Algorithm to reduce subjectivity in grading oral epithelial dysplasia - A preliminary study

Background and Objectives: The most common oral potentially malignant disorder is leukoplakia with its microscopic picture varying from simple hyperkeratosis to severe epithelial dysplasia. Numerous grading systems for oral epithelial dysplasia (OED) have been reported over the years. However, interand intra-observer variations in the grading of OED are also well documented. The present study aimed at reducing interobserver variability in grading OED using an algorithm. The objectives were to review H and E stained sections of normal oral mucosal samples and cases of OED, by manual and by photographic methods. Materials and Methods: A total of 50 cases (n = 50) constituted the study material. 10 cases of normal oral mucosa and 40 histopathologically confirmed cases of oral leukoplakia (both dysplastic and non-dysplastic) were retrieved from the archives of the department. Slides were reviewed by manual and by photographic methods. Five observers had participated in the study. Results: Substantial agreement was found between the observers in grading OED (both by manual and by photographic methods). Interpretation and Conclusions: An algorithm may be used as a tool to reduce the subjectivity of OED grading.