Binary Grading Research Articles

Is Binary Grading Better Than WHO System for Grading Epithelial Dysplasia? A Systematic Review and Meta-Analysis.

This meta-analysis summarizes the current evidence on the intra- and inter-observer agreement between WHO and the binary grading systems used to assess epithelial dysplasia (ED). A systematic search for observational studies that compared the level of agreement among pathologists between WHO and binary grading systems for ED was conducted using three databases: Medline, Scopus, and EBSCOhost. For the meta-analysis, summary estimations of kappa value (κ) and standard error (SE) were utilized. The pooled analysis of observations by 46 pathologists from a total of eight studies showed better interobserver agreement in the interpretation of ED for the binary system (κ = 0.31; 95% confidence interval [CI], 0.23-0.40) in comparison with the WHO (κ = 0.14; 95% CI, 0.10-0.19). The intra-observer agreement was reported only by five studies and was also found to be higher for the binary system (κ = 0.44; 95% CI, 0.31-0.57) compared to the WHO (κ = 0.25; 95% CI, 0.11-0.39). Our results validate that the binary system has better overall intra-observer and interobserver agreement than the WHO system. Further studies with larger cohorts are mandatory before clinically relevant conclusions are drawn, as evidence remains inadequate.

Decreased Nuclear Immunoexpression of ING3 is a Frequent Event in Lip Carcinogenesis.

Evaluate the immunohistochemical expression of the ING3 in actinic cheilitis and squamous cell carcinoma of the lower lip. Forty-five specimens of actinic cheilitis and 48 specimens of squamous cell carcinoma of the lower lip were submitted to immunohistochemical detection of ING3. The protein expression in different cellular sublocations was compared between the two groups, and associations with the clinicopathological variables were analyzed. A significance level of 5% was adopted for all tests. Deaths were significantly more frequent in tumors with a high histopathological risk score (p < 0.05). In actinic cheilitis, significant differences were found in the nucleus-cytoplasmic expression of ING3 and expression restricted to the cytoplasm with binary histopathological grading (p < 0.05). In squamous cell carcinoma of the lower lip, there was no statistically significant difference when comparing ING3 expressions with clinical and morphological parameters (p > 0.05). Nucleo-cytoplasmic ING3 expression was significantly lower in squamous cell carcinoma of the lower lip when compared to actinic cheilitis (p < 0.05) and the expression restricted to the cytoplasm was significantly higher in squamous cell carcinoma of the lower lip (p < 0.05). The results of this study suggest that there is a marked decrease in the nuclear expression of ING3 as malignant progression occurs, indicating an impaired tumor suppressor function of this protein in actinic cheilitis and squamous cell carcinoma of the lower lip.

Binary Soong grading as a predictor for flexor pollicis longus tendon rupture after distal radial fracture fixation: a retrospective study.

This retrospective cohort study evaluates the concordance between Soong grades classified from radiographs and computed tomography (CT) scans and whether a Soong grade ≥1 is associated with flexor pollicis longus (FPL) injury and reoperation incidence. We included 181 patients with 185 dorsally displaced distal radial fractures treated with anterior locking plates. For the analysis of binary Soong grades, grade 0 was compared with grades 1 and 2. A moderate correlation was found between Soong grades on radiographs and CT scans (MCC 0.66). FPL injury occurred in 3% (6/185) and reoperation in 15% (28/185) of cases. There was no statistically significant difference between Soong grades when correlated with the incidence of FPL injury or reoperation, but no patients with a Soong grade 0 had an FPL injury. Binary Soong grading is non-inferior in predictive value and has a better correlation between radiographs and CT scans. Using the Soong classification as a binary system may be easier than a ternary system in clinical practice.Level of evidence: IV.

