Evaluation of a new binary system of grading oral epithelia dysplasia for prediction of malignant transformation
Evaluation of a new binary system of grading oral epithelia dysplasia for prediction of malignant transformation
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DOI：
10.1016/j.oraloncology.2005.12.014
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发表时间：
2006-11-01
期刊：
影响因子：
4.8
通讯作者：
Sloan, Philip
中科院分区：
文献类型：
--
作者：
Kujan, Omar;Oliver, Richard J.;Sloan, Philip
本文的目的是评估一种新的口腔上皮细胞二进制分级系统(高/低风险)的重复性。并将其与世卫组织2005年分类进行比较。对新系统预测恶变的准确性也进行了评估。从口腔病理学档案中检索到96例临床结果已知的连续口腔骨膜发育不良活检标本。对28例患者进行了初步研究，以确定其分类过程。然后，四名观察者回顾了68个口腔痉挛病变的同一组H&E染色的玻片，使用了两种分级系统，对临床结果视而不见。WHO分级系统的总体观察者间未加权和加权Kappa一致性分别为K-S=0.22(95%CI：0.11-0.35)，K-W=0.63(95%CI：0.42-0.78)，而新的二元系统的K=0.50(95%CI：0.35-0.67)。有趣的是，所有病理学家在使用新的WHO分类方法区分轻度不典型增生与重度不典型增生以及与原位癌的区别上都表现出令人满意的一致性。然而，对中度不典型增生的评估仍然存在问题。新的二元分级系统预测口腔上皮恶变和异型增生的敏感性和特异性分别为85%和80%，准确率为82%。新的二元分级系统补充了世界卫生组织2005年的分类，可能有助于临床医生做出关键的临床决定，特别是对于中度不典型增生的病例。根据已建立的标准对异型增生进行组织学分级是一种可重复性预测口腔粘膜发育不良的指标。发育不良。此外，目前的研究表明，应该鼓励专家小组对消化不良的程度、风险评估或每种形态特征的存在进行更多的共识评分。(C)2005爱思唯尔有限公司。保留所有权利。
The aim of this paper is to assess the reproducibility of a novel binary grading system (high/low risk) of oral epithelial. dysplasia and to compare it with the WHO classification 2005. The accuracy of the new system for predicting malignant transformation was also assessed. Ninety-six consecutive oral epithetial dysplasia biopsies with known clinical outcomes were retrieved from the Oral Pathotogy archives. A pilot study was conducted on 28 cases to determine the process of classification. Four observers then reviewed the same set of H&E stained slides of 68 oral dysptastic lesions using the two grading systems blinded to the clinical outcomes. The overall inter-observer unweighted and weighted kappa agreements for the WHO grading system were K-s = 0.22 (95% Cl: 0.11-0.35), K-W = 0.63 (95% Cl: 0.42-0.78), respectively, versus K = 0.50 (95% Cl: 0.35-0.67) for the new binary system. Interestingly, all pathologists showed satisfactory agreement on the distinction of mild dysplasia from severe dysplasia and from carcinoma in situ using the new WHO classification. However, assessment of moderate dysplasia remains problematic. The sensitivity and specificity of the new binary grading system for predicting malignant transformation in oral epithelial, dysplasia were 85% and 80%, respectively and the accuracy was 82%. The new binary grading system complemented the WHO Classification 2005 and may have merit in helping clinicians to make critical clinical decisions particularly for the cases of moderate dysplasia. Histological grading of dysplasia using established criteria is a reproducible prognosticator in oral epithetial. dysplasia. Furthermore, the present study showed that more consensus scoring on either the degree of dysptasia, assessment of risk or the presence of each morphological characteristic by a panel should be encouraged. (c) 2005 Elsevier Ltd. All rights reserved.