Abstract
Background:
Oral epithelial dysplasia (OED) encompasses a range of architectural and cytological changes in epithelial tissue due to genetic alterations. Traditional grading methods for OED often suffer from subjectivity and lack numerical precision.
Objective:
This study aimed to develop a new scoring system to objectively grade OED based on architectural and cytological features.
Materials and Methods:
We analyzed 150 cases of OED from our institutional database. A scoring sheet was created to record the presence (score of 1) or absence (score of 0) of specific dysplastic features. Scores were categorized into three ranges: 1–4, 5–8, and 9–16. This new system was validated against the World Health Organization (WHO) Grading System and Binary System, with interobserver variability assessed using kappa statistical analysis.
Results:
Scores ranged from 1 to 4 for mild dysplasia, from 5 to 8 for moderate dysplasia, and from 9 to 16 for severe dysplasia (P < 0.001). The new system aligned closely with the WHO grading: 92% of cases with mild dysplasia scored 1–4, 74% of moderate dysplasia cases scored 5–8, and 92% of severe dysplasia cases scored 9–16 (P = <0.001). Two cases initially classified as mild and moderate dysplasia by WHO progressed to malignancy within 6–8 months and scored 12 and 9, respectively, in our system. The new system demonstrated fair interobserver agreement, with kappa scores ranging from 0.24 to 0.317.
Discussion:
This novel scoring system addresses limitations of existing grading methods, such as subjectivity and variability. It offers a more objective approach to diagnosing and managing OED, potentially improving the early detection and prevention of oral squamous cell carcinoma.
Keywords: Diagnosis, dysplasia, epithelial dysplasia, scoring system
INTRODUCTION
Oral epithelial dysplasia (OED) is a spectrum of architectural and cytological epithelial changes caused by the accumulation of genetic changes.[1] The presence of dysplastic changes in the oral epithelium, if not treated, is associated with an increased risk of progression to oral squamous cell carcinoma (OSCC).[2,3] The greater degree of dysplasia increases the risk of progression to malignancy in an individual dysplastic lesion.[4] Therefore, accurate early diagnosis and prognostic assessment are critical for determining appropriate management strategies and preventing the malignant transformation of OED.[5] The evaluation of OED poses several challenges due to its subjective nature, interobserver variability, and the limited predictive power of existing diagnostic criteria.[6]
Many grading methods have been proposed over the years to grade OED objectively.[7] There are various drawbacks associated with each grading system. The most commonly accepted World Health Organization (WHO) Grading System (2017) is a three-tiered system categorizing into mild, moderate, and severe dysplasia and is based on the presence of 16 different histological features The main drawback of the WHO grading system is that variability in the thickness of the oral epithelial lining in different lesions leading to inaccurate grading,[8] and the complexity of OED is oversimplified by the definition of dysplasia by thirds. Furthermore, the lack of numerical values leads to failure in providing statistical analysis. The site of biopsy also has a greater significance in grading, especially in those sites that are normally thin or atrophic, such as in the floor of the mouth or ventral tongue. A grading system may underestimate the degree of risk.[9] Such sites generally harbor mild or minimal dysplasia despite their high risk of malignant transformation.[10,11] There is increased intraobserver and interobserver heterogeneity in the grading of epithelial dysplasia, and thus it has been the subject of much discussion.[12] The binary grading system (two-tiered) of OED, based on the presence or absence of dysplasia, lacks validation against malignant transformation.[1] Though the interobserver variability in grading was less, this system provided less information to the clinician.[13] The development of a new grading system for OED holds great promise in addressing the limitations of existing diagnostic approaches. Such a grading system would not only enhance the consistency and objectivity of evaluations but also provide clinicians and researchers with a robust tool for making informed decisions regarding patient management and treatment strategies.[14]
Scoring systems often segregate samples into defined categories, as it is essential to have clear criteria for characterizing each category.[15] A well-designed grading system based on scoring criteria can facilitate risk stratification and aid in clinical decision-making, helping clinicians identify patients who may require more aggressive interventions or closer surveillance. Additionally, it can provide a standardized framework for reporting and comparing data across different research studies and clinical settings, fostering collaboration and facilitating the development of evidence-based treatment guidelines. This study aimed to present new scoring criteria for grading OED based on scores assigned for each architectural and cytological feature of OED.
MATERIALS AND METHODS
The study was a cross-sectional retrospective study and was conducted according to the guidelines of the Helsinki Declaration, protecting the subject’s autonomy and confidentiality, and was conducted after procuring Ethical clearance from the Institutional Review Board (IHEC/SDC/OPATH-2101/23/015).