Implementation of a soft grading system for chemistry in a Moodle plugin: reaction handling

Here, we present a new method for evaluating questions on chemical reactions in the context of remote education. This method can be used when binary grading is not sufficient as some tolerance may be acceptable. In order to determine a grade, the developed workflow uses the pairwise similarity assessment of two considered reactions, each encoded by a single molecular graph with the help of the Condensed Graph of Reaction (CGR) approach. This workflow is part of the ChemMoodle project and is implemented as a Moodle Plugin. It uses the Chemdoodle engine for reaction drawing and visualization and communicates with a REST server calculating the similarity score using ISIDA fragment descriptors. The plugin is open-source, accessible in GitHub (https://github.com/Laboratoire-de-Chemoinformatique/moodle-qtype_reacsimilarity) and on the Moodle plugin store (https://moodle.org/plugins/qtype_reacsimilarity?lang=en). Both similarity measures and fragmentation can be configured.Scientific contribution This work introduces an open-source method for evaluating chemical reaction questions within Moodle using the CGR approach. Our contribution provides a nuanced grading mechanism that accommodates acceptable tolerances in reaction assessments, enhancing the accuracy and flexibility of the grading process.

Histopathological risk assessment in multisite epithelial dysplasia: A meta‐analysis

AbstractObjectiveHistopathological grading of oral epithelial dysplasia (OED) is the current standard for stratifying cancer progression risk but is associated with subjectivity and variability. This problem is not commonly seen regarding the grading of epithelial dysplasia in other sites. This systematic review aims to compare grading systems for oral, anal, penile, and cervical epithelial dysplasia to determine their predictive accuracy for recurrence and malignant transformation (MT) outcomes.MethodsThe review protocol was registered in PROSPERO (CRD42023403035) and was reported according to the PRISMA checklist. A comprehensive search was performed in the main databases and gray literature. The risk of bias in individual studies was analyzed using the Joanna Briggs Institute checklist for each study design.ResultsForty‐six studies were deemed eligible and included in this systematic review, of which 45 were included in the quantitative analysis. Meta‐analysis revealed that the binary system demonstrated a higher predictive ability for MT/recurrence of OED compared to multilevel systems. Higher predictive accuracy of MT was also observed for binary grading systems in anal intraepithelial neoplasia.ConclusionsNo significant difference was found between the current grading systems of epithelial dysplasia in different body parts. However, binary grading systems have shown better clinical outcomes.

Evaluating insomnia queries from an artificial intelligence chatbot for patient education.

We evaluated the accuracy of ChatGPT in addressing insomnia-related queries for patient education and assessed ChatGPT's ability to provide varied responses based on differing prompting scenarios. Four identical sets of 20 insomnia-related queries were posed to ChatGPT. Each set differed by the context in which ChatGPT was prompted: no prompt, patient-centered, physician-centered, and with references and statistics. Responses were reviewed by 2 academic sleep surgeons, 1 academic sleep medicine physician, and 2 sleep medicine fellows across 4 domains: clinical accuracy, prompt adherence, referencing, and statistical precision, using a binary grading system. Flesch-Kincaid grade-level scores were calculated to estimate the grade level of the responses, with statistical differences between prompts analyzed via analysis of variance and Tukey's test. Interrater reliability was calculated using Fleiss's kappa. The study revealed significant variations in the Flesch-Kincaid grade-level scores across 4 prompts: unprompted (13.2 ± 2.2), patient-centered (8.1 ± 1.9), physician-centered (15.4 ± 2.8), and with references and statistics (17.3 ± 2.3, P < .001). Despite poor Fleiss kappa scores, indicating low interrater reliability for clinical accuracy and relevance, all evaluators agreed that the majority of ChatGPT's responses were clinically accurate, with the highest variability on Form 4. The responses were also uniformly relevant to the given prompts (100% agreement). Eighty percent of the references ChatGPT cited were verified as both real and relevant, and only 25% of cited statistics were corroborated within referenced articles. ChatGPT can be used to generate clinically accurate responses to insomnia-related inquiries. Alapati R, Campbell D, Molin N, etal. Evaluating insomnia queries from an artificial intelligence chatbot for patient education. J Clin Sleep Med. 2024;20(4):583-594.

Calibration improves the agreement in grading oral epithelial dysplasia-Findings from a National Workshop in Malaysia.

A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems. A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems. A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; Kw 0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise. This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.

Predictive value of the National Early Warning Score 2 for hospitalised patients with viral respiratory illness is improved by the addition of inspired oxygen fraction as a weighted variable

ObjectivesThe National Early Warning Score 2 (NEWS2) is validated for predicting acute deterioration, however, the binary grading of inspired oxygen fraction (FiO2) may limit performance. We evaluated the incorporation of...

Validity of nomograms for predicting cancer risk in oral leukoplakia and oral lichen planus.

