Binary Grading Research Articles

Holistic multi-class classification & grading of diabetic foot ulcerations from plantar thermal images using deep learning

PurposeDiabetic foot is a common complication associated with diabetes mellitus (DM) leading to ulcerations in the feet. Due to diabetic neuropathy, most patients have reduced sensitivity to pain. As a result, minor injuries go unnoticed and progress into ulcers. The timely detection of potential ulceration points and intervention is crucial in preventing amputation. Changes in plantar temperature are one of the early signs of ulceration. Previous studies have focused on either binary classification or grading of DM severity, but neglect the holistic consideration of the problem. Moreover, multi-class studies exhibit severe performance variations between different classes.MethodsWe propose a new convolutional neural network for discrimination between non-DM and five DM severity grades from plantar thermal images and compare its performance against pre-trained networks such as AlexNet and related works. We address the lack of data and imbalanced class distribution, prevalent in prior work, achieving well-balanced classification performance.ResultsOur proposed model achieved the best performance with a mean accuracy of 0.9827, mean sensitivity of 0.9684 and mean specificity of 0.9892 in combined diabetic foot detection and grading.ConclusionTo the best of our knowledge, this study sets a new state-of-the-art in plantar foot thermogram detection and grading, while being the first to implement a holistic multi-class classification and grading solution. Reliable automatic thermogram grading is a first step towards the development of smart health devices for DM patients.

The clinical utility of contemporary oral epithelial dysplasia grading systems.

Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. While adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. One hundred thirty-one cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ=0.753 - 0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ=0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).

Binary glioma grading framework employing locality preserving projections and Gaussian radial basis function support vector machine

AbstractGliomas are one of the most dangerous brain tumours, which are life‐threatening in their highest grade. Manual diagnosis and detection of brain tumours are time‐consuming. Thus, early and accurate detection of such tumours becomes essential for its prognosis. In this work, we aim to develop a fully automated glioma grade classification framework. The proposed method aims to learn relevant and non‐redundant features from magnetic resonance brain tumour images. Gabor filter banks extract discriminant features from the brain images, and locality preserving projections are utilized for feature reduction to achieve non‐redundant features. We train Gaussian radial basis function–support vector machine classifiers using these features for classifying gliomas into low grade glioma (LGG) or high‐grade glioma. We apply Synthetic Minority Over‐Sampling Technique on the minority class (LGG) to mitigate the class imbalance problem. The performance of the proposed method is validated by conducting fivefold cross‐validation. We evaluate the performance of our proposed framework on different BRATS datasets: BRATS 2013, BRATS 2015, and BRATS 2017. We perform extensive experiments on each dataset separately, and experimental findings demonstrate that our proposed approach provides significantly superior performance compared to state‐of‐the‐art techniques.

Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis.

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. 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). 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). 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. 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.

Exploring Radiologic Criteria for Glioma Grade Classification on the BraTS Dataset

ObjectivesGlioma grading using maching learning on magnetic resonance data is a growing topic. According to the World Health Organization (WHO), the classification of glioma discriminates between low grade gliomas (LGG), grades I, II; and high grade gliomas (HGG), grades III, IV, leading to major issues in oncology for therapeutic management of patients. A well-known dataset for machine-based grade prediction is the MICCAI Brain Tumor Segmentation (BraTS) dataset. However this dataset is not divided into WHO-defined LGG and HGG, since it combines grades I, II and III as “lower grades gliomas”, while its HGG category only presents grade IV glioblastoma multiform. In this paper we want to train a binary grade classifier and investigate the consistency of the original BraTS labels with radiologic criteria using machine-aided predictions. Material and methodsUsing WHO-based radiomic features, we trained a SVM classifier on the BraTS dataset, and used the prediction score histogram to investigate the behaviour of our classifier on the lower grade population. We also asked 5 expert radiologists to annotate BraTS images between low (as opposed to lower) grade and high grade glioma classes, resulting in a new groundtruth. ResultsOur first training reached 84.1% accuracy. The prediction score histogram allows us to identify the radiologically high grade patients among the original lower grade population of the BraTS dataset. Training another SVM on our new radiologically WHO-aligned groundtruth shows robust performances despite important class imbalance, reaching 82.4% accuracy. ConclusionOur results highlight the coherence of radiologic criteria for low grade versus high grade classification under WHO terms. We also show how the histogram of prediction scores and crossed prediction scores can be used as tools for data exploration and performance evaluation. Therefore, we propose to use our radiological groundtruth for future development on binary glioma grading.

