Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement.

At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Precancer in the United Kingdom issues related to potentially malignant disorders of the oral cavity were discussed by an expert group. The consensus views of the Working Group are presented in a series of papers. In this report, we review the oral epithelial dysplasia classification systems. The three classification schemes [oral epithelial dysplasia scoring system, squamous intraepithelial neoplasia and Ljubljana classification] were presented and the Working Group recommended epithelial dysplasia grading for routine use. Although most oral pathologists possibly recognize and accept the criteria for grading epithelial dysplasia, firstly based on architectural features and then of cytology, there is great variability in their interpretation of the presence, degree and significance of the individual criteria. Several studies have shown great interexaminer and intraexaminer variability in the assessment of the presence or absence and the grade of oral epithelial dysplasia. The Working Group considered the two class classification (no/questionable/ mild - low risk; moderate or severe - implying high risk) and was of the view that reducing the number of choices from 3 to 2 may increase the likelihood of agreement between pathologists. The utility of this need to be tested in future studies. The variables that are likely to affect oral epithelial dysplasia scoring were discussed and are outlined here; these need to be researched in longitudinal studies to explore the biological significance of a low-risk or high-risk dysplasia.

[1]  S. Warnakulasuriya,et al.  Nomenclature and classification of potentially malignant disorders of the oral mucosa. , 2007, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[2]  P. Speight,et al.  Natural history of potentially malignant oral lesions and conditions: an overview of the literature. , 2007, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[3]  Philip Sloan,et al.  Why oral histopathology suffers inter-observer variability on grading oral epithelial dysplasia: an attempt to understand the sources of variation. , 2007, Oral oncology.

[4]  Philip Sloan,et al.  Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation. , 2006, Oral oncology.

[5]  Calum MacAulay,et al.  Natural History of Cervical Intraepithelial Neoplasia , 2005, Acta Cytologica.

[6]  V. Hazarey,et al.  An assessment of oral epithelial dysplasia using criteria of `Smith & Pindborg Grading System′ & `Ljubljana Grading System′ in oral precancerous lesions , 2004, Journal of Oral and Maxillofacial Pathology.

[7]  C. R. Leemans,et al.  Genetically Altered Fields as Origin of Locally Recurrent Head and Neck Cancer , 2004, Clinical Cancer Research.

[8]  Joel B Epstein,et al.  Interobserver reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions. , 2004, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[9]  G. Bradley,et al.  Observer agreement in the grading of oral epithelial dysplasia. , 2003, Community dentistry and oral epidemiology.

[10]  P. V. van Diest,et al.  Comparative molecular and histological grading of epithelial dysplasia of the oral cavity and the oropharynx , 2003, The Journal of pathology.

[11]  P. Speight,et al.  Oral yeast carriage correlates with presence of oral epithelial dysplasia. , 2002, Oral oncology.

[12]  T. Lombardi,et al.  Premalignant lesions of the oral mucosa. A discussion about the place of oral intraepithelial neoplasia (OIN). , 2002, Oral oncology.

[13]  S. Warnakulasuriya.  Histological grading of oral epithelial dysplasia: revisited , 2001, The Journal of pathology.

[14]  M. Poljak,et al.  The Ljubljana Classification: A Practical Strategy for the Diagnosis of Laryngeal Precancerous Lesions , 2000, Advances in anatomic pathology.

[15]  N. Gale,et al.  Clinical applicability of the Ljubljana classification of epithelial hyperplastic laryngeal lesions. , 2000, Clinical otolaryngology and allied sciences.

[16]  S. Lippman,et al.  Predicting cancer development in oral leukoplakia: ten years of translational research. , 2000, Clinical cancer research : an official journal of the American Association for Cancer Research.

[17]  S. Warnakulasuriya.  Lack of molecular markers to predict malignant potential of oral precancer , 2000, The Journal of pathology.

[18]  J. Califano,et al.  Genetic progression and clonal relationship of recurrent premalignant head and neck lesions. , 2000, Clinical cancer research : an official journal of the American Association for Cancer Research.

[19]  Hellquist,et al.  Criteria for grading in the Ljubljana classification of epithelial hyperplastic laryngeal lesions. A study by members of the Working Group on Epithelial Hyperplastic Laryngeal Lesions of the European Society of Pathology , 1999, Histopathology.

[20]  K. Schepman,et al.  Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. , 1998, Oral oncology.

[21]  Paul M. Speight,et al.  The pathology of oral cancer and precancer , 1996 .

[22]  E. Eisenberg,et al.  Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[23]  A. Karabulut,et al.  Observer variability in the histologic assessment of oral premalignant lesions. , 1995, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[24]  D. Macdonald,et al.  Epithelial cell kinetics in oral leukoplakia. , 1995, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[25]  C. Crum,et al.  Prediction of 'high-risk' cervical papillomavirus infection by biopsy morphology. , 1989, American journal of clinical pathology.

[26]  H. Wulff,et al.  Rational diagnosis and treatment. , 1986, The Journal of medicine and philosophy.

[27]  M. Gorsky,et al.  Oral leukoplakia and malignant transformation. A follow‐up study of 257 patients , 1984, Cancer.

[28]  I. Kramer,et al.  The Use of Discriminant Analysis for Examining the Histological Features of Oral Keratoses and Lichen Planus , 1970, British Journal of Cancer.

[29]  J. Reibel.  Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics. , 2003, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[30]  E. Eisenberg,et al.  The effect of clinical information on the histopathologic diagnosis of oral epithelial dysplasia. , 1998, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[31]  D. M. Walker.  Histological Typing of Cancer and Precancer of the Oral Mucosa , 1998 .

[32]  Dr. J. J. Pindborg,et al.  Histological Typing of Cancer and Precancer of the Oral Mucosa , 1997, World Health Organization.

[33]  E. Eisenberg,et al.  Dysplasia of oral mucosa: a unified approach to proper evaluation. , 1991, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[34]  D. Macdonald,et al.  Oral epithelial atypia in denture induced hyperplasia, lichen planus and squamous cell papilloma. , 1975, International journal of oral surgery.