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Purpose <p>Oral squamoproliferative lesions (SPL) represent a spectrum of lesions ranging from benign proliferations to dysplasia and squamous cell carcinoma (SCC). Although incisional biopsies are one of the preliminary diagnostic tools, at times they pose diagnostic challenges. The present study evaluated histomorphological features of SPL in the initial biopsies and correlated them with final wide local excision (WLE) diagnoses, to identify features predictive of malignancy.</p> Methods <p>The retrospective observational study included oral cavity lesions diagnosed as SPL on initial biopsy between March 2023 and February 2025, followed by WLE within one year. Slides were reviewed and based on final WLE diagnoses, cases were categorised as SCC or non-malignant SPL. Univariate and multivariate analyses were performed, with <i>p</i> &lt; 0.05 considered statistically significant.</p> Results <p>Among 100 cases, 62 (62%) were confirmed as SCC and 38 (38%) as SPL on WLE. SCC cohort showed larger mean lesion size and more frequent combined ulceroproliferative &amp; ulceroinfiltrative gross patterns. Several architectural and cytological features were significantly associated with SCC on univariate analysis. Multivariate logistic regression identified lesion size (OR 2.05, 95% CI 1.20–3.49, <i>p</i> = 0.009) and abnormal variation in cell size and shape (OR 113.8 (95% CI 3.89–9510.00, <i>p</i> = 0.008) were independently associated with malignancy.</p> Conclusions <p>This study highlights that lesion size and abnormal variation in cell size and shape are strong independent predictors of malignancy in oral squamoproliferative lesions. Incorporating key microscopic clues with clinical assessment improves diagnostic accuracy in biopsies and facilitates earlier recognition of invasive SCC.</p>

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The Whole Story: From Fragment to Resection - Predicting Invasive Carcinoma in Oral Squamoproliferative Lesions

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Varnika Rai,
  • Shailee Mehta,
  • Kumar Shivalingaiah,
  • Sarah John,
  • Priti Trivedi

摘要

Purpose

Oral squamoproliferative lesions (SPL) represent a spectrum of lesions ranging from benign proliferations to dysplasia and squamous cell carcinoma (SCC). Although incisional biopsies are one of the preliminary diagnostic tools, at times they pose diagnostic challenges. The present study evaluated histomorphological features of SPL in the initial biopsies and correlated them with final wide local excision (WLE) diagnoses, to identify features predictive of malignancy.

Methods

The retrospective observational study included oral cavity lesions diagnosed as SPL on initial biopsy between March 2023 and February 2025, followed by WLE within one year. Slides were reviewed and based on final WLE diagnoses, cases were categorised as SCC or non-malignant SPL. Univariate and multivariate analyses were performed, with p < 0.05 considered statistically significant.

Results

Among 100 cases, 62 (62%) were confirmed as SCC and 38 (38%) as SPL on WLE. SCC cohort showed larger mean lesion size and more frequent combined ulceroproliferative & ulceroinfiltrative gross patterns. Several architectural and cytological features were significantly associated with SCC on univariate analysis. Multivariate logistic regression identified lesion size (OR 2.05, 95% CI 1.20–3.49, p = 0.009) and abnormal variation in cell size and shape (OR 113.8 (95% CI 3.89–9510.00, p = 0.008) were independently associated with malignancy.

Conclusions

This study highlights that lesion size and abnormal variation in cell size and shape are strong independent predictors of malignancy in oral squamoproliferative lesions. Incorporating key microscopic clues with clinical assessment improves diagnostic accuracy in biopsies and facilitates earlier recognition of invasive SCC.