Proposition of a simple binary grading of estimated blood loss during colon surgery

PurposeIntraoperative estimated blood loss (EBL) is often reported in nearly all surgical papers; however, there is no consensus regarding its measurement. The aim of this study was to determine whether EBL (ml) is as reliable and reproducible in predicting complications as a simple binary grading of EBL.MethodsAll consecutive patients undergoing colectomies between January 2015 and December 2018 were included. EBL was assessed prospectively by the surgeon and anaesthesiologist in ml and with a binary scale: bleeding “as usual” versus “more than usual” by the surgeon. Differences between pre- and post-operative haemoglobin levels (ΔHb g/dl) were correlated to EBL. Blood loss impact on 30-day postoperative morbidity was analysed.ResultsA total of 270 patients were included, with a mean age of 65 years (SD 17). Mean EBL documented by surgeons correlated to EBL by anaesthesiologists (79.5 ml, SD 99 vs. 84.5 ml, SD 118, ϱ = 0.926, p < 0.001). Surgeons and anaesthesiologists’ EBL correlated also with ΔHb (ϱ = − 0.273, p = 0.01 and ϱ = − 0.344, p = 0.01, respectively). Patient with surgeon EBL ≥ 250 ml or graded as “more than usual” bleeding had significantly more severe complications (8% vs. 20%, p = 0.02 and 8% vs. 27%, p = 0.001, respectively).ConclusionAnaesthesiologist and surgeon’s EBL correlated with ΔHb. Simple grading of blood loss as “usual” and “more than usual” predicted severe complications and higher mortality rates. This simple binary grading of blood loss in colon surgery could be an alternative to the estimation of blood loss in ml as it is easy to apply but needs to be validated externally.

Quantification of pial collateral pressure in acute large vessel occlusion stroke: basic concept with patient outcomes.

Pial collateral perfusion to the ischemic penumbra plays a critical role in determining patient outcomes in acute stroke. We aimed to assess the validity and reliability of an intra-procedural technique for measuring and quantifying the pial collateral pressure (QPCP) to ischemic brain tissue during acute stroke secondary to LVO. QPCP measurements were correlated with standard computed tomography angiography (CTA) and digital subtraction angiography imaging assessments of pial collateral perfusion and outcomes after mechanical endovascular revascularization (MER). This prospective cohort study included 60 consecutive patients with middle cerebral artery (MCA)-M1 and proximal M2 occlusions. QPCP measurements were obtained during MER. The validity of QPCP measurements was evaluated using four widely accepted collateral grading scales. QPCP measurements were also analyzed as a predictor of patient outcomes utilizing National Institute of Health Stroke Scale reduction at 24 h and modified Rankin Scale (mRS) scores at 30 days. QPCP measurements and QPCP ratio (QPCP/systemic mean arterial blood pressure) showed a statistically significant association with single-phase pretreatment CTA Maas and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology binary grading scales. Patient outcomes demonstrated for every 10-unit increase in QPCP, the odds of mRS 0-2 at 30 days increased by 76% (p = 0.019). QPCP measurements related best with the pretreatment CTA Maas collateral grading scale but were more strongly associated with patient outcomes than any of the four widely accepted collateral grading scales. Greater QPCP was significantly associated with better overall patient outcomes as defined by mRS at 30 days.

