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Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study

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Abstract

The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss’ kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons’ responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.

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Acknowledgements

The authors are thankful to Drs. John Hardeman, University of Florida College of Dentistry; Andrew Salama, Boston University Henry M. Goldman School of Dental Medicine; Bradley Szutz, Alaska Oral and Facial Cosmetic Surgery, Anchorage, AK; Michael McDermott, Midwest Oral & Maxillofacial Surgery, Omaha, NE; Ravi Chandran, University of Mississipi Medical Center, Jackson, MS; George Kushner, University of Louisville School of Dentistry; Eric Fox, Oral Surgey Coral Springs, FL; Michael Langan, Central Florida Oral & Maxillofacial Surgery; Danielle Freburg-Hoffmeister, University of Florida College of Dentistry; and Carl Kimbler, Northern Plains Oral & Maxillofacial, Aberdeen, SD, for their participation in the oral and maxillofacial surgeon survey.

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Authors and Affiliations

  1. Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Alton, IL, 62002, USA

    Jasbir D. Upadhyaya

  2. Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA

    Sarah G. Fitzpatrick, Donald M. Cohen, Indraneel Bhattacharyya & Mohammed N. Islam

  3. Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA

    Elizabeth A. Bilodeau

  4. Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    James S. Lewis Jr.

  5. Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Jinping Lai & Marino E. Leon

  6. Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX, USA

    John M. Wright

  7. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Justin A. Bishop

  8. Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA

    Raja Seethala

  9. Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Ricardo J. Padilla

  10. Pathology Division, Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala

    Roman Carlos

  11. Emory University School of Medicine, Atlanta Oral Pathology, Decatur, GA, USA

    Susan Müller

  12. Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA

    Lester D. R. Thompson

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  1. Jasbir D. Upadhyaya
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Correspondence to Jasbir D. Upadhyaya.

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All authors declare that they have no conflict of interest as it relates to this research project.

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All procedures performed in this retrospective data analysis involving human participants were in accordance with the ethical standards of the institutional review board, which did not require informed consent.

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Upadhyaya, J.D., Fitzpatrick, S.G., Cohen, D.M. et al. Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study. Head and Neck Pathol 14, 156–165 (2020). https://doi.org/10.1007/s12105-019-01035-z

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