Gururaj Arakeri1,2, Deepak Thomas3, Abdulsalam S Aljabab1,4, Santosh Hunasgi5, Kirthi Kumar Rai6, Beverley Hale7, Felipe Paiva Fonseca8, Ricardo Santiago Gomez8, Siavash Rahimi9,10, Matthias A W Merkx2, Peter A Brennan3. 1. Department of Oral and Maxillofacial Surgery, King Fahad Medical City, Riyadh, Saudi Arabia. 2. Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. 3. Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK. 4. Faculty of Dentistry, Department of Dentistry, King Saud University, Riyadh, Saudi Arabia. 5. Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka, India. 6. Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India. 7. Institute of Sport, University of Chichester, Chichester, UK. 8. Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 9. Pathology Centre-Histopathology, Queen Alexandra Hospital, Portsmouth, UK. 10. School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK.
Abstract
BACKGROUND: We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (OSMF) based on how they are categorized. A novel classification and staging scheme is proposed. METHODS: A total of 300 OSMF patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of OSMF in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross-tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using SPSS Statistics (version 25.0, IBM, USA). RESULTS: A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components (K = 0.312, 0.167, 0.152) in OSMF. Following analysis, a three-component classification scheme (TFM classification) was developed that describes the severity of each independently, grouping them using a novel three-tier staging scheme as a guide to the treatment plan. CONCLUSION: The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers OSMF malignant transformation in detail.
BACKGROUND: We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (OSMF) based on how they are categorized. A novel classification and staging scheme is proposed. METHODS: A total of 300 OSMF patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of OSMF in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross-tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using SPSS Statistics (version 25.0, IBM, USA). RESULTS: A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components (K = 0.312, 0.167, 0.152) in OSMF. Following analysis, a three-component classification scheme (TFM classification) was developed that describes the severity of each independently, grouping them using a novel three-tier staging scheme as a guide to the treatment plan. CONCLUSION: The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers OSMF malignant transformation in detail.