Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Jan;115(1):87-94. doi: 10.1016/j.oooo.2012.10.015.
A binary system is reputed to be superior to the World Health Organization (WHO) system in grading oral dysplasia. We aimed to validate its reproducibility and prognostic ability and examine whether it could be improved.
Three pathologists graded 141 oral epithelial dysplasia biopsies with the use of both systems. Observer variability and prognostic ability were assessed with the use of kappa and logistic regression models.
The binary system showed superior agreement to the WHO system (multirater kappa 0.59 vs. 0.49, respectively) but similar prognostic ability (odds ratio [OR] 4.59 [P = .014] vs. OR 2.25 [P = .02], respectively). Adding smoking and alcohol slightly improved the prognostic ability of both systems (OR 5.10 vs. OR 2.42, respectively). Our new binary system with a refined diagnostic threshold demonstrated a slightly greater prognostic ability and improved ability to differentiate between high- and low-risk moderate dysplasia cases.
The binary system has similar prognostic ability but superior reproducibility compared with the WHO system. Prognostication is improved still further by using a new threshold.
二进制系统在口腔发育不良分级方面据称优于世界卫生组织（WHO）系统。我们旨在验证其可重复性和预后能力，并研究是否可以改善。
三位病理学家使用两种系统对 141 例口腔上皮发育不良活检进行分级。使用kappa 和逻辑回归模型评估观察者的变异性和预后能力。
二进制系统与 WHO 系统相比显示出更高的一致性（多评估者 kappa 值分别为 0.59 和 0.49），但预后能力相似（比值比 [OR] 分别为 4.59 [P =.014] 和 2.25 [P =.02]）。添加吸烟和饮酒略微改善了两种系统的预后能力（OR 分别为 5.10 和 2.42）。我们的新二进制系统具有更精细的诊断阈值，显示出稍高的预后能力，并改善了区分高风险和低风险中度发育不良病例的能力。
与 WHO 系统相比，二进制系统具有相似的预后能力，但具有更高的可重复性。使用新阈值进一步改善了预后。
