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

Jasbir D. Upadhyaya, Sarah G. Fitzpatrick, Donald M. Cohen, Elizabeth A. Bilodeau, Indraneel Bhattacharyya, James S. Lewis, Jinping Lai, John M. Wright, Justin Avery Bishop, Marino E. Leon, Mohammed N. Islam, Raja Seethala, Ricardo J. Padilla, Roman Carlos, Susan Müller, Lester D.R. Thompson

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
JournalHead and Neck Pathology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Leukoplakia
Observer Variation
Terminology
Hyperplasia
Verrucous Carcinoma
Oral and Maxillofacial Surgeons
Neck
Head
Pathologists
Students
Therapeutics

Keywords

  • Atypical epithelial proliferation
  • Inter-observer variability
  • Papillary squamous cell carcinoma
  • Proliferative verrucous leukoplakia
  • Verrucous hyperplasia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Otorhinolaryngology
  • Oncology

Cite this

Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia : Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study. / Upadhyaya, Jasbir D.; Fitzpatrick, Sarah G.; Cohen, Donald M.; Bilodeau, Elizabeth A.; Bhattacharyya, Indraneel; Lewis, James S.; Lai, Jinping; Wright, John M.; Bishop, Justin Avery; Leon, Marino E.; Islam, Mohammed N.; Seethala, Raja; Padilla, Ricardo J.; Carlos, Roman; Müller, Susan; Thompson, Lester D.R.

In: Head and Neck Pathology, 01.01.2019.

Research output: Contribution to journalArticle

Upadhyaya, JD, Fitzpatrick, SG, Cohen, DM, Bilodeau, EA, Bhattacharyya, I, Lewis, JS, Lai, J, Wright, JM, Bishop, JA, Leon, ME, Islam, MN, Seethala, R, Padilla, RJ, Carlos, R, Müller, S & Thompson, LDR 2019, '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 Pathology. https://doi.org/10.1007/s12105-019-01035-z
Upadhyaya, Jasbir D. ; Fitzpatrick, Sarah G. ; Cohen, Donald M. ; Bilodeau, Elizabeth A. ; Bhattacharyya, Indraneel ; Lewis, James S. ; Lai, Jinping ; Wright, John M. ; Bishop, Justin Avery ; Leon, Marino E. ; Islam, Mohammed N. ; Seethala, Raja ; Padilla, Ricardo J. ; Carlos, Roman ; Müller, Susan ; Thompson, Lester D.R. / Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia : Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study. In: Head and Neck Pathology. 2019.
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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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AU - Islam, Mohammed N.

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N2 - 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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