Patient selection
OED cases (n = 150) between 2020 and 2023 at a private institution in Chennai were studied retrospectively. The inclusion criteria constituted all the cases that were histopathologically diagnosed as OED and graded according to the WHO grading system (2017). The exclusion criteria included cases that showed dysplastic features secondary to inflammation and infection. Out of 150 cases, mild dysplasia (Group 1) constituted 50, moderate dysplasia (Group 2) constituted 50, and severe dysplasia (Group 3) constituted 50. Out of the included cases, only two cases had undergone malignant transformation.
Group 1: Cases histopathologically diagnosed as mild epithelial dysplasia
Group 2: Cases histopathologically diagnosed as moderate epithelial dysplasia
Group 3: Cases histopathologically diagnosed as severe epithelial dysplasia
Patient demographic and medical records, including the patient’s age at the time of diagnosis, gender, site of biopsy, provisional diagnosis, and date of the biopsy, were obtained, and the respective histopathological diagnosis was retrieved from the institution database (Data Integration and Analysis System [DIAS]). All the data entered in our software was reviewed by three independent pathologists before the final diagnosis and reporting.
The presence or absence of all the 16 cytological and architectural features according to the WHO (2017) grading system was noted for each case of OED from the database. The architectural features assessed included irregular epithelial stratification, loss of polarity of basal cells, drop-shaped rete ridges, increased number of mitotic figures, abnormal superficial mitosis, premature keratinization in single cells (dyskeratosis), keratin pearls within rete ridges, and loss of epithelial cell cohesion. The cytological features evaluated were abnormal variation in nuclear size (anisonucleosis), abnormal variation in nuclear shape (nuclear pleomorphism), abnormal variation in cell size (anisocytosis), abnormal variation in cell shape (cellular pleomorphism), increased nuclear-to-cytoplasmic ratio, atypical mitotic figures, increased number and size of nucleoli, and hyperchromasia. Each feature was scored as present or absent, contributing to a total score ranging from 0 to 16. The detailed histopathological features represented by each score are given in Figures 1 and 2. A score sheet was designed for recording the scores of each architectural and cytological feature of dysplasia in each case to record the presence (or absence) of individual dysplasia features; a score of 1 was given if the feature was marked as present, and a score of 0 if the feature was marked as absent [Figure 3]. The scores assigned for all the features of dysplasia were added, and a total score for each patient was obtained. The categorized Group 1, Group 2, and Group 3 cases based on known histopathological diagnosis (WHO, 2017), given in the database, and their corresponding total scores were entered and tabulated. Based on the preliminary results obtained, the cut-off values for categorizing the lesions into mild, moderate, and severe dysplasia were determined by examining the distribution of scores in relation to the WHO 2017 grades in the preliminary dataset. Cases diagnosed as mild dysplasia predominantly showed scores between 0 and 4, moderate dysplasia cases clustered within 5–8, and severe dysplasia cases showed scores ranging from 9 to 16. This natural clustering provided a data-driven rationale for selecting these thresholds, ensuring that the scoring system aligned with WHO grading patterns while offering a more objective numerical stratification. Scores were categorized into these three score ranges, and the number of cases with respect to the degree of dysplasia in each score range was calculated.
Figure 1.
Histopathological features illustrating individual architectural features of oral epithelial dysplasia
Figure 2.
Histopathological features illustrating individual cytological features of oral epithelial dysplasia
Figure 3.
Score sheet for grading oral epithelial dysplasia
Threshold analysis and comparison
The threshold comparison was conducted to evaluate the effectiveness of the proposed cut-off scores in distinguishing between different grades of dysplasia. Two specific thresholds were tested: between scores 4 and 5, and between scores 8 and 9. An independent t test was performed to compare the means of the scores around each threshold, and the effect sizes were calculated to determine the practical significance of the observed differences.
Validation of the scoring system
A total of 50 OED slides were randomly selected after sample size calculation, and consensus grading according to the WHO 2017 system was performed by a panel of three pathologists. Three oral pathologists with a minimum of 5 years of post-qualification diagnostic experience were selected as observers for the validation phase, as they routinely report cases of OED in the institution. Before the validation exercise, a brief calibration session was conducted in which the observers jointly reviewed a representative set of slides spanning mild, moderate, and severe dysplasia. The criteria for each architectural and cytological feature were discussed to ensure uniform interpretation of the scoring definitions, and none of the calibration slides were included in the study sample.
