Clinical-pathologic agreement for oral lesions in an oral medicine setting

Background: Histopathological examination remains the gold standard for the diagnosis of oral mucosal lesions. To date little is known on the clinical–pathologic agreement for oral lesions diagnosed by oral medicine experts. Objective: This retrospective study attempts to quantify the clinical–pathologic agreement for oral lesions diagnosed by oral medicine experts. Methods: Data were collected retrospectively from the medical records of all new oral medicine consultations. The clinical diagnosis provided by an oral medicine expert was compared to the histopathological diagnosis. Clinical–pathologic agreement was estimated as the percentage agreement and was measured using weighted Kappa. Results: The most common oral lesions were oral lichen planus (34.7%), traumatic fibroma (23.4%), squamous cell carcinoma (SCC) or severe dysplasia (6.7%), mucous membrane pemphigoid (MMP) (5.7%), leukoplakia (5.6%) and squamous papilloma (4.3%). The overall clinical–pathologic agreement for all lesions had a weighted kappa of 0.81 [95%CI 0.78% to 0.85%]. The concordance for the most common oral lesions in the study population was 90.2%, with a weighted kappa of 0.88 [95%CI 0.85% to 0.92%]. The clinical–pathologic agreement for SCC/severe dysplasia was 78.7%, for traumatic fibroma 91.4%, for leukoplakia 97.4%, for oral lichen planus 93.8%, for squamous papilloma 96.7% and for MMP 65%. Conclusions: The overall concordance between clinical and histopathological diagnosis for oral lesions was excellent. Dentists have the unique opportunity to refer patients to oral medicine experts for diagnosis and management of oral diseases. Given their expertise patients may require fewer visits for diagnostic purposes.