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

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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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 guide management (watchful waiting vs. excision) of these OPMDs.

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Author information

Authors and Affiliations

  1. Head and Neck Tumor Center, Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA

    Flora Yan, Priyanka D. Reddy, Shaun A. Nguyen & Terry A. Day

  2. Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA

    Angela C. Chi & Brad W. Neville

Authors
  1. Flora Yan
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  2. Priyanka D. Reddy
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  3. Shaun A. Nguyen
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  4. Angela C. Chi
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  5. Brad W. Neville
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  6. Terry A. Day
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Contributions

FY conceptualization, methodology, formal analysis, data curation, writing—original draft, writing—review and editing. PDR data curation, writing—original draft, writing—review and editing. SAN formal analysis, writing—review and editing. ACC writing—review and editing, supervision. BWN review and editing, supervision. TAD conceptualization, methodology, writing—review and editing, supervision. All authors approved the final version to be published.

Corresponding author

Correspondence to Flora Yan.

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Ethical approval was not required as this did not involve individual patient data.

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Electronic supplementary material

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405_2020_6036_MOESM1_ESM.tif

Supplementary file1 Supplemental Figure 1 Funnel plot of studies included in meta-analysis of determining odds ratio of malignant transformation of high-risk lesions over low-risk lesions (TIF 112 kb)

405_2020_6036_MOESM2_ESM.tif

Supplementary file2 Supplemental Figure 2 Risk of bias graph. A review of authors’ judgments about each risk of bias item presented as percentages across all included studies. (TIF 185 kb)

405_2020_6036_MOESM3_ESM.tif

Supplementary file3 Supplemental Figure 3 Risk of bias summary. A review of authors’ judgments about each risk of bias item for each included study (TIF 179 kb)

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Yan, F., Reddy, P.D., Nguyen, S.A. et al. Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 277, 2967–2976 (2020). https://doi.org/10.1007/s00405-020-06036-1

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  • DOI: https://doi.org/10.1007/s00405-020-06036-1

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