Kannan Ranganathan1,2, Loganathan Kavitha1,2, Prakash Sharada3, Radhika M Bavle4, Roopa S Rao5, Smita M Pattanshetty6, Vinay K Hazarey7, Murittige Gopalakrishna Madhura8, Tejavathi Nagaraj9, Ashok Lingappa10, Saman Warnakulasuriya11. 1. Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai, India. 2. The Tamil Nadu Dr. MGR Medical University, Chennai, India. 3. Department of Oral and Maxillo Facial Pathology, AECS Maaruti College of Dental Sciences, Bengaluru, India. 4. Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, India. 5. Department of Oral Pathology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangaluru, India. 6. Maratha Mandal's NGH Institute of Dental Sciences & Research Centre, Belagavi, India. 7. Datta Meghe Institute of Medical Sciences, Wardha, India. 8. Department of Oral Pathology and Microbiology, DAPM R V Dental College and Hospital, Bengaluru, India. 9. Sri Rajiv Gandhi College of Dental sciences & Hospital, Bengaluru, India. 10. Bapuji Dental College & Hospital, Davangere, India. 11. Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, WHO Collaborating Centre for Oral Cancer, London, UK.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
Authors: Brunno Santos de Freitas Silva; Danielle Coelho Ribeiro Batista; Camila Ferro de Souza Roriz; Lorena Rosa Silva; Ana Gabriela Costa Normando; Alan Roger Dos Santos Silva; Maria Alves Garcia Silva; Fernanda Paula Yamamoto-Silva Journal: Clin Oral Investig Date: 2021-05-29 Impact factor: 3.573