All observers were blinded to the initial diagnosis, to the grading performed by the other observers, and to all patient identifiers. The slides were anonymized and presented in a randomized sequence to avoid any potential assessment bias. Score sheets were provided for all three grading systems (Novel Scoring, WHO, and Binary), and the observers independently graded each slide according to all three systems, after which the results were tabulated.
Statistical analysis
The statistical analysis was done using Statistical Package for the Social Sciences software version 21 (IBM Corp., Armonk, NY, USA). The chi-square test was done to compare the total scores obtained in each group of known histopathological grades of dysplasia and the proposed score range between each group of dysplasia.
The sample size was calculated using G Power version 3. Kappa statistics were used to assess the interobserver agreement and to compare the agreement between the Consensus grading (WHO) by all three observers and the independent grading by each observer according to all three grading systems (Novel Scoring, WHO, and Binary).
RESULTS
The results of this study show that all the histopathologically diagnosed (WHO, 2017) Group I cases (mild epithelial dysplasia WHO, 2017) had scores in the range of 1–4, Group II (moderate dysplasia) secured scores in the range of 5–8, and Group III (severe dysplasia) in the range of 9–16 (P < 0.001) [Figures 4–7; Table 1].
Figure 4.
Histopathological image showing mild epithelial dysplasia with all features marked, each assigned a score of 1, giving a total score of 4
Figure 7.
The scores (1–14) in X-axis and the total number of cases seen in each cumulative score in Y-axis
Table 1.
Number of epithelial dysplasia cases with respect to their scores obtained in each group (mild, moderate, and severe)
| Scores | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of mild dysplasia cases (Group 1) | 2 | 13 | 20 | 11 | 3 | 1 | – | – | – | – | – | – | – | – |
| Number of moderate dysplasia cases (Group 2) | – | – | – | 2 | 6 | 9 | 12 | 10 | 6 | 4 | 1 | – | – | – |
| Number of severe dysplasia cases (Group 3) | – | – | – | – | – | 1 | 1 | 2 | 7 | 13 | 8 | 10 | 4 | 4 |
Figure 5.
Histopathological image depicting moderate epithelial dysplasia with all features marked, each assigned a score of 1, giving a total score of 7
Figure 6.
Histopathological image depicting severe epithelial dysplasia with all features marked, each assigned a score of 1, giving a total score of 11
Based on the preliminary observations of the histopathological grading data, we categorized the scores into three categories based on the scores obtained in each known degree of dysplasia, with score ranges 1–4, 5–8, and 9–16, which were denoted as mild, moderate, and severe dysplasia, respectively.
Forty six out of 50 cases (92%) of mild epithelial dysplasia (WHO, 2017) were observed in the first scoring group (1–4), 37 out of 50 (74%) cases of moderate epithelial dysplasia (WHO, 2017) were observed in the second scoring group (5–8), and 46 out of 50 (92%) of severe epithelial dysplasia (WHO, 2017) were observed in the third scoring group (9–16) [Table 2]. There were statistically significant differences (P < 0.001) observed between the scores obtained in each scoring group and between each grade of dysplasia [Figure 8]. Thus, the proposed scoring criteria [Table 3] were based on the results obtained from the study.
Table 2.
Score range obtained in each known grade of dysplasia
| Scoring group | Mild dysplasia | Moderate dysplasia | Severe dysplasia |
| 1–4 | 46 (92%) | 4 (8%) | 0 |
| 5–8 | 2 (4%) | 37 (74%) | 11 (22%) |
| 9–16 | 0 | 4 (8%) | 46 (92%) |
Figure 8.
Total number of cases obtained in each score group
Table 3.
Proposed scoring criteria for grading of dysplasia
| Score | Grading of dysplasia |
|---|---|
| 1–4 | Mild |
| 5–8 | Moderate |
| 9–16 | Severe |
Threshold 1: Scores 4 versus 5 and scores 8 versus 9
For the first threshold, cases with scores just below (≤4) and just above (≥5) the cut-off were compared. The independent samples t test revealed a statistically significant difference in the mean scores between the two groups (P < 0.001), indicating that the threshold of 4–5 effectively separates different grades of dysplasia. Similarly, statistically significant differences (P < 0.001) between cut-off 8 and 9 were also found. This finding reinforces the relevance of score 8 as a critical threshold for grading dysplasia severity.
