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DYSPLASIA AND DNA PLOIDY TO PROGNOSTICATE CLINICAL OUTCOME IN ORAL
POTENTIALLY MALIGNANT DISORDERS

Sathasivam HP, Nayar D, Sloan P, Thomson PJ, Odell EW, Robinson M

Introduction: Oral potentially malignant disorders are a clinical conundrum as there are no
reliable methods to predict their behaviour. We combine conventional oral epithelial
dysplasia grading with DNA ploidy analysis to examine the validity of this approach to risk
assessment in a cohort of patients with known clinical outcomes. Materials and Methods:
Sections from diagnostic biopsies were assessed for oral epithelial dysplasia using the WHO
grading system, and DNA ploidy analysis was performed using established methods.
Patients were reviewed for a minimum of 5 years and those who did not develop oral
squamous cell carcinoma classified as “non-transforming” cases. Patients who developed
oral squamous cell carcinoma ≥ 6 months after the initial diagnostic biopsy were classified
as having “malignant transformation.” Results: Ninety cases were included in the study.
Seventy cases yielded informative DNA ploidy results of which thirty one progressed to
cancer. Oral epithelial dysplasia grading and DNA ploidy status were both significantly
associated with clinical outcome (P < 0.05). Severe dysplasia had a hazard ratio of 3.50 (CI:
1.46, 8.45; P = 0.005) compared to cases with mild dysplasia. Aneuploidy had a hazard ratio
of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to cases with a diploid/tetraploid status.
Receiver operating characteristic analysis gave an area under the curve of 0.617 for DNA
ploidy status and 0.688 when DNA ploidy status was combined with dysplasia grading.
Conclusion: Our findings suggest that combining dysplasia grading with DNA ploidy status
has clinical utility which could be used to develop novel management algorithms.

Published in J Oral Pathol Med. 2021;50:200–209. https://doi.org/10.1111/jop.13121. Epub 2020 November 05

Dr Hans Prakash Sathasivam Prof Dr Philip Sloan
Cancer Research Centre Dr Max Robinson
Institute for Medical Research Department of Cellular Pathology
National Institute of Health Newcastle upon Tyne Hospitals NHS Foundation Trust
Setia Alam Malaysia Newcastle upon Tyne UK

Dr Deepa Nayar Dr Peter J. Thomson
Dr Edward W. Odell Oral and Maxillofacial Surgery
King’s College London Faculty of Dentistry
Guy’s Hospital The University of Hong Kong, Hong Kong SAR
London, UK Hong Kong

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