Bogahawatte Samarakoon Mudiyanselage Samadarani Siriwardena

Aim: This study investigates the prognostic potential of epithelial‐mesenchymal transition (EMT) markers (E‐cadherin, N‐cadherin, Twist) and immune checkpoint markers (PD‐1, PD‐L1) in predicting malignant transformation (MT) of oral leukoplakia (OL). Methodology: Immunohistochemistry (IHC) was performed on 56 OL tissue samples, categorized equally into progressive (transformed to higher‐grade dysplasia or OSCC within 3 years) and non‐progressive groups. Expression levels of E‐cadherin, N‐cadherin, Twist, PD‐1, and PD‐L1 were systematically assessed. Results: Progressive OL cases showed descriptive trends of lower E‐cadherin expression, higher N‐cadherin and Twist expression compared with non‐progressive cases; however, these EMT‐marker differences were not statistically significant. PD‐1 expression was significantly higher in progressive OL ( p = 0.038) compared with non‐progressive OL. When stratified into non‐progressive, dysplasia‐progressive, and OSCC‐progressive subsets, PD‐L1 expression demonstrated significant variation ( p = 0.018). Higher PD‐1 expression was significantly associated with progressive OL in males ( p = 0.02) and correlated with a shorter time to progression (τb = 0.456, p = 0.004). Conclusion: The findings suggest that immune checkpoint markers, particularly PD‐1 and PD‐L1, may be associated with progression in OL and may warrant further validation as adjunctive prognostic markers.

Confidence is often treated as an indicator of readiness in clinical education, although it may not develop in parallel with assessed performance. This non-randomized longitudinal cohort evaluation followed 90 senior dental students in peer-assisted learning (PAL; n = 45) and faculty-led (n = 45) cohorts across three course-embedded assessment points. Confidence was measured with an eight-item course-specific 1–5 rating and assessed performance with structured pediatric dentistry tasks scored 0–6 using a prespecified rubric. Both measures were rescaled to their theoretical 0–100 ranges. Signed and absolute alignment gaps were analyzed with participant-clustered generalized estimating equations (GEE) and robust standard errors; a 10,000-sample participant-cluster bootstrap and a post hoc baseline-adjusted GEE were used as sensitivity analyses. Baseline confidence and performance differed little between cohorts, whereas the signed-gap standardized mean difference was larger because within-cohort variability was limited. From T1 to T3, the PAL cohort showed larger observed increases in confidence (+7.9 percentage points relative to faculty-led; 95% CI [5.4, 10.4]) and assessed performance (+6.8; 95% CI [4.9, 8.7]). Between-cohort differences in change were not statistically significant for the signed gap (+1.2; 95% CI [−1.0, 3.4], p = .28) or absolute gap (+2.21; 95% CI [−0.43, 4.85], p = .10). In the baseline-adjusted signed-gap sensitivity model, the PAL-minus-faculty difference was +11.59 points at T2 (95% CI [8.71, 14.47], p < .001) and +0.77 at T3 (95% CI [−1.70, 3.24], p = .54), preserving the interpretation of marked midpoint divergence but no detectable endpoint difference. These findings indicate that performance level, discrepancy direction, discrepancy magnitude, and longitudinal trajectory provide different educational information. Confidence and numerical gap scores should therefore be interpreted alongside repeated evidence of assessed performance rather than used as substitutes for achievement.

Accurate self-assessment depends on metacognitive monitoring—the correspondence, or calibration, between subjective confidence and objective performance. Calibration is often treated as a static trait, yet how it develops over time, and how it should be compared across groups, remains underexamined. We tracked confidence-performance calibration longitudinally in an applied clinical training context. Ninety undergraduate trainees in two naturally occurring instructional conditions (peer-assisted and faculty-led) were assessed at three time points. Self-confidence ratings and objective structured performance scores were placed on a common 0-5 scale, yielding signed calibration bias (the direction of misjudgement) and absolute calibration error (its magnitude). Descriptively, trainees in the peer-assisted condition remained near-calibrated throughout, whereas trainees in the faculty-led condition fluctuated markedly, moving from overconfidence to underconfidence and partially back toward accuracy. The conditions nevertheless differed substantially in calibration at baseline, despite being balanced on prior attainment and experience. In baseline-adjusted regression models, baseline calibration was the dominant predictor of endpoint calibration, whereas instructional condition was not independently associated with endpoint signed or absolute bias. These findings show that confidence-performance calibration is dynamic and direction-specific, and that apparent group differences in self-assessment accuracy can be largely attributable to baseline calibration. Longitudinal, paired measurement and baseline adjustment are therefore essential for valid inference about calibration.

