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Dysplasia Grading — MFDS Part 1 MCQ

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ModerateOral PathologyDysplasia GradingMFDS Part 1

An incisional biopsy from an oral leukoplakia shows epithelial dysplasia. Under the current WHO approach, which assessment principally determines whether the dysplasia is graded as mild, moderate or severe?

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Correct answer: D — The overall severity and epithelial extent of architectural disturbance and cytological atypia

The correct answer is D. Oral epithelial dysplasia is graded histologically by assessing the overall severity and epithelial distribution of architectural abnormalities and cytological atypia. The extent of epithelial involvement remains relevant, but grading should not be reduced to a rigid lower-third/lower-two-thirds/full-thickness rule; the nature and severity of the abnormalities must also be considered. Surface keratinisation and inflammation can accompany dysplasia but do not independently determine its grade. Age, anatomical site, lesion size, and tobacco or alcohol exposure contribute to clinical risk assessment and management, not microscopic dysplasia grading. The former explanation was therefore overly prescriptive, particularly in treating epithelial thirds and carcinoma in situ as mechanically separate categories.

Reference: Hankinson P, Mahmood H, Walsh H, Speight PM, Khurram SA. Demystifying oral epithelial dysplasia: a histological guide. Pathology. 2024;56(1):11–23. https://pubmed.ncbi.nlm.nih.gov/38030478/