Avaliação da variabilidade interobservador na análise dos critérios para diagnóstico e grau da displasia epitelial oral em leucoplasias, leucoeritroplasias e eritroplasias

• Autor(a) principal: Corrêa, Yasmin Peçanha Madureira
• Data de Publicação: 2024
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal Fluminense (RIUFF)
• Texto Completo: https://app.uff.br/riuff/handle/1/33563
• topic: desordens potencialmente malignas orais; leucoplasia; eritroplasia e displasia epitelial oral; Leucoplasia bucal; Displasia ectodérmica; Patologia

Introduction: For the World Health Organization, potentially malignant disorders are a heterogeneous group of clinically defined conditions associated with a variable risk of progression to squamous cell carcinoma. Leukoplakia and leukoerythroplakia are more common and erythroplakia is one of those with the greatest potential for malignancy. These terms are clinical and can represent various histopathological changes. Therefore, biopsy and histopathological examination are essential to define the nature of the lesion. Although not all disorders undergo malignant transformation, the presence of dysplasia is one of the most important indicators of malignancy. However, the diagnosis of the presence and degree of severity of dysplasia is highly subjective and many disagreements are reported in assessments between different pathologists. General objective: To verify interobserver variability in the evaluation of architectural and cytological criteria for diagnosing the presence and degree of oral epithelial dysplasia in leukoplakia, leukoerythroplakia or erythroplakia. Material and methods: The sample consisted of 232 histological slides, from 130 biopsies performed on 91 participants with a clinical diagnosis of leukoplakia, leukoerythroplakia or erythroplakia. To evaluate the dysplasia diagnostic criteria, the scanned slides were observed using the Aperio ImageScope® software, independently, by two Oral Pathologists. To assess the presence of epithelial dysplasia, the cytological and architectural criteria recommended by the World Health Organization were used. Results: The final sample consisted of 93 biopsies. In the analysis of observer 1, 46.24% had mild dysplasia, 19.35% moderate and 25.81% severe. Observer 2 classified 37.63% of the sample as mild, 29.03% as moderate and 29.03% as intense. The observers showed substantial agreement in severe dysplasia (k=0.703) and fair agreement in mild (k=0.386) and moderate dysplasia (k=0.392). The criterion loss of cohesion between epithelial cells obtained almost perfect agreement (k=0.810) while extension of changes along the ducts of the minor salivary glands (k=-0.015), varying degrees of dysplasia (k=-0.21) and multifocal or jumping lesions (k=-0.030) did not show any level of statistical agreement. Conclusion: There is interobserver variability during the analysis of the new architectural and cytological criteria proposed by the World Health Organization (2023) for the diagnosis and grading of oral epithelial dysplasia.