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Background The presence and grading of oral epithelial dysplasia (OED) are considered the gold standard for predicting the malignant risk of oral potentially malignant disorders. However, inter-observer and intra-observer agreement in the context of reporting on OED grading has been reputedly considered unreliable. Methods We undertook a multi-centre study of six Indian oral pathologists to assess variations in reporting OED using the World Health Organization (WHO; 2005) system and also the recently introduced binary system. The observer variability was assessed with the use of kappa statistics. Results The weighted kappa intra-observer agreement scores improved (κw = 0.5012) on grouping by two grades as no and mild dysplasia versus moderate and severe dysplasia compared to binary grading system (κ = 0.1563) and WHO grading system (κw = 0.4297). Poor to fair inter-observer agreement scores were seen between the principal investigator (PI) and the other five observers using the WHO grading system (κ = 0.051-0.231; κw = 0.145 to 0.361; 35% to 46%) and binary grading system (κ = 0.049 to 0.326; 50 to 65%). Conclusions There is considerable room for improvement in the assessment of OED using either system to help in standardised reporting. The professional pathology organisations in India should take steps to provide external quality assessment in reporting OED among oral and general pathologists who are engaged in routine reporting of head and neck specimens.

Objective Exophytic oral verrucous hyperplasia (OVH) is a new entity described by an expert working group from South Asia. First reported in Taiwan, there are no reports so far from an Indian population. The aim was to use the microscopic features described by the expert group to differentiate OVH from other oral verruco-papillary lesions in an Indian archive. Materials and methods In a retrospective multicentre study, using pathology archives, 188 verruco-papillary lesions were retrieved from pathology archives. A proforma listing histopathological criteria for OVH based on published guidelines (Annals of Dentistry, University of Malaya, 2013) was used. Patients’ demographic and clinical data were transcribed from patient charts. The Pearson chi-square test was used to determine associations between clinical and histopathological features. Results Of 188 oral verruco-papillary lesions that were evaluated, based on microscopic features the cases were reclassified as OVH (57), verrucous carcinoma (VC) (84), oral squamous cell carcinoma (16), and other verruco-papillary lesions (31). Both OVH (70%) and VC (60%) showed male predominance and commonly affected buccal mucosa (OVH 74% and VC 57%). Absence of downward growth of the hyperplastic epithelium into lamina propria when compared with the level of the basement membrane of the adjacent normal epithelium was a distinct feature in OVH. Keratin plugging, epithelial dysplasia and subepithelial lymphocytic infiltration were found to be significantly different (P

Aim and objectives To report on the prevalence of ‘lichenoid dysplasia’ (LD) in oral mucosal biopsies previously reported as oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral epithelial dysplasia (OED). Based on this case series, to postulate whether features of dysplasia are present in biopsies with a diagnosis of OLP or OLL and vice versa that warrant a separate diagnostic entity of ‘lichenoid dysplasia’. Material and methods This retrospective, multicentre study was carried out by retrieving archival slides of cases diagnosed with OLP, OLL and OED. Diagnostic criteria for the study were based on published guidelines from seminal papers. A total of 165 cases, 70 OLP and OLL and 95 epithelial dysplasia cases, were re-examined. The diagnosis of OLPs and OLLs was first reconfirmed according to published diagnostic criteria. They were then verified for microscopic features of epithelial dysplasia. Among cases of leukoplakia diagnosed with epithelial dysplasia, we further verified for the presence of lichenoid features. Results A total of 70 cases of OLP and OLL were microscopically evaluated (OLP-54; OLL-16). Epithelial dysplasia was noted in 11 cases (OLP – 8 of 54; OLL – 3 of 16). Nineteen cases of OLP (19 of 54) were found to bear features of OLLs as per published diagnostic criteria. Among the OED group, 22 of the 95 cases showed lichenoid features. Conclusion The study confirms lichenoid features may be found in OEDs and epithelial dysplasia may be found in OLP/OLL. We reconfirm that these microscopic features may coexist. Our findings require further discussion by a panel of experts to redefine the entity known as ‘lichenoid dysplasia’. Future studies should address the concept of lichenoid dysplasia that may assist to resolve any controversies with regard to the malignant potential of OLP.