Follow-up data
Furthermore, follow-up data revealed that two cases, which were previously diagnosed as mild and moderate dysplasia (WHO), respectively, underwent malignant transformation in a period of 6–8 months. These cases secured a score of 12 and 9, respectively, according to this scoring system, which indicates that both cases fall under severe dysplasia (9–16).
The clinicopathological details of these two cases are summarized in Table 4.
Table 4.
The clinicopathological details of the two malignant transformed cases
| Case | Age (years)/sex | Biopsy site | WHO grade at diagnosis | Novel score (0–16) | Time to malignant transformation | Outcome |
|---|---|---|---|---|---|---|
| Case 1 | 65/F | Tongue | Mild epithelial dysplasia | 12 | 6 months | Progressed to OSCC |
| Case 2 | 55/F | Right buccal mucosa | Moderate epithelial dysplasia | 9 | 8 months | Progressed to OSCC |
WHO: World Health Organization, OSCC: oral squamous cell carcinoma
Interobserver agreement
The number of cases graded according to each grading system is given in Table 5. Interobserver agreement was assessed between the three observers for all three grading systems, and kappa scores were calculated.
Table 5.
Number of cases of dysplasia graded according to three different observers
| Observer 1 | Observer 2 | Observer 3 | |
|---|---|---|---|
| Scoring system | |||
| Number of cases graded as mild dysplasia | 4 | 2 | 2 |
| Number of cases graded as moderate dysplasia | 19 | 21 | 12 |
| Number of cases graded as severe dysplasia | 12 | 12 | 21 |
| WHO, 2017 | |||
| Number of cases graded as mild dysplasia | 3 | 6 | 10 |
| Number of cases graded as moderate dysplasia | 13 | 8 | 6 |
| Number of cases graded as severe dysplasia | 19 | 11 | 9 |
| Binary system | |||
| Number of cases graded as low risk | 16 | 11 | 14 |
| Number of cases graded as high risk | 19 | 24 | 21 |
WHO: World Health Organization
Novel Scoring System
The agreement between observers 1 and 2 showed a kappa score of 0.273 (fair agreement; 95% confidence interval [CI]: 0.05–0.48, P = 0.046), between 1 and 3 the score was 0.24 (fair agreement; 95% CI: 0.01–0.46, P = 0.054) and between 2 and 3 was 0.317 (95% CI: 0.11–0.52, P = 0.014; fair agreement).
World Health Organization Grading System (2017)
The agreement between observers 1 and 2 showed a kappa score of 0.313 (fair agreement; 95% CI: 0.10–0.51, P = 0.01), between 1 and 3 the score was 0.142 (slight agreement; 95% CI: -0.07–0.36, P = 0.191) and between 2 and 3 was 0.28 (fair agreement; 95% CI: 0.06–0.48, P = 0.03).
Binary System
The agreement between observers 1 and 2 showed a kappa score of 0.198 (slight agreement; 95% CI: -0.03–0.41, P = 0.07), between 1 and 3 the score was 0.073 (95% CI: -0.15–0.29, P = 0.485; slight agreement) and between 2 and 3 was 0.562 (95% CI: 0.38–0.73, P < 0.001; moderate agreement).
AGREEMENT WITH CONSENSUS GRADING
Scoring system
The grades obtained by the consensus grading (WHO) by three pathologists and the grades obtained by the scoring system by the independent observers were compared. Kappa scores of 0.73 (P = P < 0.001; substantial agreement), 0.271 (P < 0.001; fair agreement), and 0.308 (P = 0.01; fair agreement) were obtained by the independent observers 1, 2, and 3, respectively.
World Health Organization Grading System
The grades obtained by the consensus grading (WHO) by three pathologists and the grades obtained according to the WHO system by the independent observers were compared. Kappa scores of 0.086 (P = 0.478; slight agreement), 0.202 (P = 0.092; fair agreement), and 0.165 (P = 0.158; slight agreement) were obtained by observers 1, 2, and 3, respectively.
DISCUSSION
From the results, it was observed that 92% of the cases previously diagnosed as mild epithelial dysplasia (WHO, 2017) secured scores in the range of 1–4 (P < 0.001) out of the total score of 16. This shows that the results obtained with this scoring system are in concordance with the WHO grading. However, there were few cases (8%) where the cases diagnosed as mild dysplasia had scores of 5–8, signifying the increased number of individual cellular and architectural changes in these cases. This may be due to the multi-step, multi-path, and multi-factorial process that requires the participation of innumerable critical molecular players and pathways in the pathogenesis of OSCC.[16,17,18,19,20] Similarly, 92% of the cases previously diagnosed as severe dysplasia with WHO grading secured high scores in the range of 9–16. However, 8% of these severe dysplasia cases scored only in the range of 5–8. This may be due to variability in the thickness of the epithelium in different sites of the oral cavity, leading to overdiagnosis of the lesion as severe dysplasia when dysplastic changes are observed throughout the entire thickness of an atrophied or thin epithelium. Earlier numerical scoring models for OED, such as the Ljubljana classification and the scoring methods introduced by Smith and Pindborg, relied either on grouping broad morphological changes or assigning subjective weighted scores to features. While these frameworks were historically valuable, they often suffered from complexity, inconsistent weighting, or reliance on epithelial thickness.[7] Conversely, the current scoring system assesses each dysplastic characteristic separately and assigns an equal binary score (0 or 1), thereby minimizing subjectivity and making quantification more straightforward. By attributing equal significance to all 16 WHO-recognized architectural and cytological features, the system provides a clearer numerical representation of dysplastic burden and avoids over- or under-diagnosis caused by variable epithelial thickness or descriptive grading alone. The WHO 2022 classification gives more weight to the documentation of the individual architectural and cytological changes, and it also supports a tiered and feature-driven assessment system, which is not solely dependent on descriptive grade labels.[1] The current scoring system is in full harmony with such a framework, as it takes each dysplastic feature separately and transforms them into a total numerical value. Our dataset, though, was scored according to the WHO 2017; however, the proposed system is structured in such a way that it can be easily adapted to the updated WHO 2022 approach, where low-grade and high-grade dysplasias can be further delineated by measuring the extent of dysplastic change. The scores of 0–4 generally signify low-grade disease, whereas the higher scores (5–16) indicate a progressive dysplastic severity, thus providing an objective stratification that not only complements but also does not replace the WHO 2022 criteria.
The degree of heterogeneity associated with the oral mucosa, with wide variation in size, thickness, and complexity of rete architecture, also contributes to underdiagnosis as well as overdiagnosis of a potentially malignant lesion.[13] This is in accordance with the results obtained in our study, wherein cases diagnosed as moderate epithelial dysplasia with the WHO grading system had a wide range of scores of 4–11, with 74% of the cases in the score range of 5–8. However, one case, which was diagnosed as moderate epithelial dysplasia with WHO grading, was found to have undergone malignant transformation after a follow-up of 6 months. When graded according to our scoring criteria, this case obtained a score of 10, indicating an increased number of architectural and cytological changes. As a result, it falls under severe dysplasia (score 9–16) according to our scoring system. Therefore, every individual architectural and cellular feature has to be taken into account for grading a dysplastic lesion.[20] Nevertheless, not all characteristics are present in every lesion, and at times few features can also be observed in reactive and benign circumstances. In such cases, grading has to be considered based on scoring by careful assessment of individual features related to the normal anatomy at the site and secondary inflammatory changes.
The results of the proposed scoring system, grouped into three categories: 1–4 as mild, 5–8 as moderate, and 9–16 as severe epithelial dysplasia was in accordance with the WHO, 2017 grading system. The main advantage of this scoring system over the WHO grading system is the numerical values, which aid in ascertaining the severity of the lesion. The WHO grading system is based on thirds and may lead to an inaccurate diagnosis in lesions with variable thickness of the epithelium. The scoring would overcome this drawback as the scores are independent of the thickness of the epithelium and enable accurate diagnosis. Furthermore, the scores would aid the surgeons in making important clinical judgments.[21] The Numerical Scoring System offers practical clinical value by providing an objective measure of dysplastic burden. Higher scores may prompt closer surveillance or earlier intervention, even when the descriptive grade appears mild or moderate, whereas lower scores may help avoid unnecessary overtreatment. By reducing subjectivity and offering clearer risk stratification, the scoring system supports more consistent and timely clinical decision-making.
We observed that our novel scoring system showed fair interobserver agreement among observers, with kappa scores ranging from 0.24 to 0.317. This suggests that the novel scoring system shows promise in achieving consistent grading among different observers. This may be a result of the score sheet proposed in this study, which facilitates a standardized approach to overcome difficulties in subjective reporting of epithelial dysplasia by careful assessment of each cellular and architectural feature.[22] The proposed scoring system could be easily integrated into automated diagnostic workflows with the rapid growth of digital pathology and artificial intelligence (AI)-assisted image analysis. The model’s binary (0/1) structure is particularly favorable for the computational extraction of histological features, making it possible to achieve consistent pattern recognition and minimize variability caused by observers. The integration of the scoring sheet into AI-based platforms may not only improve reproducibility but also facilitate extensive validation through the use of multi-institutional datasets, thus making it more applicable in everyday clinical practice.
Conversely, the WHO grading system (2017) exhibited fair to slight interobserver agreement, with kappa scores ranging from 0.142 to 0.313. This suggests that the WHO system may present challenges in achieving consistent grading among observers, which may be due to the subjectivity of its criteria. The Binary System showed slight to moderate interobserver agreement, with kappa scores ranging from 0.073 to 0.562. While moderate agreement was observed between some observers, the overall agreement was lower compared to the novel scoring system.
Furthermore, the novel scoring system demonstrated substantial to fair agreement with the consensus grading (WHO) by three pathologists, with kappa scores ranging from 0.271 to 0.73. These findings suggest that the novel scoring system aligns well with expert consensus grading, indicating its validity in grading OED. In contrast, the agreement between the WHO grading system and consensus grading, which was graded according to the WHO system, ranged from slight to fair, with kappa scores ranging from 0.086 to 0.202. These results highlight the potential discrepancies and lack of reproducibility between the WHO grading by independent observers and expert consensus grading. This highlights the need for the continued evaluation and refinement of the existing criteria and the importance of identifying specific criteria or individual features that contribute to improved reliability in grading. The Binary System could not be evaluated for agreement with consensus grading due to the lack of common values, indicating the limitations in comparing and assessing its reliability with expert consensus. Our findings emphasize the importance of a scoring system for OED, as accurate assessment is critical for guiding clinical management decisions. The novel scoring system shows promise in achieving consistent grading among observers and aligning with expert consensus grading.
This study has certain limitations. As a retrospective, single-center analysis, the findings may not be fully generalizable. Follow-up information was limited, with only two cases demonstrating malignant transformation, restricting evaluation of the scoring system’s predictive value. Additionally, most cases in the dataset were graded using WHO 2017 criteria, as records from 2018 to 021 did not include the features required for WHO 2022 categorization. Future multi-center, prospective studies incorporating WHO 2022 features and extended follow-up are essential to further refine and validate this scoring system. While our current model assigns equal weight to individual features, it is intended as a preliminary framework. This foundational model can later be refined as more research identifies specific features that correlate with increased malignancy risk, allowing for an effective scoring system in the future by assigning weights according to the degree of association between each feature and malignant transformation risk. The use of weighted scoring could help improve prognostic accuracy by making high-impact features that have the greatest influence on dysplastic progression visible. However, such improvement would need longitudinal follow-up data and sophisticated statistical techniques to ascertain feature-specific predictive power. Furthermore, refinement and validation of this system in longitudinal follow-up studies are needed to enhance its utility in clinical practice and explore its value in the prediction of malignant transformation risk of oral potentially malignant disorders, and its impact on patient outcomes, and the potential for integration with emerging technologies and biomarkers should be emphasized.
In conclusion, the introduction of a novel scoring system for OED represents a significant advancement in the field. By addressing the limitations of existing diagnostic criteria, this scoring system has the potential to improve diagnostic accuracy, enhance prognostic assessment, and ultimately contribute to more effective management and prevention of OSCC.
Author contributions
GP: conceptualization, data curation, manuscript formal analysis, methodology, and investigation. PR: resources, project administration, supervision, validation, visualization, and writing—review and editing. WMT: supervision, validation, visualization, and writing—review and editing. SK: supervision, validation, and visualization. The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work.
Data availability statement
Data were retrieved from our institution’s Indigenous software called the Data Integration and Analysis System. All the data retrieved are included in the manuscript.
Ethical approval
This study was approved by the Saveetha Dental College, Institutional Human Ethical Committee number for the study entitled “Novel Histopathological Scoring system for Oral Epithelial Dysplasia” with approval number IHEC/SDC/OPATH-2101/23/015.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors sincerely thank Dr. Deepak Pandiar, Dr. Reshma, Dr. Dharini, Dr. Neha, Dr. Deeksheetha, Dr. Fazulu, Dr. Hema, and Dr. Suvarna for their valuable assistance in scoring calculations, slide evaluations, and statistical analysis.
Funding Statement
Nil.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data were retrieved from our institution’s Indigenous software called the Data Integration and Analysis System. All the data retrieved are included in the manuscript.