A comparative study using WHO and binary oral epithelial dysplasia grading systems in actinic cheilitis

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To evaluate comparatively the influence of histopathological features on epithelial dysplasia (ED) and the effectiveness in usage of WHO and binary grading systems in actinic cheilitis (AC).

Material and methods

Cytological and architectural alterations established by WHO for ED were evaluated in 107 cases of AC. Epithelial dysplasia was graded using WHO and binary systems. The comparisons were performed using kappa, chi-square, and phi coefficient tests (P< 0.05).


Most cases were classified as mild ED (44.5%) in the WHO system and as low risk for malignant transformation (64.5%) in the binary system. There was a positive correlation between WHO and binary systems (k= 0.33;P< 0.0002). Loss of basal cell polarity (P< 0.001) was associated with severity of ED grade in the WHO system. Anisonucleosis (P< 0.0001), nuclear pleomorphism (P< 0.0001), anisocytosis (P= 0.03), cell pleomorphism (P= 0.002) increased nuclear/cytoplasm ratio (P< 0.0001), increased nuclear size (P< 0.0001), increased number of mitotic figures (P= 0.0006), and dyskeratosis (P= 0.008) were associated with severity of ED grade in the binary system.


It seems that usage of binary ED grading system in AC may be more precise because there is correlation between many of cytological and some of architectural microscopic alterations with increased grade of ED.

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