Comparison of the whole slide imaging and conventional light microscopy in the grading of oral epithelial dysplasia: a multi-institutional study.

BACKGROUND: Whole Slide Imaging (WSI) is an alternative method to light microscopy (LM). However, few studies have compared the diagnostic agreement between WSI and LM, especially to grade oral epithelial dysplasia (OED). The purpose of this study was to evaluate the variability in grading OED by the World Health Organization grading system, using WSI and conventional LM, and to investigate whether the access to clinical information, and psychologic or physical states of the pathologists could interfere with the diagnosis. MATERIAL AND METHODS: eleven experienced pathologists from seven Brazilian universities independently evaluated twenty-five OED cases. The analyses were performed in duplicate for each method, with an interval of at least 30 days, and the time consumed in each analysis was measured. Physical and psychologic states were evaluated by blood pressure levels, heart rate and two questionnaires: State-Trait Anxiety Inventory and Perceived Stress Scale. Clinical information was provided after the second evaluation using WSI and the pathologist could change their diagnostic decision or not. RESULTS: LM showed a higher inter-examiner agreement (k=0.53) than WSI (k=0.45) and a smaller time consumed by the pathologists (mean of 65.53 seconds compared to 91.02 seconds in WSI). In the first analysis using conventional microscopy, there was a positive correlation between kappa values and anxiety (r=0.47, p=0.02), and stress (r=0.64, p<0.01), and an inverse correlation with heart rate (r=-0.48, p=0.02). In the digital analysis, there was also a positive correlation between kappa values and anxiety (r=0.75, p<0.001). After clinical information was given, there was a slight change in 11.3% of the cases, and a great discrepancy in 1.1% of the cases, mainly increasing the OED grade. CONCLUSIONS: both microscopy systems had similar results, although LM had slightly higher kappa values, and WSI was more time consuming.

Feelings, perceptions, and expectations of patients during the process of oral cancer diagnosis.

PURPOSE: Communication barriers during the process of cancer diagnosis can adversely affect how patients understand their health, and understanding patient's perceptions and expectations can favor adherence to professional recommendations and their prognosis. This study aimed to describe the sociodemographic characteristics, perceptions, expectations, and psychological symptoms of patients during the process of oral cancer diagnosis. METHODS: Patients were assessed at two time points: pre-biopsy (T0) and post-diagnosis (T1). At T0, 49 patients answered a sociodemographic, perceived social support, lifestyle questionnaire and inventories (anxiety-State-Trait Anxiety Inventory (STAI-S/T), depression-Beck Depression Inventory (BDI), risk drinkers-Alcohol Use Disorders Identification Test (AUDIT)). They also were interviewed concerning their perceptions, feelings, and expectations. At T1, the 29 patients diagnosed with oral cancer were reassessed for anxiety (STAI-E) and depression symptoms. An interview investigated the same aspects at T0. RESULTS: Patient mean age was 59 years old (±13.7) and 73.5 % were men. At T0, depression symptoms were more frequent among cancer patients (83.3 %) than those without the disease (p < 0.05), with a prevalence of 36.7 %. Patients presented anxiety (40.8 %) and alcohol abuse behavior (32.6 %). Associations between characteristics and categories at T0 showed that patients with lower income and living with a partner reported negative feelings (p < 0.05) more frequently, together with negative expectations concerning the diagnosis among older patients (p < 0.05) and those with depressive symptoms (p < 0.05). At T1, negative feelings were more frequently reported among patients with anxiety (p < 0.01) and depression symptoms (p < 0.05). CONCLUSION: Professional support and care regarding the psychological aspects and characteristics of patients is required during the diagnosis process in order to promote patient adhesion and favorable prognosis.