Evidence map›Paper›PMID 41450095›Full record

ArticleOral diseases2026

Independent Multicentre Validation of the 'Six-Point' Model for Malignant Transformation Risk in Oral Epithelial Dysplasia.

Hanya Mahmood, Mike Bradburn, Nadim M Islam, Omar Kujan, Nasir Rajpoot, Alan Roger Santos-Silva, Pablo Agustin Vargas, Jacqueline James, Paul Nankivell, Hisham Mehanna and 1 more

Abstract readMulticenter StudyValidation Study
In one paragraph

Article in Oral diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Predicting Malignant Transformation in Oral Epithelial Dysplasia: A Systematic Comparison of Artificial Intelligence-Based Risk Models and Pathologist-Based Microscopy.Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology · 2026
    Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Hanya MahmoodSchool of Clinical Dentistry, Faculty of Health, University of Sheffield, Sheffield, UK.ORCID https://orcid.org/0000-0001-7159-0368
Mike BradburnClinical Trials Research Unit, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK.
Nadim M IslamDepartment of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA.
Omar KujanOral Diagnostic and Surgical Sciences Division, UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia.ORCID https://orcid.org/0000-0002-5951-8280
Nasir RajpootDepartment of Computer Science, Tissue Image Analytics Centre, University of Warwick, Coventry, UK.
Alan Roger Santos-SilvaOral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil.ORCID https://orcid.org/0000-0003-2040-6617
Pablo Agustin VargasOral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil.
Jacqueline JamesPrecision Medicine Centre, Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
Paul NankivellInstitute of Head and Neck Studies and Education, Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0003-4664-6117
Hisham MehannaInstitute of Head and Neck Studies and Education, Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Syed Ali KhurramSchool of Clinical Dentistry, Faculty of Health, University of Sheffield, Sheffield, UK.ORCID https://orcid.org/0000-0002-0378-9380

Funding

Cancer Research UKNational Institute for Health and Care Research
6 · The paper itself

Abstract

backgroundHistological grading of oral epithelial dysplasia (OED) is used for predicting malignant transformation risk. However, grading is associated with significant subjectivity and observer variability leading to inconsistency in prognosis prediction. Alternate histological feature-specific models ('six-point' and 'two-point') have been shown to have potentially better prognostic reliability than conventional grading. This study conducts a multicentre validation of these models.

methods102 OED cases (dating 2012-2017) were acquired from 4 independent centres (13 (13%) Sheffield; 40 (39%) Belfast; 30 (29%) Birmingham; 19 (19%) Piracicaba, Brazil) were independently scored using the 'six-point' and 'two-point' models. Feature prevalence, observer agreement and malignant transformation risk were evaluated and compared to conventional grading systems.

resultsThe 'six-point' system demonstrated superior predictive value (AUROC of 0.81) compared to the 'two-point' system (AUROC = 0.73, p = 0.004), WHO grading (AUROC = 0.71, p = 0.03) and binary grading (AUROC = 0.68, p = 0.009). Transformation rate for the 'six-point' model was 50% (95% CI 27%-78%) when all 6 features were present compared to 14% (95% CI 5%-32%) when 2-3 features were present.

conclusionsThis study supports the superior performance of the 'six-point' system for transformation prediction on a multicentric sample. Findings indicate that feature-specific models may be more reliable than existing histological grading systems for prognosis prediction.

Indexed as

Cell Transformation, NeoplasticMouth MucosaMouth NeoplasmsPrecancerous ConditionsFemaleHumansMaleMiddle AgedNeoplasm GradingReproducibility of ResultsRisk Assessmenthistological gradingmalignant transformationoral epithelial dysplasiaoutcome predictionprognosis

Identifiers

PMID41450095
PMCPMC13365013

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.