Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis
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REVIEW ARTICLE
Grading systems of oral cavity pre‑malignancy: a systematic review and meta‑analysis Flora Yan1 · Priyanka D. Reddy1 · Shaun A. Nguyen1 · Angela C. Chi2 · Brad W. Neville2 · Terry A. Day1 Received: 26 February 2020 / Accepted: 5 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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.
Introduction Oral cavity squamous cell carcinoma (OCSCC) is one of the most common head and neck cancers [1]. The 5-year relative survival rate for cancers of the oral cavity and pharynx is 65%, with survival rates generally lower among those with oral cavity over oropharyngeal disease [1, 2]. Development Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00405-020-06036-1) contains supplementary material, which is available to authorized users. * Flora Yan [email protected] 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
Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA
2
of OCSCC occurs in a multistep process from initial epithelial hyperplasia progressing into invasive carcinoma [3]. OCSCCs are often preceded by oral potentially malignant dis
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