Grading of Oral Leukoplakia: Can It be Improvised Using Immunohistochemical Markers p63 and CD31.

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.

Annual malignant transformation rate of oral leukoplakia remains consistent: A long-term follow-up study.

Numerous clinical and histopathological characteristics have been associated with malignant transformation (MT) of oral leukoplakia (OL), including classic and differentiated epithelial dysplasia, but MT predictions remain suboptimal. The objective of this study was to determine the annual MT rate of OL and to identify clinicopathological risk factors associated with MT. 170 patients with OL were included in this retrospective cohort study, 117 females and 53 males. Follow-up ranged from 12 to 219months (median 54). The analyzed variables included age, gender, smoking habits, clinical presentation, subsite, size and treatment. In a subgroup of 140 patients, histopathological diagnoses were reviewed with regard to the presence of dysplasia, discerning both classic dysplasia and differentiated dysplasia. MT occurred in 23% of the patients, resulting in an annual MT rate of 4.9% (95% CI: 3.5 - 6.6) which remained consistent. High-risk subsite (tongue and floor of mouth) was the only clinical predictor for MT (Hazard Ratio=2.7, 95% CI: 1.3 - 5.5, p=0.007). In 140 patients, classic dysplasia (Hazard Ratio=7.2, 95% CI: 1.6 - 33.1, p=0.012) and differentiated dysplasia (Hazard Ratio=6.6, 95% CI: 1.2 - 25.4, p=0.026) were predictors for MT. Binary grading between dysplasia and no dysplasia was significant for predicting MT (Hazard Ratio=6.4, 95% CI: 1.5 - 27.5, p=0.013). Since annual MT rate of OL remains stable during follow-up, regular long-term or even life-long follow-up is advocated. Specific oral subsites and epithelial dysplasia are predictors for MT of OL.

Binary grading may be more appropriate for endometrial cancer

Objective:To elucidate the survival consequences of the prognostic factors for endometrial cancer.Material and Methods:This was a retrospective study of 276 patients diagnosed with endometrial cancer who admitted for staging surgery. The extent of the surgery was determined by clinical staging and preoperative evaluation. The pathology specimens were reassessed by a gynecopathologist. Independent risk factors were revealed for the progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) utilizing Kaplan-Meier and “Cox” proportional analysis.Results:The median follow up of the patients was 50 months. Of the 29 patients who died, 15 (5.43%) died because of endometrial cancer. Multivariate analysis revealed that independent risk factors for OS and PFS were stage (p=0.002, 0.002, respectively) and grade 3 (G3) histology (p=0.013, 0.015, respectively). Positive peritoneal cytology was an independent risk factor for OS (p=0.024), but not for PFS (p=0.050). Stage (p=0.005) was found to be the only independent risk factor for DSS. Patients with G1 and G2 histology had a similar and more favorable prognosis than patients with G3 histology.Conclusion:Advanced stage, high-grade tumor and the presence of positive peritoneal cytology were ascertained as independent prognostic factors for endometrial cancer. A binary histological grading system could be simpler and as effective as the current three grade system because grade 1 and 2 patients showed similar prognosis.