This study assessed the validity of nomograms for predicting malignant transformation (MT) among patients with oral leukoplakia (OL) and oral lichen planus (OLP). Two nomograms were identified following a systematic search. Variables to interrogate both nomograms were obtained for a retrospective OL/OLP cohort. Then, the nomograms were applied to estimate MT probabilities twice and their average was used to calculate the discriminatory performance, calibration, and potential net benefit of the models. Subgroup analyses were performed for patients with OL, OLP, and oral epithelial dysplasia. Predicted probabilities were mostly significantly higher among OL/OLP patients who developed MT compared to those who did not (p = <0.001-0.034). AUC values and Brier scores of the nomograms were 0.644-0.844 and 0.040-0.088 among OL patients and 0.580-0.743 and 0.008-0.072 among OLP patients. Decision curve analysis suggested that the nomograms had some net benefit for risk stratification. However, the models did not best binary dysplasia grading in discriminatory validity and net benefit among patients with OL and oral epithelial dysplasia. Nomograms for predicting MT may have satisfactory validity among patients with OL than OLP, but they do not outperform binary dysplasia grading in risk stratification of OL.

Proposal of Novel Binary Grading Systems for Cervical Squamous Cell Carcinoma.

We compared grading systems and examined associations with tumor stroma and survival in patients with cervical squamous cell carcinoma. Available tumor slides were collected from 10 international institutions. Broders tumor grade, Jesinghaus grade (informed by the pattern of tumor invasion), Silva pattern, and tumor stroma were retrospectively analyzed; associations with overall survival (OS), progression-free survival (PFS), and presence of lymph node metastases were examined. Binary grading systems incorporating tumor stromal changes into Broders and Jesinghaus grading systems were developed. Of 670 cases, 586 were reviewed for original Broders tumor grade, 587 for consensus Broders grade, 587 for Jesinghaus grade, 584 for Silva pattern, and 556 for tumor stroma. Reproducibility among grading systems was poor (κ = 0.365, original Broders/consensus Broders; κ = 0.215, consensus Broders/Jesinghaus). Median follow-up was 5.7 years (range, 0-27.8). PFS rates were 93%, 79%, and 71%, and OS rates were 98%, 86%, and 79% at 1, 5, and 10 years, respectively. On univariable analysis, original Broders ( P < 0.001), consensus Broders ( P < 0.034), and Jesinghaus ( P < 0.013) grades were significant for OS; original Broders grade was significant for PFS ( P = 0.038). Predictive accuracy for OS and PFS were 0.559 and 0.542 (original Broders), 0.542 and 0.525 (consensus Broders), 0.554 and 0.541 (Jesinghaus grade), and 0.512 and 0.515 (Silva pattern), respectively. Broders and Jesinghaus binary tumor grades were significant on univariable analysis for OS and PFS, and predictive value was improved. Jesinghaus tumor grade ( P < 0.001) and both binary systems (Broders, P = 0.007; Jesinghaus, P < 0.001) were associated with the presence of lymph node metastases. Histologic grade has poor reproducibility and limited predictive accuracy for squamous cell carcinoma. The proposed binary grading system offers improved predictive accuracy for survival and the presence of lymph none metastases.

Head-to-head: how many categories for grading urothelial carcinoma?

Tumour grade is a critical prognostic parameter for guiding the management of patients with non-muscle invasive bladder cancer. In 2004, the World Health Organisation (WHO) adopted a binary (low-grade/high-grade) grading system to replace the three-tier (grades 1-3) system used to grade urothelial carcinoma since 1973. However, there is significant global variation in the grading of urothelial carcinoma. Some pathology and clinical guidelines recommend reporting of the WHO 1973 and 2004 grades in parallel, while others require reporting only of the WHO 2004 grade. This variation in pathology practice is clinically significant, because the two grading systems are not readily translatable. Some experts have proposed novel systems for grading urothelial carcinoma that involve splitting of the WHO 1973 and 2004 grade categories. The arguments for and against splitting urothelial carcinomas into two-, three- and four-grade categories are independently discussed by the three authors.

