de Freitas Silva Brunno Santos, Batista Danielle Coelho Ribeiro, de Souza Roriz Camila Ferro, Silva Lorena Rosa, Normando Ana Gabriela Costa, Dos Santos Silva Alan Roger, Silva Maria Alves Garcia, Yamamoto-Silva Fernanda Paula
Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Av. Primeira Avenida, s/n. Setor Leste Universitário, Goiânia, GO, CEP 74605-020, Brazil.
University of Anápolis, Anápolis, GO, Brazil.
Clin Oral Investig. 2021 Jul;25(7):4329-4340. doi: 10.1007/s00784-021-04008-1. Epub 2021 May 29.
The aim of this systematic review was to examine the evidence of the binary histologic grading system capacity for predicting malignant transformation and to compare it with that of the WHO systems.
A systematic review was conducted, using PubMed, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO databases without any language or timeframe restrictions. Studies were included if they compared the binary and the WHO histologic grading systems in the prediction of malignant transformation of oral epithelial dysplasia (OED).
The capacity of the WHO and binary grading systems to predict malignant transformation ranged from 16 to 80% and from 5 to 80%, respectively. The pooled malignant transformation rate of lesions classified as severe dysplasia or carcinoma in situ by the WHO grading was 40% (95% confidence interval (CI), 0.02-0.87; I = 92%; P = 0.00), while the corresponding value for lesions classified as high-risk by the binary grading system was 31% (95% CI, 0.00-0.84; I = 97%; P = 0.00). Overall, there was no significant difference in prognostication accuracy between the WHO and the binary systems (odds ratio = 2.02; 95% CI, 0.88-4.64).
Although some studies suggest that the binary system is associated with lower inter-rater variability when grading OED, the evidence remains inconclusive on whether this system is superior to that of the WHO at predicting malignant transformation.
The reproducibility of the binary system has the potential to be better for prognostic purposes. However, there is no high-quality evidence to confirm if this advantage may assist clinicians in decision-making.
本系统评价旨在研究二元组织学分级系统预测恶性转化的证据，并将其与世界卫生组织（WHO）的分级系统进行比较。
进行了一项系统评价，使用PubMed、EMBASE、LILACS、Web of Science、Scopus和LIVIVO数据库，无任何语言或时间限制。纳入的研究需比较二元分级系统和WHO组织学分级系统在预测口腔上皮发育异常（OED）恶性转化方面的情况。
WHO分级系统和二元分级系统预测恶性转化的能力分别为16%至80%和5%至80%。WHO分级为重度发育异常或原位癌的病变的汇总恶性转化率为40%（95%置信区间（CI），0.02 - 0.87；I² = 92%；P = 0.00），而二元分级系统分类为高危病变的相应值为31%（95% CI，0.00 - 0.84；I² = 97%；P = 0.00）。总体而言，WHO分级系统和二元分级系统在预后准确性上无显著差异（优势比 = 2.02；95% CI，0.88 - 4.64）。
尽管一些研究表明在对OED进行分级时二元系统的评分者间变异性较低，但关于该系统在预测恶性转化方面是否优于WHO分级系统的证据仍不明确。
二元系统的可重复性在预后方面可能更好。然而，尚无高质量证据证实这一优势是否有助于临床医生进行决策。
