Oral Potentially Malignant Disorder Based Customized Epithelial Dysplasia Grading: a Need of the Hour

Excerpt

The WHO 2005 epithelial dysplasia grading system is the most commonly used system for grading the malignant potential of oral potentially malignant disorders (OPMDs) [1, 2] Although the 3-tier grading system is universally followed, the subjective variation causing inter and intraobserver bias has led to significant discrepancies in determining the malignant potential of OPMDs [3]. Thus, the WHO introduced the binary system to stratify lesions into high and low-risk categories, which would enable the clinician to determine whether to treat the lesion or adopt a wait and watch policy respectively [4]. Even in the binary system, the pathologist must determine the stratification of the OPMDs based on the extent of the cytological and architectural features, which remain to be subjective. In addition to the subjectivity, the grading system also lacks the ability to accurately determine the malignant potential of the OPMD. Thus, we need to establish criteria’s capable of reducing the subjective variations and increasing the prognostic value of the grading system. We believe that customizing criteria for each OPMD will aid us in determining the malignant potential more accurately. The epithelium status at the mucosal margins of the surgically resected cancer specimen can be considered as highly evolved in terms of malignant transformation. Thus, dysplastic features present at the surgical margins could be considered as essential features required for malignant transformation. …