COMPARISON OF WORLD HEALTH ORGANIZATION AND BINARY GRADING SYSTEMS IN ACTINIC CHEILITIS

Abstract

Objective To compare the role of histologic epithelial changes of epithelial dysplasia (ED) in actinic cheilitis (AC) in 2 grading systems: World Health Organization (WHO) and binary (BS). Study Design Cytologic and architectural changes of ED, proposed by WHO, were microscopically evaluated in 26 AC by 2 observers. Data correlation was performed using kappa and chi-square tests (P < .05). Results Most cases were graded as moderate ED (41.7%) and low risk in BS (58.3%). There was a positive interobserver correlation in WHO grading (k = 0.515; P = .001) and between WHO and BS grading systems (k = 0.385; P = .017). Intense ED and high-risk cases were statistically associated with 3 architectural changes: irregular stratification, dyskeratosis, and loss of cell polarity (P < .05). It was also observed, in high-risk cases, an association between the increase in the number of mitotic figures. Among cytologic changes, atypical mitosis was associated with both high-risk cases and intense ED, the last also associated to cellular and nuclear pleomorphism (P < .05). Conclusions The presence of both architectural and cytologic changes is necessary for the 2 grading systems. However, our results suggest that architectural changes were more significant to indicate high risk in BS in actinic cheilitis. To compare the role of histologic epithelial changes of epithelial dysplasia (ED) in actinic cheilitis (AC) in 2 grading systems: World Health Organization (WHO) and binary (BS). Cytologic and architectural changes of ED, proposed by WHO, were microscopically evaluated in 26 AC by 2 observers. Data correlation was performed using kappa and chi-square tests (P < .05). Most cases were graded as moderate ED (41.7%) and low risk in BS (58.3%). There was a positive interobserver correlation in WHO grading (k = 0.515; P = .001) and between WHO and BS grading systems (k = 0.385; P = .017). Intense ED and high-risk cases were statistically associated with 3 architectural changes: irregular stratification, dyskeratosis, and loss of cell polarity (P < .05). It was also observed, in high-risk cases, an association between the increase in the number of mitotic figures. Among cytologic changes, atypical mitosis was associated with both high-risk cases and intense ED, the last also associated to cellular and nuclear pleomorphism (P < .05). The presence of both architectural and cytologic changes is necessary for the 2 grading systems. However, our results suggest that architectural changes were more significant to indicate high risk in BS in actinic cheilitis.