INTRAEXAMINER AND INTEREXAMINER RELIABILITY IN THE DIAGNOSIS OF ORAL EPITHELIAL DYSPLASIA

Objectives. Pathologists differ in their definition of ''dysplasia.'' This study was done to test the hypothesis that experienced oral patho logists are consistent in diagnosing epithelial dysplasia. Study Desig n. Six board-certified oral pathologists examined 120 oral biopsies ex hibiting simple hyperkeratosis to severe dysplasia. No clinical inform ation was given, and presence of dysplasia was judged by histomorpholo gy. Examiners' diagnoses were compared with sign-out diagnoses for eac h case. Months later, each examiner Viewed 60 relabeled slides from th e original 120. Each diagnosis was compared with the diagnosis in the first round. Results. Exact agreement with the sign-out diagnosis aver aged 50.5% (within one histologic grade 90.4%). Examiners agreed exact ly with their own diagnoses 50.8% of the time (within one histologic g rade 92.4%). Agreement distinguishing dysplasia from no dysplasia comp ared with original sign-out diagnosis was 81.5%. Agreement with themse lves distinguishing dysplasia from no dysplasia was 80.3%. Conclusions . Accurate reproducible agreement among experienced board-certified or al pathologists diagnosing oral epithelial dysplasia is difficult to a chieve.