EVALUATION OF INFLAMMATORY MARKERS IN POTENTIALLY MALIGNANT DISORDERS OF THE ORAL CAVITY

Objective: The aim this study was to evaluate the expression of inflammatory markers in potentially malignant disorders of oral cavity (leukoplakia) and its relationship with the degree of epithelial dysplasia. Study design: Immunohistochemistry was used to identify the number (cells/mm2) of interleukin 17 (IL-17+), neutrophil (CD66 b+), matrix metalloproteinase‐9 (MMP-9+) cells, and neoformed microvessels (CD105+) in the subepithelial region of leukoplakia samples from 31 patients. Evaluation of IL‐17 expression in keratinocytes cells was semiquantitative and performed by assigning scores. Samples of healthy oral mucosa (n = 10) were used as controls. Results: The classification of epithelial dysplasia by the binary grading system totaled 17 samples with high risk and 14 samples with low risk of malignant transformation. Irrespective of the severity of epithelial dysplasia, the counts of inflammatory markers (CD66 b, IL-17, MMP-9, and CD105) were higher in the leukoplakia group compared to controls (P< .05 for all comparisons). In addition, the intraepithelial expression of IL-17 was high in leukoplakia samples (44%) and absent/low in the control group (100%; P< .05). Conclusions: This study showed that potentially malignant disorders of oral cavity are characterized by a high count of inflammatory markers. Objective: The aim this study was to evaluate the expression of inflammatory markers in potentially malignant disorders of oral cavity (leukoplakia) and its relationship with the degree of epithelial dysplasia. Study design: Immunohistochemistry was used to identify the number (cells/mm2) of interleukin 17 (IL-17+), neutrophil (CD66 b+), matrix metalloproteinase‐9 (MMP-9+) cells, and neoformed microvessels (CD105+) in the subepithelial region of leukoplakia samples from 31 patients. Evaluation of IL‐17 expression in keratinocytes cells was semiquantitative and performed by assigning scores. Samples of healthy oral mucosa (n = 10) were used as controls. Results: The classification of epithelial dysplasia by the binary grading system totaled 17 samples with high risk and 14 samples with low risk of malignant transformation. Irrespective of the severity of epithelial dysplasia, the counts of inflammatory markers (CD66 b, IL-17, MMP-9, and CD105) were higher in the leukoplakia group compared to controls (P< .05 for all comparisons). In addition, the intraepithelial expression of IL-17 was high in leukoplakia samples (44%) and absent/low in the control group (100%; P< .05). Conclusions: This study showed that potentially malignant disorders of oral cavity are characterized by a high count of inflammatory markers.

Intra-observer and inter-observer variability in two grading systems for oral epithelial dysplasia: A multi-centre study in India.

The presence and grading of oral epithelial dysplasia (OED) are considered the gold standard for predicting the malignant risk of oral potentially malignant disorders. However, inter-observer and intra-observer agreement in the context of reporting on OED grading has been reputedly considered unreliable. We undertook a multi-centre study of six Indian oral pathologists to assess variations in reporting OED using the World Health Organization (WHO; 2005) system and also the recently introduced binary system. The observer variability was assessed with the use of kappa statistics. The weighted kappa intra-observer agreement scores improved (κw =0.5012) on grouping by two grades as no and mild dysplasia versus moderate and severe dysplasia compared to binary grading system (κ=0.1563) and WHO grading system (κw =0.4297). Poor to fair inter-observer agreement scores were seen between the principal investigator (PI) and the other five observers using the WHO grading system (κ=0.051-0.231; κw =0.145 to 0.361; 35% to 46%) and binary grading system (κ=0.049 to 0.326; 50 to 65%). There is considerable room for improvement in the assessment of OED using either system to help in standardised reporting. The professional pathology organisations in India should take steps to provide external quality assessment in reporting OED among oral and general pathologists who are engaged in routine reporting of head and neck specimens.

Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis.

Oral potentially malignant disorders (OPMDs) may have varying degrees of oral epithelial dysplasia (OED). Traditional grading schemes separate OED into three-tiers (mild, moderate, and severe). Alternatively, a binary grading system has been previously proposed that stratifies OED into low-risk and high-risk categories based on a quantitative threshold of dysplastic pathologic characteristics. This systematic review evaluates the predictive value of a binary OED grading system and examines agreement between pathologists. This meta-analysis queried 4 databases (PubMed, Ovid-MEDLINE, Cochrane, and SCOPUS) and includes 4 studies evaluating binary OED grading systems. Meta-analysis of proportions and correlations was performed to pool malignant transformation rates (MTR), risk of malignant transformation between OED categories, and measures of interobserver agreement. Pooled analysis of 629 lesions from 4 different studies found a six-time increased odds of malignant transformation in high-risk lesions over low-risk lesions [odds ratio (OR) 6.14, 95% 1.18-15.38]. Reported ORs ranged from 2.8 to 22.4. The overall MTR was 26.8%, with the high-risk and low-risk lesions having MTRs of 57.9% (95% CI 0.386-0.723) and 12.7% (95% CI - 0.210 to 0.438), respectively. Pooled unweighted interobserver kappa values for the binary grading system and three-tiered system were 0.693 (95% CI 0.640-0.740) and 0.388 (95% CI 0.195-0.552), respectively. Binary grading of OED into low-risk and high-risk categories may effectively determine malignant potential, with improved interobserver agreement over three-tiered grading. Improved grading schemes of OED may help guidemanagement (watchful waiting vs. excision) of these OPMDs.

