Observer variability in the histologic assessment of oral premalignant lesions

Histopathologic examination of oral leukoplakias has a major impact on the assessment of prognosis and treatment planning. We investigated the extent of agreement in grading epithelial dysplasia between pathologists with the same or different educational backgrounds. Two general pathologists and two oral pathologists were each given 100 sections of oral leukoplakia to grade from no dysplasia to carcinoma in-situ. The interobserver agreement rates were in the range of 49% to 69%. The calculated kappa values were in the range of 27% to 45%, showing poor to moderate agreement between the pathologists. When comparing the kappa values between the two pairs of pathologists with the same education, these values did not diverge from the general level of kappa values, indicating that the interobserver variability was due to individual differences rather than to educational background.