Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility.
BACKGROUND
Grading of dysplasia, including head and neck lesions, continues to be a hotly debated subject. It is subjective and lacks intra- and inter-observer reproducibility due to the insufficiency of validated morphological criteria and the biological nature of dysplasia. Moreover, due to the absence of a consensus, several systems are currently employed.


OBJECTIVE
The aims of this review are to: 1) Highlight the significance of dysplasia and the importance of a valid method for assessing precursor lesions of the head and neck. 2) Review the different histopathological classification systems for grading intraepithelial lesions of the head and neck. 3) Discuss and review quality requirements for these grading systems.


CONCLUSIONS
Regarding the different classification systems, data concerning the WHO classification system are the most available in current literature. There is no simple relationship or overlapping between the classification systems. Further studies should be done to see whether other systems have advantages above the current WHO system and to discover indications that could lead to an universal classification system for intraepithelial lesions of the head and neck.
Department of Otolaryngology/Head and Neck Surgery, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. A.Fleskens@kno.umcn.nl
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Fleskens
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Slootweg
D006258:Head and Neck Neoplasms / Q000145:classification / Q000473:pathology*; D006801:Humans; D011230:Precancerous Conditions / Q000145:classification / Q000473:pathology*; D011379:Prognosis; D015203:Reproducibility of Results; D014944:World Health Organization