Malignant transformation of oral leukoplakia: a follow-up study.

The main objective of the study was to identify the determinants that contribute to the malignant transformation of oral leukoplakia in a group of patients managed in secondary care. A secondary objective was to compare two dysplasia grading systems to determine their utility in assessing the prognosis. The cohort consisted of 93 patients diagnosed during the period 2009-2013. The variables recorded and analysed included age and sex, clinical presentation (colour) and severity of oral epithelial dysplasia (OED) scored by the WHO (2005) and the binary grading systems. The planned management included excision of high-grade dysplasia and observation of low-grade dysplasia lesions based on the WHO grading system. Patient factors were transcribed from the pathology records and updated using a questionnaire sent out to the whole group of patients. Data were analysed using χ2 test and Kaplan-Meier analysis (P < 0.05). Complete follow-up data were available for 93 patients. Malignant transformation occurred in 7 patients (7.5%) during a mean follow-up period of 30months. Among the surgically excised group (n = 51), a recurrence of oral leukoplakia was noted in 16 patients (31%). WHO OED grading (P = 0.02) and the presence of red areas (P = 0.012) were useful in predicting malignant transformation with severe epithelial dysplastic lesions and red and white mixed lesions showing higher rates. Leukoplakias (7.5%) transformed over a mean follow-up period of 30months. Dysplasia grading and the clinical appearance by colour (mixed white and red) were significant predictors of malignant transformation CLINICAL SIGNIFICANCE: Patients with erythroleukoplakia and those diagnosed with moderate or severe epithelial dysplasia require more intensive interventions as such lesions have a higher risk of developing a malignancy.

FR02-10 AUA PRESIDENTIAL ADDRESSES

INTRODUCTION AND OBJECTIVE: The AUA Presidential address has been an important feature of every AUA meeting since 1904. We wished to know how the addresses have changed over the century, their themes and topics, and how well the addresses reflected an underlying sentiment or outlook of contemporary urology. METHODS: We converted all written (published or unpublished) or video AUA Presidential addresses into a searchable database of text files. We obtained biographical data from the AUA Didusch Museum and digitalized newspaper archives. Flesch Reading Ease and Flesch-Kinkaid Grade Level statistics were generated using Microsoft Word. Sentiment analysis was conducted using Voyant Tools, a common open source natural language processing (NLP) platform to assess for positive and negative word association sets. Lastly, we used analog (i.e. reading) methods to assess for blinded sentiment analysis using an internally validated crowd-sourced binary grading metric. Regression analysis was used to assess for statistically significant trends. RESULTS: 95 addresses from 1904-2018 were entered into a searchable database representing 93 AUA Presidents 60.0 +/- 9.3 years of age. Only 59 addresses (62%) were published in the Journal of Urology from 1921-1999. On average, each address was 2990 +/- 1350 words (range 687 (William Garlick, MD, 1979) to 7752 (Ramon Guiteras, 1904). There were significant decreases in word count and use of the passive voice over the century (p< .001). Readability metrics suggested that addresses became ‘less difficult’ over time. Negative sentiment was associated with speeches of a financial or legislative theme and positive sentiment with speeches regarding the art and practice of urology (p<.04). There was no association of negative sentiment with speeches during the Great Depression or war time. CONCLUSIONS: AUA Presidential Addresses have become shorter and more readable while negative sentiment scores increased, especially in speeches of a financial or legislative theme. The database continues to be supplemented as more unpublished addresses are located. The AUA President Digital Humanities Project may provide scholars with a useful platform for digital analysis and research.Source of Funding: None

