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

doi:10.1111/jop.12689

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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Abstract

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 language	English
Pages (from-to)	403-409
Journal	Journal of Oral Pathology & Medicine
Volume	47
Issue number	4
Early online date	2 Mar 2018
DOIs	https://doi.org/10.1111/jop.12689
Publication status	Published - 15 Apr 2018

Keywords

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

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10.1111/jop.12689

TFM classification and Staging of oral
This is the peer reviewed version of the following article: Arakeri, G, Thomas, D, Aljabab, AS, et al. TFM classification and staging of oral submucous fibrosis: A new proposal. J Oral Pathol Med. 2018; 47: 403–409 which has been published in final form at https://doi.org/10.1111/jop.12689. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited
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title = "TFM classification and staging of oral submucous fibrosis: a new proposal",

abstract = "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.",

keywords = "Oral Submucous fibrosis, Potentially malignant disorder, TFM Classification, TFM Staging, Malignant transformation",

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

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AU - Thomas, Deepak

AU - Aljabab, Abdulsalam S.

AU - Hunasgi, Santosh

AU - Rai, Kirthi Kumar

AU - Hale, Beverley

AU - Fonseca, Felipe Paiva

AU - Gomez, Ricardo Santiago

AU - Rahimi, Siavash

AU - Merkx, Matthias A. W.

AU - Brennan, Peter A.

PY - 2018/4/15

Y1 - 2018/4/15

N2 - 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.

AB - 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.

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KW - Potentially malignant disorder

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KW - TFM Staging

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EP - 409

JO - Journal of Oral Pathology & Medicine

JF - Journal of Oral Pathology & Medicine

IS - 4

ER -

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

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