TWO GRADING SYSTEMS FOR ORAL EPITHELIAL DYSPLASIA IN ORAL POTENTIALLY MALIGNANT DISORDERS: A CLINICOPATHOLOGICAL STUDY

Objectives To classify oral epithelial dysplasia (OED), defined by the WHO, and binary grading systems in oral potentially malignant disorders (OPMDs), besides associating sociodemographic and histopathological features of these OPMDs. Study Design Records and slides of 65 cases compatible with clinicopathological diagnoses of OPMDs were evaluated for both classification systems and submitted to bivariate analysis. Results Middle-aged white men, non-smokers, and non-drinkers predominated. Smoking was associated with high-risk lesions by the binary system (p=0.036) and oral leukoplakia (p=0.003). The cases graded as mild-OED and severe-OED by the WHO system (85.7%) were reclassified as low-risk and high-risk respectively by the binary system. By contrast, 61.8% of moderate-OED cases were reclassified as low-risk for malignant transformation. Abnormal variation in cell size and shape, increased number and size of nucleoli, drop-shaped rete ridges, loss of epithelial cell cohesion, and abnormally superficial mitotic figures were statistically significant (p<0.05) in both grading systems. Cytological changes were significant in the WHO system, whereas architectural changes were significant in the binary system. Conclusions These are important histopathological features that should be taken into consideration when grading OED. Smoking was strengthened by the binary system as a risk factor for developing oral leukoplakia and its progression to malignancy. CNPq. To classify oral epithelial dysplasia (OED), defined by the WHO, and binary grading systems in oral potentially malignant disorders (OPMDs), besides associating sociodemographic and histopathological features of these OPMDs. Records and slides of 65 cases compatible with clinicopathological diagnoses of OPMDs were evaluated for both classification systems and submitted to bivariate analysis. Middle-aged white men, non-smokers, and non-drinkers predominated. Smoking was associated with high-risk lesions by the binary system (p=0.036) and oral leukoplakia (p=0.003). The cases graded as mild-OED and severe-OED by the WHO system (85.7%) were reclassified as low-risk and high-risk respectively by the binary system. By contrast, 61.8% of moderate-OED cases were reclassified as low-risk for malignant transformation. Abnormal variation in cell size and shape, increased number and size of nucleoli, drop-shaped rete ridges, loss of epithelial cell cohesion, and abnormally superficial mitotic figures were statistically significant (p<0.05) in both grading systems. Cytological changes were significant in the WHO system, whereas architectural changes were significant in the binary system. These are important histopathological features that should be taken into consideration when grading OED. Smoking was strengthened by the binary system as a risk factor for developing oral leukoplakia and its progression to malignancy. CNPq.

The Significance of International Federation of Gynecology and Obstetrics Grading in Microsatellite Instability-High and POLE-Mutant Endometrioid Endometrial Carcinoma

With the advancement of diagnostic molecular technology and the molecular classification of endometrial endometrioid carcinoma (EEC), it remains to be seen whether conventional International Federation of Gynecology and Obstetrics (FIGO) grading retains clinical significance in certain molecular subtypes of EECs. In this study, we explored the clinical significance of FIGO grading in microsatellite instability-high (MSI-H) and POLE-mutant EECs. A total of 162 cases of MSI-H EECs and 50 cases of POLE-mutant EECs were included in the analysis. Significant differences in tumor mutation burden (TMB), progression-free survival, and disease-specific survival were seen between the MSI-H and POLE-mutant cohorts. Within the MSI-H cohort, there were statistically significant differences in TMB and stage at presentation across FIGO grades, but not survival. Within the POLE-mutant cohort, there was significantly greater TMB with increasing FIGO grade, but there were no significant differences in stage or survival. In both the MSI-H and POLE-mutant cohorts, log-rank survival analysis showed no statistically significant difference in progression-free and disease-specific survival across FIGO grades. Similar findings were also seen when a binary grading system was utilized. Since FIGO grade was not associated with survival, we conclude that the intrinsic biology of these tumors, characterized by their molecular profile, may override the significance of FIGO grading.

Recent Advances in the Classification of Bladder Cancer - Updates from the 5th Edition of the World Health Organization Classification of the Urinary and Male Genital Tumors.