A New Multimodel Machine Learning Framework to Improve Hepatic Fibrosis Grading Using Ultrasound Elastography Systems from Different Vendors

The purpose of the work described here was to determine if the diagnostic performance of point and 2-D shear wave elastography (pSWE; 2-DSWE) using shear wave velocity (SWV) with a new machine learning (ML) technique applied to systems from different vendors is comparable to that of magnetic resonance elastography (MRE) in distinguishing non-significant (<F2) from significant (≥F2) fibrosis. We included two patient groups with liver disease: (i) 144 patients undergoing pSWE (Siemens) and MRE; and (ii) 60 patients undergoing 2-DSWE (Philips) and MRE. Four ML algorithms using 10 SWV measurements as inputs were trained with MRE. Results were validated using twofold cross-validation. The performance of median SWV in binary grading of fibrosis was moderate for pSWE (area under the curve [AUC]: 0.76) and 2-DSWE (0.84); the ML algorithm support vector machine (SVM) performed particularly well (pSWE: 0.96, 2-DSWE: 0.99). The results suggest that the multivendor ML-based algorithm SVM can binarily grade liver fibrosis using ultrasound elastography with excellent diagnostic performance, comparable to that of MRE.

APPLICABILITY OF ORAL EPITHELIAL DYSPLASIA GRADING IN POTENTIALLY MALIGNANT DISORDERS OF ORAL CAVITY-AN INSTITUTIONAL REVIEW

Oral cancer may be preceded by Potentially malignant lesions such as leukoplakia, erythroplakia, stomatitis nicotina, oral submucous fibrosis (OSMF) and erosive lichen planus(LP). Oral Epithelial dysplasia (OED) is an important predictor of malignant potential. According to WHO 2017, the three tiered grading reliability can be improved by Binary grading system of high & low risk. So the aim of this retrospective study was verify the applicability of the binary grading system for OED in our institution. Objective Comparison of the Binary grading system with WHO three tiered grading system in Oral Epithelial Dysplasia. Findings 116 cases reported as OED from the period 2008 to 2017, were reevaluated and graded according to WHO 2005 & the Binary system. 81.03% of cases were clinically diagnosed as oral leukoplakia, 10.34% as oral LP and 8.62% as OSMF. The frequency of distribution of cases according to WHO grading system were mild (19), moderate (55) and severe (42), whereas according to binary system 85 cases are high risk and 31 cases low risk. On comparison, all 42 cases of severe dysplasia were graded as high risk. Out of 55 cases of moderate dysplasia, 41 were graded as high risk and 14 as low risk. Among 19 cases of mild dysplasia, 2 cases were designated as high risk and 17 cases as low risk. Out of 116 cases, 11(9.48%) cases were of recurrence as OED. 9 cases (10.58%) out of 85 high risk cases showed recurrence in comparison to two (2.35%) out of 31 low risk cases. Analysis of Binary system in relation to clinical features is also attempted. Conclusion In the present analysis, though majority of the high risk cases occurred on buccal mucosa, recurrence was more on tongue. The binary system helped in defining the prognostic group by providing the histologic criteria.

A proposal for updating the staging of endometrial cancer.

