Architectural and cytological features of epithelial dysplasia associated with transformation risk

Abstract Objectives This study explored associations between histological features of dysplasia and malignant transformation, as well as genomic copy number alterations. Materials and Methods Overall, 201 samples were collected from patients of oral leukoplakia. The associations of dysplastic features with malignant transformation and copy number alterations were investigated by Cox proportional hazards regression analysis and the Mann–Whitney U ‐test. Results Eight individual histological features, such as irregular epithelial stratification ( p = 0.001), mitoses high in epithelium ( p = 0.033), extension of changes along minor gland ducts ( p < 0.001), etc., were associated with greater risk of malignant transformation. A model including histological features and age showed good performance for predicting malignant transformation (area under receiver operating characteristic curve: 0.806). Irregular epithelial stratification ( p = 0.007), abnormal nuclear shape ( p = 0.005), abnormal cell size ( p = 0.004), etc. were associated with greater genomic instability. Conclusions A Cox proportional hazards model using eight histological features and patient age reliably predicted the malignant potential of oral epithelial dysplasia. Identification of these histological features closely related to malignant transformation may aid the management of oral potentially malignant disorders and early detection of oral squamous cell carcinoma.