The World Health Organization Classification (WHO) of Urinary and Male Genital Tumors has recently been updated to its 5th edition. The new edition presents a comprehensive approach to the classification of urinary and male genital tumors with an incorporation of morphologic, clinical, and genomic data. This review aims to update the new classification of bladder cancer in the 5th edition and to highlight important changes in nomenclatures, diagnostic criteria, and molecular characterization, as compared to the 4th edition. The pathologic classification of bladder cancer in the 5th edition of WHO Classification of Urinary and Male Genital Tumours was compared to that in the 4th edition. PubMed was searched using key words, including bladder cancer, WHO 1973, WHO 1998, WHO 2004, WHO 2016, histology, pathology, genomics, and molecular classification in the time frame from 1973 to August of 2022. Other relevant papers were also consulted, resulting in the selection of 81 papers as references. The binary grading of papillary urothelial carcinoma (UC) is practical, but it may be oversimplified and contribute to "grade migration" in recent years. An arbitrary cutoff (5%) has been proposed for bladder cancers with mixed grades. The diagnosis of papillary urothelial neoplasm with low malignant potential has been dramatically reduced in recent years because of overlapping morphology and treatment with low-grade papillary UC. An inverted growth pattern should be distinguished from true (or destructive) stromal invasion in papillary UC. Several methods have been proposed for pT1 tumor substaging, but it is often challenging to substage pT1 tumors in small biopsy specimens. Bladder UC shows a high tendency for divergent differentiation, leading to several distinct histologic subtypes associated with an aggressive clinical behavior. Molecular classification based on the genomic analysis may be a useful tool in the stratification of patients for optimal treatment. The 5th edition of WHO Classification of Urinary and Male Genital Tumours has made several significant changes in the classification of bladder cancer. It is important to be aware of these changes and to incorporate them into routine clinical practice.

A complete pipeline for glioma grading using intelligible AI on multimodal MRI data

1) Objectives: Machine learning for binary glioma grading have been extensively used on anatomical MRI, especially using the BraTS dataset. The relevance of radiomic criteria based on multimodal imaging, including diffusion, perfusion and spectroscopy data is to be explored, as multimodal datasets are scarce, and there is no common benchmark for performance comparison. 2) Material and methods: Poitiers University Hospital provides 123 multimodal patient data. We computed 124 features and let a recursive feature elimination algorithm (RFE) yield a relevant, reduced subset of features. We trained a SVM classifier on this subset. We proposed a method to adapt the BraTS dataset to allow performance comparison with the literature. We got a performance reference point by training on anatomical data only, and showed improvements when multimodalities were added. We explored the feature relevance through the RFE subset. The RFE subset is not constant and induce variability in the performances. To smooth the variability, we applied the RFE algorithm 100 times and incremented the selected features, resulting in a global feature ranking. We also show the best classifier reached on these 100 trainings and its feature subset. 3) Results: The best classifier reached 86.5% accuracy, with a mean accuracy on 100 trainings of 78.6%. The rankings shows that anatomical and perfusion sequences are the most relevant for glioma grading, especially T1 post-gadolinium, cerebral blood volume and flow. Intensity and texture features are frequently selected, while anisotropic diffusion coefficient, time to peak and mean time transit mappings seem irrelevant. 4) Conclusion: Multimodal radiomics improve the classification and are consistent with the radiological analysis.

Assessment of Interobserver Agreement in the Interpretation of 99mTc-PYP SPECT Imaging of Cardiac Amyloidosis.

Background: Technetium-99m pyrophosphate single photon emission computed tomography (99mTc-PYP SPECT) imaging is widely used to diagnose cardiac amyloidosis, a disease characterized by amyloid protein deposits in the myocardium. The effects of viewing perspectives on interobserver agreement in the interpretation of 99mTc-PYP SPECT images for the diagnosis of cardiac amyloidosis remain unclear. Methods: A retrospective analysis of 32 consecutive patients who underwent 99mTc-PYP imaging for the diagnosis of cardiac amyloidosis at Nagasaki University Hospital between October 2017 and February 2020 was performed. Four evaluators independently reviewed coronal, sagittal, and transaxial images and then all images together and made a categorical diagnosis based on predefined criteria. Interobserver agreement was analyzed using Cohen's Kappa analysis. Results: Kappa coefficient values in the four-grade grading system (grades 0-3) ranged between 0.31 and 0.95, while those in the binary grading system (positive/negative) ranged between 0.88 and 1. The sagittal view showed the highest value in the four-grade grading system (0.95) and the lowest in the binary grading system (0.88). The transaxial view was more likely to show a consistently high kappa value in both the four-grade and binary grading systems. The use of the multiplanar view reduced the number of subjects classified as grade 1. Conclusion: Our study demonstrates that the transaxial view provides the most consistent interpretation of 99mTc-PYP SPECT images for the diagnosis of cardiac amyloidosis. The use of the multiplanar view may also reduce equivocal interpretations, which are graded as grade 1. Further studies with larger sample sizes and a quantitative analysis are needed to confirm the present results.

