Non-Cochrane · prognostic · PM42493423
Predicting Malignant Transformation in Oral Epithelial Dysplasia: A Systematic Comparison of Artificial Intelligence-Based Risk Models and Pathologist-Based Microscopy.
Arantes Diele Carine Barreto, Delgado Lucas Monteiro, Dos Santos Marília de Marco Pinto Paiva, et al. · Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology · 2026 · PubMed · doi:10.1111/jop.70168
Findings
12 findings
| Population | ||||
|---|---|---|---|---|
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Pathologist-based H&E microscopy: high-risk dysplasia category (all grading systems combined) | Low-risk category or no dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · All classification systems combined | OR 3.42 [2.07, 5.68] GRADE not reported 22 studies · 7554 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Pathologist-based H&E microscopy: high-risk dysplasia category | Low-risk category or no dysplasia | Pooled sensitivity for predicting malignant transformation Minimum follow-up 5 to 72 months · Human-based studies | Sensitivity 0.74 [0.68, 0.8] GRADE not reported Studies not reported |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Pathologist-based H&E microscopy: high-risk dysplasia category | Low-risk category or no dysplasia | Pooled specificity for predicting malignant transformation Minimum follow-up 5 to 72 months · Human-based studies | Specificity 0.56 [0.48, 0.64] GRADE not reported Studies not reported |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Two-tier (binary) dysplasia grading: high-risk | Low-risk | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Two-tier classification | OR 2.66 [1.27, 5.61] GRADE not reported 10 studies · 2876 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Three-tier (WHO) dysplasia grading: high-risk | Low-risk or no dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Three-tier classification | OR 3.55 [1.7, 7.41] GRADE not reported 17 studies · 4362 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Differentiated dysplasia | No differentiated dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Differentiated dysplasia | OR 20.64 [2.66, 160.41] GRADE not reported 2 studies · 316 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Mild dysplasia (pathologist microscopy) | No dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Mild dysplasia grade vs no dysplasia | OR 3.36 [1.85, 6.1] GRADE not reported 10 studies · 1970 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Moderate dysplasia (pathologist microscopy) | No dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Moderate dysplasia grade vs no dysplasia | OR 7.62 [3.91, 14.85] GRADE not reported 10 studies · 1788 participants |
| Patients with oral epithelial dysplasia (oral leukoplakia, erythroleukoplakia, erythroplakia) | Severe dysplasia (pathologist microscopy) | No dysplasia | Malignant transformation to oral squamous cell carcinoma Minimum follow-up 5 to 72 months · Severe dysplasia grade vs no dysplasia | OR 18.98 [10.25, 35.14] GRADE not reported 10 studies · 1550 participants |
| Patients with oral epithelial dysplasia (H&E whole slide images) | AI-based (machine learning or deep learning) risk prediction model on H&E histology: high-risk group | Low-risk group | Malignant transformation to oral squamous cell carcinoma AI-based models | OR 12.64 [5.65, 28.26] GRADE not reported 5 studies · 584 participants |
| Oral epithelial dysplasia (OED) in oral leukoplakia, erythroleukoplakia and erythroplakia | AI-based risk prediction models (machine learning, deep learning or hybrid) on H&E histopathology | Low-risk group predicted by the model | Pooled specificity for malignant transformation Not specified · Histopathology (H&E) risk prediction of malignant transformation | Specificity 0.70 [0.63, 0.77] GRADE not reported 5 studies |
| Oral epithelial dysplasia (OED) in oral leukoplakia, erythroleukoplakia and erythroplakia | AI-based risk prediction models (machine learning, deep learning or hybrid) on H&E histopathology | Low-risk group predicted by the model | Pooled sensitivity for malignant transformation Not specified · Histopathology (H&E) risk prediction of malignant transformation | Sensitivity 0.78 [0.72, 0.84] GRADE not reported 5 studies |
Included primary studies 61
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Zhang 2023 matched by author and year (probable) | NR | 5 other reviews | not stated | not extracted yet |
| Bagan 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bagan 2022 Effect of clinical and histologic features on time to malignancy in 224 cases of oral leukoplakia treated by surgery. PMID:35474554 | 2022 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Bashir 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bashir 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bashir 2023 A digital score of peri-epithelial lymphocytic activity predicts malignant transformation in oral epithelial dysplasia. PMID:37294162 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Brouns 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Brouns 2014 Malignant transformation of oral leukoplakia in a well-defined cohort of 144 patients. PMID:23521625 | 2014 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Brouns 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Brouns 2023 Oral leukoplakia classification and staging system with incorporation of differentiated dysplasia. PMID:35765231 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Cai 2023 Development of a Pathomics-Based Model for the Prediction of Malignant Transformation in Oral Leukoplakia. PMID:37164265 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Cai 2024 Architectural and cytological features of epithelial dysplasia associated with transformation risk. PMID:37983891 | 2024 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Cerqueira 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Cerqueira 2021 Malignant transformation of oral leukoplakia: a multicentric retrospective study in Brazilian population. PMID:33247570 | 2021 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Chaturvedi 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Chaturvedi 2020 Oral Leukoplakia and Risk of Progression to Oral Cancer: A Population-Based Cohort Study. PMID:31860085 | 2020 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Darling 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Darling 2023 