Background: Cervical lymph node metastasis is one of the most important prognosticators in oral squamous cell carcinoma (OSCC). The presence of extranodal extension (ENE) in metastatic nodes further worsens the prognosis. The primary objective of this study was to develop a simple model to predict ENE in OSCC using demographic and clinicopathological parameters that are easily available in a preoperative clinical setting. Methods: All patients who underwent surgery for the treatment of primary OSCC of the tongue or buccal mucosa with neck dissection (ND) between 1998 and 2020 from two oral pathology diagnostic units were included in the study. Chi‐square tests were utilised to analyse the presence/absence of associations between each input parameter and ENE. The strengths of these associations were assessed using univariable and multivariable logistic regressions and indicated as odds ratios. Results: Among the 1098 OSCC patients included in the study, 185 (16.85%) patients exhibited ENE. In the multivariable logistic regression model the odds for ENE were greater in females and tongue OSCC. Similarly, increasing T category and DOI as well as a dyscohesive WPOI were associated with a greater odds ratio for ENE. The AUCs from the 10‐fold cross‐validations to assess the predictive ability of the newly developed model ranged from 0.655 to 0.842 with a 95% CI of 0.663–0.744, indicating that the diagnostic accuracy of our model was acceptable. Conclusion: Our model confirms that a higher risk of ENE is associated with female gender, tumours of the tongue, increasing tumour size as well as DOI and a dyscohesive WPOI.

Background: The incidence of oral squamous cell carcinoma (OSCC) of the tongue is increasing in the younger population without traditional risk habits that lead researchers to find other related factors such as diet and viruses, especially human papillomavirus (HPV). It is noteworthy that many OSCCs develop from oral potentially malignant disorders (OPMDs). Correct diagnosis and timely management of OPMDs may help to prevent malignant transformation, and therefore it is worth seeing the involvement of HPV in OPMDs and oral cancers, as the preventive and curative measures in HPV-induced cancer types are different from the conventional types of OPMDs and OSCCs. Therefore, the main objective of this study was to identify a relationship between HPV and p16 in OPMDs and compare it with OSCC. Methods: This study was conducted on 83 cases of known OSCCs and OPMDs (oral submucous fibrosis, leukoplakia, and oral lichen planus). Assays, such as polymerized chain reaction (PCR) and reverse transcription-PCR, were carried out for HPV and p16. The results were compared with clinical information and with the literature. The results were analyzed using SPSS 16.0 for windows. Results: P16 expression was mostly seen in males than in female patients. Out of 21 cases of keratosis with dysplasia, 19% expressed p16. Of 26 oral lichen planus patients, 29% showed the p16 gene with immunohistochemistry. Interestingly, a high percentage of OSF cases expressed p16 (48.27%). Minimal expression was observed in OSCC (6.25%). HPV DNA was detected in 2.4% of the total sample. Both p16 and HPV were detected in a single case of OSCC. OPMDs expressed a significant amount of the p16 gene by immunohistochemistry and reverse transcription-PCR technique when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. HPV and p16 are mostly negative in our OSCC sample, exhibiting low prevalence. Conclusions: OPMDs expressed a significant amount of the p16 gene when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. Although OSF expressed p16, HPV was not detected, suggesting that over-expression could be independent of HPV. OSCC shows low HPV prevalence.

Introduction: Verruco papillary lesions (VPL) in the oral cavity encompass a spectrum of lesions starting from benign, potentially malignant to entirely malignant tumors. Much of the controversies in these entities occur due to lack of consensus on the disease characteristics and the management. This systematic review was conducted to identify and describe different lesions categorized as VPL in the oral cavity and their association with malignancy.Methods: An electronic literature search was conducted in MEDLINE (via PubMed), Scopus, LILAC, IMSEAR, and CENTRAL databases, which retrieved a total of 1020 abstracts. These abstracts were managed through Rayyan and Mendeley software, and only 28 studies with high quality were included in the systematic review.Results: Studies were published from 1992 to 2021. From the extracted data, nine different entities under the umbrella term VPL were identified associated with malignancy. We describe the clinical and histopathological characteristics of these and propose a uniform framework for nomenclature.Conclusions: Lack of well‐planned research with adequate follow‐up duration and inadequate quality standards are major barriers for the lack of evidence. The use of uniform nomenclature, as proposed in this study, and research at the molecular level will greatly reduce the controversies in understanding oral VPL associated with malignancy.

Background: Lymph node metastasis in oral squamous cell carcinoma (OSCC) is influenced by clinical and histopathological variables. The aim of this study was to develop a simple model to predict nodal metastasis of OSCC in clinically negative necks (cN0).Methods: Data from patients who underwent surgery for treatment of OSCC of the tongue or buccal mucosa with neck dissection were used for model development and validation.Results: Nodal metastasis was significantly associated with gender, age, tumor size, site, pattern of invasion and depth of invasion on univariate analysis. All the five variables except age were retained at the variable selection step of the model development and were used in the final model because it was not significant at 0.10 significance level after adjusting for other variables. Regression coefficients of the model were used to estimate risks of nodal metastases for each combination of clinicopathological characteristics. A 10‐fold cross‐validation was used to assess the model. The average of the resultant 10 AUCs (along with its 95% confidence interval estimated using bootstrap) was used as the overall validated measure of the model. A risk chart was produced using probability of nodal metastasis predicted by the model for each combination of five characteristics. The model's ability to identify patients with nodal metastases as assessed by the area under the ROC curve (AUC) was 0.752.Conclusion: The model based on established clinicopathological variables has been internally validated on a large cohort of patients and offers practicability for use in OSCCs of the tongue and buccal mucosa.