Interobserver Variability in Reporting Oral Dysplasia: Sources of Variability and Strategies to Minimize

Oral squamous carcinoma which is a major healthcare concern is often preceded by non-invasive precursor disorders called oral potentially malignant disorders. The current gold standard for evaluating the potential for malignant transformation in these disorders is the assesment of oral epithelial dysplsia. The accuracy of oral epithelial dysplasia grading to predict the prognosis will depend on its reproducibility. Oral epithelial dysplasia grading is found to have poor inter- and intraobserver agreements due to the subjectivity involved in the assessment of dysplastic features. The objecitve of this review is to understand the reasons and possible solutions for the poor reproducability in the grading of oral epithelial dysplsia.

A narrative review of all relevant published papers known to the authors on interobserver variability and subjecitvity in the grading of oral epithelial dysplaisia was conducted.

Possible reasons for the subjectivity include (1) poorly defined dysplastic features (2) poorly understood biological significance of dysplastic features (3) histologic variabilities of oral mucosal subsites and (4) histological variabilities of various oral potentially malignant disorders.

Subjectivity in dysplasia grading can be reduced by calibration exercises among the pathologists on dysplastic features and grading. More research should be focused on understanding the biological significance of the dysplastic features in predicting malignant transformation.