Assessing Oral Epithelial Dysplasia Risk for Transformation to Cancer: Comparison Between Histologic Grading Systems Versus S100A7… PMID:37249075 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Dost 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Dost 2014 Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading. PMID:24388536 | 2014 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Ellonen 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ellonen 2023 Histopathological findings of oral epithelial dysplasias and their relation to malignant transformation. PMID:36481601 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Ellonen 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ellonen 2025 Binary- and Three-Tiered Oral Epithelial Dysplasia Grading System and Malignant Transformation. PMID:40231735 | 2025 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Hankinson 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hankinson 2021 Malignant transformation in a cohort of patients with oral epithelial dysplasia. PMID:34303542 | 2021 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Jayasooriya 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Jayasooriya 2020 Malignant transformation of oral leukoplakia: a follow-up study. PMID:32436158 | 2020 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Mahmood 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mahmood 2022 Prediction of malignant transformation and recurrence of oral epithelial dysplasia using architectural and cytological feature specific… PMID:35361889 | 2022 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Mahmood 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mahmood 2023 Development and validation of a multivariable model for prediction of malignant transformation and recurrence of oral epithelial dysplasia. PMID:37758836 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Mahmood 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mahmood 2025 Independent Multicentre Validation of the 'Six-Point' Model for Malignant Transformation Risk in Oral Epithelial Dysplasia. PMID:41450095 | 2026 | this review only | not stated | not extracted yet |
| Pedroso 2026 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Pedroso 2026 Machine learning models for predicting recurrence and malignant transformation of oral leukoplakia. PMID:41109769 | 2026 | this review only | not stated | not extracted yet |
| Pontes 2026 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Pontes 2026 Predicting Malignant Transformation in Oral Leukoplakia: A Multilayer Perceptron Approach Incorporating Clinicopathological Features and… PMID:41220072 | 2026 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Rodrigues 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Rodrigues 2025 Diagnostic Criteria for Oral Epithelial Dysplasia: Predicting Malignant Transformation. PMID:39918668 | 2025 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Schepman 1998 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Schepman 1998 Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from… PMID:9813722 | 1998 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Shearston 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shearston 2019 Malignant transformation rate of oral leukoplakia in an Australian population. PMID:31172563 | 2019 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Shephard 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shephard 2024 A fully automated and explainable algorithm for predicting malignant transformation in oral epithelial dysplasia. PMID:38942998 | 2024 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Shephard 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shephard 2025 A novel AI-based score for assessing the prognostic value of intra-epithelial lymphocytes in oral epithelial dysplasia. PMID:39616233 | 2025 | this review only | not stated | not extracted yet |
| Soares 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Soares 2025 Risk Assessment of Oral Leukoplakia by Individual Dysplasia Features. PMID:40432218 | 2025 | this review only | not stated | not extracted yet |
| Sperandio 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sperandio 2023 Oral epithelial dysplasia grading: Comparing the binary system to the traditional 3-tier system, an actuarial study with malignant… PMID:36177736 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Tovaru 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tovaru 2023 Oral leukoplakia: A clinicopathological study and malignant transformation. PMID:34982498 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Wils 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Wils 2023 The role of differentiated dysplasia in the prediction of malignant transformation of oral leukoplakia. PMID:37749621 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Yasothkumar 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Yasothkumar 2025 Clinico-Pathological Assessment and Malignant Transformation in Patients with Oral Epithelial Dysplasia - A Follow-up Cohort Study. PMID:40758174 | 2025 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Zaini 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Zaini 2018 Predicting malignant progression in clinically high-risk lesions by DNA ploidy analysis and dysplasia grading. PMID:30367100 | 2018 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
| Zhang 2023 Deep learning-based pathology image analysis predicts cancer progression risk in patients with oral leukoplakia. PMID:36721313 | 2023 | this review only | Malignant transformation to oral squamous cell carcinoma | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | OED in oral potentially malignant disorders (leukoplakia, erythroleukoplakia, erythroplakia) | OED cases (human-based n=5733 cases in 23 studies; AI-based n=1813 cases in 9 studies) |
| Intervention | AI-based approaches (machine or deep learning) on H&E histopathology | AI-based risk models (9 studies) |
| Comparison | Conventional H&E microscopy | Human-based microscopy grading (23 studies) |
| Outcomes | Performance of risk prediction models for malignant transformation (OR, sensitivity, specificity) | Malignant transformation: pooled OR, sensitivity, specificity |
| Study designs | Observational studies and comparative studies | 32 studies, mostly retrospective |
| Timing | Not specified | Minimum follow-up 5-72 months in human-based studies |