# Clinical Features Associated With Malignant Transformation of Low‐Grade Dysplasia

## TL;DR

This study identifies clinical features that increase the risk of low-grade oral dysplasia progressing to cancer, helping doctors decide on monitoring and treatment.

## Contribution

The study introduces two risk models for malignant transformation in low-grade oral epithelial dysplasia using North American data.

## Key findings

- High-risk anatomic sites increase progression risk by 2.6-fold in the primary model.
- Toluidine blue staining adds 2.4-fold increased risk in the primary model.
- Anatomic site remains a strong risk factor (2.7-fold) even without toluidine blue in the secondary model.

## Abstract

Inferring risk for malignant transformation (MT) in patients with lesions diagnosed as mild or moderate oral epithelial dysplasia (low‐grade OED) remains challenging. We developed two models assessing the risk of progression to high‐grade OED (severe dysplasia or carcinoma in situ) or OSCC in patients with low‐grade OED lesions.

We included demographic, risk habit and clinical data from participants with low‐grade OED lesions enrolled in the BC Oral Cancer Prevention Program's Oral Cancer Prediction Longitudinal study. Cox proportional hazard models were fit to estimate the effects of anatomic site and toluidine blue findings and adjusted for confounders, as both are associated with MT in the literature but without a North American‐specific cohort analysis. Our primary model included both variables of interest. A secondary model included only anatomic site since toluidine blue is not in widespread use.

Five hundred and thirty‐four participants with 605 lesions met final inclusion criteria, with 339 mild and 266 moderate OED at baseline. In the primary model, lesions at a high‐risk anatomic site or with positive toluidine blue staining were associated with a 2.6 and 2.4‐fold increased risk of progression, respectively. In the second model that did not incorporate toluidine blue, high‐risk anatomic site remained a highly associated risk factor (2.7‐fold increased risk of progression).

Lesion anatomic site is associated with higher risk of MT for the general practitioner, while a specialist with access to toluidine blue results can assume additional risk associated with positive staining. These models may inform decisions for surveillance and intervention for OED.