Since the last update of the International Federation of Gynecology and Obstetrics (FIGO) staging for corpus uteri cancer in 2009, a number of new insights into pathology, molecular genetics, and prognostic factors that justify a revision have been made. We recommend incorporation of histotype and grade along with depth of myometrial invasion to define stage I endometrial cancer, a change from 3-tier grading to binary grading, and inclusion of lymph node status (negative vs not removed) in the definition of stage I disease. Elimination of cervical involvement to define stage II and inclusion of positive peritoneal cytology to upstage otherwise stage I cancers to stage IIA is also recommended. Extrauterine pelvic involvement should be classified as stage IIB disease, and stage III should be reclassified based exclusively on retroperitoneal pelvic and/or para-aortic lymph node involvement. If feasible, molecular staging by immunohistochemistry (mismatch repair proteins and p53) as well as POLE exonuclease sequencing may be carried out in order to assign one of the four categories from The Cancer Genome Atlas.

The Prognostic Impact of Grading in FIGO IB and IIB Squamous Cell Cervical Carcinomas.

Background Tumor grade is one of the more controversial factors, and the data regarding its prognostic impact in squamous cell carcinoma (SCC) of the uterine cervix are controversial. Methods The histological slides of 467 surgically treated FIGO stage IB1 to IIB cervical SCC were re-examined regarding the prognostic impact of the histological tumor grade based on the degree of keratinization (conventional tumor grade) according to the WHO recommendation on recurrence-free and overall survival as well as on the prediction of pelvic lymph node involvement. Results 46.0% presented with well-differentiated tumors (G1, n = 215), 30.6% with moderate (G2, n = 143) and 23.3% with poor differentiation (G3, n = 109). The recurrence-free survival was significantly reduced in patients with poorly differentiated tumors (G1: 81.4%, G2: 70.6%, G3: 64.2%; p = 0.008). There was no impact on overall survival. Because of the lack of survival differences between G1- and G2-tumors, they were merged into low-grade tumors, and their prognostic outcome was compared to the high-grade group (G3-tumors). Based on this binary conventional grading system there was a significantly longer recurrence-free (low-grade: 77.1% vs. high-grade: 64.2%; p = 0.008) and overall survival (low-grade: 76.0% vs. high-grade: 65.1%; p = 0.031) in the low-grade group. However, both the conventional three-tiered and the binary grading systems (separating tumors into a low- and high-grade group) failed to predict pelvic lymph node involvement (p = 0.9 and 0.76, respectively). Conclusion A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may be suitable for the prognostic survival evaluation but failed to predict pelvic lymph node involvement.

Prognostic relevance of low-grade versus high-grade FIGO IB1 squamous cell uterine cervical carcinomas.

Tumor grade is one of the more controversial factors with limited prognostic information in squamous cell carcinomas (SCC) of the uterine cervix. Histologic slides of 233 surgically treated cervical SCC (FIGO IB1) were re-examined regarding the prognostic impact of the WHO-based grading system, using the different degree of keratinization, categorizing the tumors in G1, G2 and G3 (conventional tumor grade). 45.1% presented with well-differentiated tumors (G1), 29.2% with moderate (G2) and 25.8% with poor differentiation (G3). Tumor grade significantly correlated with decreased recurrence-free and overall survival. However, detailed analyses between G1- and G2-tumors failed to show any correlation with either recurrence-free or overall survival. G1- and G2-tumors were therefore merged into low-grade tumors and were compared to the high-grade group (G3-tumors). This binary conventional grading system showed an improved 5-years recurrence-free (low-grade: 90.2% vs. high-grade: 71.6%; p = 0.001) and overall survival rates (low-grade: 89.9% vs. high-grade: 71.1%; p = 0.001) for low-grade tumors. On multivariate analysis adjusted for lymph node metastasis, high-grade tumors represented a hazard ratio of 2.4 (95% CI 1.3-4.7) for reduced recurrence-free and 2.4 (95% CI 1.2-4.6) for overall survival. High-grade tumors showed a significantly higher risk for pelvic lymph node involvement [OR 2.7 (95% CI 1.4-5.5); p = 0.003]. The traditional three-tiered grading system failed to predict pelvic lymph node metastases. A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may allow a better prognostic discrimination than the traditionally used three-tiered system.