Abstract
Objective: To assess inter and intra observer variability in grading oral epithelial dysplasia (OED) using Smith and Pindborg grading system, WHO classification system and Brothwell DJ et al. classification system. Study design: In the study 45 histological tissues of dysplasia, 15 each of mild, moderate and severe dysplasia were coded and blindly graded by three observers in three grading systems. Further on the same observers graded 15 slides again of the previous 45 for analyzing the reproducibility in the three grading systems. The individual significance of various indicators of dysplasia among various grades of dysplasia was also assessed. Result: Inter observer agreement was significantly higher in Brothwell system as compared to WHO and Smith and Pindborg system. Intra observer agreement was significantly higher in Smith and Pindborg system, but the predictability and the probability index was distributed over a larger range in this system. Each indicator of dysplasia was also found to be statistically significant (P<0.05) for grading dysplasia. Conclusion: The present study puts forth the inherent intricacies in the grading of oral premalignant lesions. Key words:Carcinoma, dysplasia, grading systems, reproducibility.
Highlights
The term cancer, by itself has evoked a sense of morbidity and mortality among the medical fraternity as well as in general population
Oral carcinomas frequently arise from a spectrum of abnormalities ranging from hyperplasia to intraepithelial neoplasia termed histopathologically oral epithelial dysplasia (OED) (3)
This confusion in terminology has lead to inconsistency in the reporting of oral epithelial dysplasia lesions by pathologists
Summary
The term cancer, by itself has evoked a sense of morbidity and mortality among the medical fraternity as well as in general population. We aimed to assess inter and intra observer variability in grading oral epithelial dysplasia using Smith and Pindborg grading system (5), WHO classification system (8) and Brothwell DJ et al classification system (1). -Study Design In the first phase of the study, the observers were given all 45 cases individually without the sign out diagnosis with slides marked randomly with a coded labeling system, the details of which were accessible only to the non participating oral pathologist. Observers were asked to complete the examination within a 2 month period and to assess each slide for the presence and severity of dysplasia based on the following systems: Smith and Pindborg system, WHO system, Brothwell D J et al system. The features of dysplasia along with its severity according to Smith and Pindborg System are tabulated
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