Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility

Contains fulltext : 80594.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Grading of dysplasia, including head and neck lesions, continues to be a hotly debated subject. It is subjective and lacks intra- and inter-observer reproducibility due to the insufficiency of validated morphological criteria and the biological nature of dysplasia. Moreover, due to the absence of a consensus, several systems are currently employed. OBJECTIVES: The aims of this review are to:1) Highlight the significance of dysplasia and the importance of a valid method for assessing precursor lesions of the head and neck.2) Review the different histopathological classification systems for grading intraepithelial lesions of the head and neck.3) Discuss and review quality requirements for these grading systems. CONCLUSION: Regarding the different classification systems, data concerning the WHO classification system are the most available in current literature. There is no simple relationship or overlapping between the classification systems. Further studies should be done to see whether other systems have advantages above the current WHO system and to discover indications that could lead to an universal classification system for intraepithelial lesions of the head and neck

Maximum phonation time: variability and reliability

The objective of the study was to determine maximum phonation time reliability as a function of the number of trials, days, and raters in dysphonic and control subjects. Two groups of adult subjects participated in this reliability study: a group of outpatients with functional or organic dysphonia versus a group of healthy control subjects matched by age and gender. Over a period of maximally 6 weeks, three video recordings were made of five subjects' maximum phonation time trials. A panel of five experts were responsible for all measurements, including a repeated measurement of the subjects' first recordings. Patients showed significantly shorter maximum phonation times compared with healthy controls (on average, 6.6 seconds shorter). The averaged interclass correlation coefficient (ICC) over all raters per trial for the first day was 0.998. The averaged reliability coefficient per rater and per trial for repeated measurements of the first day's data was 0.997, indicating high intrarater reliability. The mean reliability coefficient per day for one trial was 0.939. When using five trials, the reliability increased to 0.987. The reliability over five trials for a single day was 0.836; for 2 days, 0.911; and for 3 days, 0.935. To conclude, the maximum phonation time has proven to be a highly reliable measure in voice assessment. A single rater is sufficient to provide highly reliable measurements

Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation.

Item does not contain fulltextThe objective of this study is to measure interobserver variability in the classification of laryngeal mucosal premalignant lesions by reassessing the histopathology of previously diagnosed cases and to determine the possible therapeutic consequences of disagreement among observers. Histopathological assessment of 110 laryngeal mucosal premalignant lesions was done by three pathologists. Each slide had to be classified according to the World Health Organization, Squamous Intraepithelial Neoplasia, and the Ljubljana Squamous Intraepithelial Lesions systems. After the independent assessment, a joint meeting took place. To assess the relation between histopathological grading and subsequent clinical management, we created a two- and a three-grade system besides one comprising all options. For all analyses, the SAS/STAT statistical software was used. The highest unweighted kappa-values concerning the all-options system are observed for the Squamous Intraepithelial Neoplasia classification (0.28, 95% confidence interval 0.23-0.33), followed by the World Health Organization and Ljubljana classifications. For the two-grade system the Ljubljana classification shows the highest unweighted kappa-values (0.50, 95%, 0.39-0.61), followed by the World Health Organization and Squamous Intraepithelial Neoplasia classifications. For the three-grade system, the unweighted kappa-values are similar. The implementation of weighted kappa-values led to higher scores within all three classification systems, although these did not exceed 0.55 (moderate agreement). Given the high level of consensus, simultaneous pathological assessment may be said to provide added value in comparison with independent assessment. In the current study, no clear tendency is observed in favor of any one classification system. The proposed three-grade system could be an improved histopathological tool because it is easier to correlate with clinical decision making and because it yields better unweighted kappa-values and proportions of concordance than the all-options system. Furthermore, clinical management could benefit from assessment by more than one pathologist in suspected cases of dysplasia or carcinoma.1 juli 201