erythroplakia (EP). Clinical data and information regarding associated factors were gathered from biopsy reports. Histological diagnoses were collected from histopathological records. Among 208 IOPMD cases, 84.13% involved LKP; 11.1%, ELKP; and 4.8%, EP. The most affected sites were the gingiva and buccal mucosa. Histologically, epithelial dysplasia was present in 66.8% of the lesions, acanthosis and hyperkeratosis without epithelial dysplasia were present in 27.9%, and squamous cell carcinoma was present in 2.9%. Most patients were males, fair-skinned, with mean age of 53.4 years. Chronic smokers represented 73% of subjects, of which 30% also consumed alcohol. Smokers and drinkers were mostly males (p < 0.001). EP and ELKP represented histologically more severe degrees of epithelial dysplasia than LKP (p < 0.001). In conclusion, individuals with IOPMD were more frequently fair-skinned men in the sixth decade of life, with smoking habit. Special attention is required to clinical diagnoses of ELKP and EP since the prevalence of severe epithelial dysplasia, in situ carcinoma, and squamous cell carcinoma is higher than in LKP.
Collapse
|