Correlation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria

doi:10.1016/j.tripleo.2009.02.020

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 107, Issue 6, June 2009, Pages 796-800

https://doi.org/10.1016/j.tripleo.2009.02.020 Get rights and content

Objective

We studied the correlation between the clinical and histopathologic diagnoses of oral lichen planus (OLP) based on the modified World Health Organization (WHO) diagnostic criteria (2003).

Study design

First, 4 oral pathologists and 4 clinicians reviewed and categorized 62 microscopic slides and clinical photographs based on WHO 1978 criteria, and then based on modified WHO definition. The number of photographs and microscopic slides in which all clinicians and all pathologists agreed were calculated and compared.

Results

Based on 1978 criteria, in 68% of cases in which all clinicians agreed about the diagnosis of OLP, all pathologists agreed about the diagnosis of OLP. Conversely, in 79% of cases in which all pathologists agreed on the diagnosis of OLP, all clinicians agreed on the diagnosis of OLP. Based on modified criteria, in 93.87% of cases in which all clinicians agreed on the diagnosis of OLP, all pathologists agreed on the diagnosis of OLP. Similarly, in 95.83% of the cases in which all pathologists agreed about the diagnosis of OLP, all clinicians agreed about the diagnosis of OLP.

Conclusion

Results show higher clinicopathologic correlation in the diagnosis of OLP based on the modified criteria of OLP compared with the 1978 criteria.

Section snippets

Material and Methods

This study was approved by The Ethics Committee of Research Project in Kerman University of Medical Sciences. The study involved the review of clinical photographs and histological slide specimens.

Microscopic slides and clinical and historical records of patients with oral white lesions were obtained from the files of the Departments of Oral Medicine and Pathology of the Kerman University of Medical Sciences, Iran. Seventy-one microscopic slides were collected by an investigator who did not

Results

Seventy-one pathologic slides were retrieved; clinical photographs were available for 62 of the cases. Pathologic slides consisted of 50 patients with OLP and OLL lesions. Of the 50 slides, 35 (70%) were OLP and 15 (30%) were OLL. Twenty-one cases were other oral white lesions (i.e., 17 cases were leukoplakia and 3 cases were squamous cell carcinoma). Photographs included 47 cases of OLP and 15 cases with other oral white lesions. Of the 71 cases, 41 cases were females and 30 were males. The

Discussion

In this study, the 1978 WHO criteria for the diagnosis of OLP were compared with the modified WHO criteria of 2003. Interobserver and intraobserver variability in clinical and pathologic evaluations were assessed by calculation of unweighted kappa scores. The grading of kappa values were categorized as follows: kappa <0.40 = poor agreement, 0.41< kappa <0.60 = moderate agreement, 0.61< kappa <0.80 = substantial agreement, kappa >0.81 = good agreement.¹⁶ Results showed that based on the 1978

References (16)

S.L. Myers et al.
A retrospective survey of oral lichenoid lesions: revisiting the diagnostic process for oral lichen planus
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2002)
E. Eisenberg et al.
Lichenoid lesions of oral mucosa: diagnostic criteria and their importance in the alleged relationship to oral cancer
Oral Surg Oral Med Oral Pathol
(1992)
G.W. Gynther et al.
Direct oral microscopy and its value in diagnosing mucosal lesions: a pilot study
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2000)
E.H. van der Meij et al.
The possible premalignant character of oral lichen planus and oral lichenoid lesions: A prospective study
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2003)
A. Larsson et al.
Malignant transformation of oral lichen planus
Oral Oncol
(2003)
N. Chainani-Wu et al.
Oral lichen planus: patient profile, disease progression and treatment responses
J Am Dent Assoc
(2001)
S.B. Ismail et al.
Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation
J Oral Sci
(2007)
S. Gonzaga HF de et al.
Prevalence of oral lichen planus in Brazilian patients with cutaneous lichen planus
Rev Fac Odontol Bauru
(1999)

There are more references available in the full text version of this article.

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: This work was supported by Research Center of Kerman Medical Science.

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Oral medicineCorrelation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria

Objective

Study design

Results

Conclusion

Section snippets

Material and Methods

Results

Discussion

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Oncol

J Am Dent Assoc

Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation

J Oral Sci

Prevalence of oral lichen planus in Brazilian patients with cutaneous lichen planus

Rev Fac Odontol Bauru

Oral medicine
Correlation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria