Is Binary Grading Better Than WHO System for Grading Epithelial Dysplasia? A Systematic Review and Meta-Analysis.

IF 2.9 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Oral diseases Pub Date : 2024-11-06 DOI:10.1111/odi.15160

Divya Gopinath, Cheng Yung On, Sajesh Kalkandi Veettil, W M Tilakaratne

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Abstract

Background: This meta-analysis summarizes the current evidence on the intra- and inter-observer agreement between WHO and the binary grading systems used to assess epithelial dysplasia (ED).

Methods: A systematic search for observational studies that compared the level of agreement among pathologists between WHO and binary grading systems for ED was conducted using three databases: Medline, Scopus, and EBSCOhost. For the meta-analysis, summary estimations of kappa value (κ) and standard error (SE) were utilized.

Results: The pooled analysis of observations by 46 pathologists from a total of eight studies showed better interobserver agreement in the interpretation of ED for the binary system (κ = 0.31; 95% confidence interval [CI], 0.23-0.40) in comparison with the WHO (κ = 0.14; 95% CI, 0.10-0.19). The intra-observer agreement was reported only by five studies and was also found to be higher for the binary system (κ = 0.44; 95% CI, 0.31-0.57) compared to the WHO (κ = 0.25; 95% CI, 0.11-0.39).

Conclusions: Our results validate that the binary system has better overall intra-observer and interobserver agreement than the WHO system. Further studies with larger cohorts are mandatory before clinically relevant conclusions are drawn, as evidence remains inadequate.

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二元分级比 WHO 上皮增生异常分级系统更好吗？系统回顾与元分析》。

背景：这是一项荟萃分析：本荟萃分析总结了目前用于评估上皮发育不良（ED）的WHO分级系统和二元分级系统在观察者内部和观察者之间的一致性的证据：方法：利用三个数据库对病理学家之间比较 WHO 和二元分级系统对 ED 的一致性水平的观察性研究进行了系统检索：Medline、Scopus 和 EBSCOhost。在进行荟萃分析时，使用了卡帕值（κ）和标准误差（SE）的汇总估计值：对来自 8 项研究的 46 位病理学家的观察结果进行汇总分析后发现，与 WHO（κ = 0.14；95% 置信区间 [CI]，0.10-0.19）相比，二元系统（κ = 0.31；95% 置信区间 [CI]，0.23-0.40）对 ED 的解释具有更好的观察者间一致性。仅有五项研究报告了观察者内部的一致性，并发现二元系统（κ = 0.44; 95% CI, 0.31-0.57）的一致性高于世界卫生组织（κ = 0.25; 95% CI, 0.11-0.39）：我们的研究结果验证了二元系统在观察者内部和观察者之间的整体一致性优于 WHO 系统。由于证据仍不充分，在得出临床相关结论之前，必须进行更大规模的研究。

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来源期刊

Oral diseases 医学-牙科与口腔外科

CiteScore

7.60

自引率

5.30%

发文量

325

审稿时长

4-8 weeks

期刊介绍： Oral Diseases is a multidisciplinary and international journal with a focus on head and neck disorders, edited by leaders in the field, Professor Giovanni Lodi (Editor-in-Chief, Milan, Italy), Professor Stefano Petti (Deputy Editor, Rome, Italy) and Associate Professor Gulshan Sunavala-Dossabhoy (Deputy Editor, Shreveport, LA, USA). The journal is pre-eminent in oral medicine. Oral Diseases specifically strives to link often-isolated areas of dentistry and medicine through broad-based scholarship that includes well-designed and controlled clinical research, analytical epidemiology, and the translation of basic science in pre-clinical studies. The journal typically publishes articles relevant to many related medical specialties including especially dermatology, gastroenterology, hematology, immunology, infectious diseases, neuropsychiatry, oncology and otolaryngology. The essential requirement is that all submitted research is hypothesis-driven, with significant positive and negative results both welcomed. Equal publication emphasis is placed on etiology, pathogenesis, diagnosis, prevention and treatment.