Understanding interobserver variability of pathologists to improve oral epithelial dysplasia grading

• Published in: Oral diseases 2024-07
• Main Authors: Ng, Grace Tze Ern, Phang, Sarah Carmen, Yu, Kae Shyang, Tiwari, Lalima, Khurram, Syed Ali, Sloan, Philip, Kujan, Omar
• Format: Article
• Language: English
• ISSN: 1354-523X; 1601-0825; 1601-0825
• DOI: 10.1111/odi.15078

This study aimed to understand reasons for interobserver variability in the grading of oral epithelial dysplasia (OED) through a survey of pathologists to provide insight for improvements in the reliability and reproducibility of OED diagnoses. The study design included quantitative and qualitative methodology. A pre-validated 31-item questionnaire was distributed to general, head and neck, and oral and maxillofacial histopathology specialists worldwide. A total of 132 pathologists participated and completed the questionnaire. Over two-thirds used the three-tier grading system for OED, while about a third used both binary and three-tier systems. Regular reporters of OED preferred the three-tier system and grading architectural features. Continuing education significantly aided recognition of architectural and cytological changes. Irregular epithelial stratification and drop-shaped rete ridges had the lowest prognostic value and recognition scores, while loss of epithelial cell cohesion had the highest. Most participants used clinical information and often sought a second opinion when grading OED. Our study has found that frequency of OED reporting and attendance of CME/CPD can play an important role in grading OED. Variations in the prognostic value of individual histological features and the use of clinical information may further contribute to interobserver variability.