TFM classification and staging of oral submucous fibrosis: a new proposal

Gururaj Arakeri, Deepak Thomas, Abdulsalam S. Aljabab, Santosh Hunasgi, Kirthi Kumar Rai, Beverley Hale, Felipe Paiva Fonseca, Ricardo Santiago Gomez, Siavash Rahimi, Matthias A. W. Merkx, Peter A. Brennan

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Background: We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (OSMF) based on how they are categorized. A novel classification and staging scheme is proposed.

Methods: A total of 300 OSMF patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of OSMF in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross-tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using SPSS Statistics (version 25.0, IBM, USA).

Results: A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components (K = 0.312, 0.167, 0.152) in OSMF. Following analysis, a three-component classification scheme (TFM classification) was developed that describes the severity of each independently, grouping them using a novel three-tier staging scheme as a guide to the treatment plan.

Conclusion: The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers OSMF malignant transformation in detail.
Original languageEnglish
Pages (from-to)403-409
JournalJournal of Oral Pathology & Medicine
Issue number4
Early online date2 Mar 2018
Publication statusPublished - 15 Apr 2018


  • Oral Submucous fibrosis
  • Potentially malignant disorder
  • TFM Classification
  • TFM Staging
  • Malignant transformation


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