A New Approach for Diagnosing Oral Epithelial Dysplasia: A Proposal for a Novel Histopathological Scoring System

Abstract Background: Oral epithelial dysplasia (OED) encompasses a range of architectural and cytological changes in epithelial tissue due to genetic alterations. Traditional grading methods for OED often suffer from subjectivity and lack numerical precision. Objective: This study aimed to develop a new scoring system to objectively grade OED based on architectural and cytological features. Materials and Methods: We analyzed 150 cases of OED from our institutional database. A scoring sheet was created to record the presence (score of 1) or absence (score of 0) of specific dysplastic features. Scores were categorized into three ranges: 1–4, 5–8, and 9–16. This new system was validated against the World Health Organization (WHO) Grading System and Binary System, with interobserver variability assessed using kappa statistical analysis. Results: Scores ranged from 1 to 4 for mild dysplasia, from 5 to 8 for moderate dysplasia, and from 9 to 16 for severe dysplasia ( P < 0.001). The new system aligned closely with the WHO grading: 92% of cases with mild dysplasia scored 1–4, 74% of moderate dysplasia cases scored 5–8, and 92% of severe dysplasia cases scored 9–16 ( P =