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Prediction of malignant transformation and recurrence of oral epithelial dysplasia using architectural and cytological feature specific prognostic models
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Mahmood, Hanya, Bradburn, Mike, Rajpoot, Nasir M. (Nasir Mahmood), Islam, Nadim Mohammed, Kujan, Omar and Khurram, Syed Ali (2022) Prediction of malignant transformation and recurrence of oral epithelial dysplasia using architectural and cytological feature specific prognostic models. Modern Pathology, 35 . pp. 1151-1159. doi:10.1038/s41379-022-01067-x ISSN 0893-3952.
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Official URL: https://doi.org/10.1038/s41379-022-01067-x
Abstract
Oral epithelial dysplasia (OED) is a precursor state usually preceding oral squamous cell carcinoma (OSCC). Histological grading is the current gold standard for OED prognostication but is subjective and variable with unreliable outcome prediction. We explore if individual OED histological features can be used to develop and evaluate prognostic models for malignant transformation and recurrence prediction. Digitised tissue slides for a cohort of 109 OED cases were reviewed by three expert pathologists, where the prevalence and agreement of architectural and cytological histological features was assessed and association with clinical outcomes analysed using Cox proportional hazards regression and Kaplan-Meier curves. Within the cohort, the most prevalent features were basal cell hyperplasia (72%) and irregular surface keratin (60%), and least common were verrucous surface (26%), loss of epithelial cohesion (30%), lymphocytic band and dyskeratosis (34%). Several features were significant for transformation (p < 0.036) and recurrence (p < 0.015) including bulbous rete pegs, hyperchromatism, loss of epithelial cohesion, loss of stratification, suprabasal mitoses and nuclear pleomorphism. This led us to propose two prognostic scoring systems including a '6-point model' using the six features showing a greater statistical association with transformation and recurrence (bulbous rete pegs, hyperchromatism, loss of epithelial cohesion, loss of stratification, suprabasal mitoses, nuclear pleomorphism) and a 'two-point model' using the two features with highest inter-pathologist agreement (loss of epithelial cohesion and bulbous rete pegs). Both the 'six point' and 'two point' models showed good predictive ability (AUROC ≥ 0.774 for transformation and 0.726 for recurrence) with further improvement when age, gender and histological grade were added. These results demonstrate a correlation between individual OED histological features and prognosis for the first time. The proposed models have the potential to simplify OED grading and aid patient management. Validation on larger multicentre cohorts with prospective analysis is needed to establish their usefulness in clinical practice. [Abstract copyright: © 2022. Crown.]
Item Type: | Journal Article | ||||||||||||
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Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Computer Science | ||||||||||||
SWORD Depositor: | Library Publications Router | ||||||||||||
Library of Congress Subject Headings (LCSH): | Epithelial cells , Squamous cell carcinoma , Oral mucosa -- Diseases | ||||||||||||
Journal or Publication Title: | Modern Pathology | ||||||||||||
Publisher: | Nature Publishing Group | ||||||||||||
ISSN: | 0893-3952 | ||||||||||||
Official Date: | September 2022 | ||||||||||||
Dates: |
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Volume: | 35 | ||||||||||||
Page Range: | pp. 1151-1159 | ||||||||||||
DOI: | 10.1038/s41379-022-01067-x | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 4 May 2022 | ||||||||||||
Date of first compliant Open Access: | 5 May 2022 | ||||||||||||
RIOXX Funder/Project Grant: |
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