Implementation of a soft grading system for chemistry in a Moodle plugin

We report a novel approach for grading chemical structure drawings for remote teaching, integrated into the Moodle platform. Typically, existing online platforms use a binary grading system, which often fails to give a nuanced evaluation of the answers given by the students. Therefore, such platforms are unevenly adapted to different disciplines. This is particularly true in the case of chemical structures, where most questions simply cannot be evaluated on a true/false basis. Specifically, a strict comparison of candidate and expected chemical structures is not sufficient when some tolerance is deemed acceptable. To overcome this limitation, we have developed a grading workflow based on the pairwise similarity score of two considered chemical structures. This workflow is implemented as a Moodle plugin, using the Chemdoodle engine for drawing structures and communicating with a REST server to compute the similarity score using molecular descriptors. The plugin (https://github.com/Laboratoire-de-Chemoinformatique/moodle-qtype_molsimilarity) is easily adaptable to any academic user; both embedding and similarity measures can be configured.

A review of the changes in higher education assessment and grading policy during covid-19

The Covid-19 pandemic has not only brought about sociocultural, psychological and economic challenges, but also educational problems that have entailed radical policy changes to allow universities and colleges to fulfil their role. Before the pandemic, the majority of university courses were designed for face-to-face settings; but under the social distancing policies since Covid-19, institutions have had to react quickly, revising their teaching and assessment policies to ensure that education continues for all students and accommodate the new remote reality of education. This paper provides a review of the changes in educational assessment and grading policies of universities around the world in response to the Covid-19 pandemic, where five key themes were identified: covid-19 binary grading system, revised regulations governing the final degree award, relaxed academic progression policies, revised extension, deferral and exceptional circumstances policies, and mark adjustments. This review will serve as a useful summary for institutions to reflect upon and inform planning strategies for subsequent unexpected future events.

Correlation of a New Binary System in Grading of Oral Leukoplakia for Its Prediction of Malignant Transformation - A Retrospective Record-Based Study

Introduction: Oral Leukoplakia is a premalignant lesion with an increased risk of developing oral cancer when the lesion is non-homogeneous. There is a need to validate clinical presentations of a commonly occurring Leukoplakia lesion and its probability of dysplastic changes over some time. Aim: To correlate the Diagnostic accuracy of clinical lesion diagnosed as Leukoplakia and the presence or absence of dysplasia through its histopathological correlation. Materials and Methods: This study gathered data retrospectively during 2016–2021 with an initial diagnosis of oral Leukoplakia. A set of 611 slides were included in the study that was signed out as oral Leukoplakia. We tested the hypothesis that a binary grading system categorizes lesions as “presence” or “absence” of oral epithelial dysplasia. A logistic regression analysis was used in predicting the presence of dysplasia among the various clinical criteria. Results: Most of the mild dysplasia was reported in the buccal mucosa (n = 195; 31.91%), followed by 6 (0.98%) cases in the vestibule. A mean age of 32.33 ± 7.0 was observed for severe dysplasia. A statistically significant relationship between the risk estimates for the clinical diagnosis and dysplasia was noted for all the lesion types. Conclusion: The study concludes that the clinical presentation of a lesion can predict the underlying dysplastic changes, and mixed red and white lesions with growth possess the highest risk of malignant transformations.

Combination of Binary System with Ki67 Immunohistochemical Staining: a Reliable Grading Method for Oral Epithelial Dysplasia.

Oral epithelial dysplasia (OED) is a common potentially malignant lesion of oral cavity that should be managed to prevent likely malignant transformation. Here, we present a combination of binary grading system with complementary immunohistochemical (IHC) staining for Ki67 biomarker to provide a reproducible OED grading system. 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. 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. 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.