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- Title
Retrospective Analysis of Discrepancies between Clinical and Histopathological Diagnoses in Head and Neck Lesions: An Institutional Study with 10 Years Database.
- Authors
Kalele, Ketki P.; Kulkarni, Noopur; Patil, Kaustubh P.; Nayyar, Abhishek Singh; Kulkarni, Meena; Atram, Prachi
- Abstract
Introduction: Oral and maxillofacial lesions present a wide spectrum of clinical manifestations ranging from an asymptomatic small lesion to a large destructive one. Several lesions mimic each other in their clinical presentation posing a diagnostic dilemma. Due to interoperator subjectivity and lack of defined objective diagnostic criteria, histopathological investigation, most of the times, plays a vital role in final diagnosis. Many studies have reported the concordance rates among the clinical and histopathological diagnoses of oral lesions, however, there are very few studies which have highlighted the discrepancies in them that have led to drastic changes in the lines of diagnoses and treatment. This institutional retrospective descriptive study intended to highlight this lacuna by going through histopathological registry to study such cases with discrepancies in clinical and histopathological diagnoses in last 10 years. The aim of this study was to systematically analyze the discrepancies in clinical and histopathological diagnoses of various oral lesions with an emphasis on malignant and nonmalignant groups so as to stress the importance of histopathological examination to ultimately minimize the risk of inadvertent inappropriate treatment. Materials and methods: A total of 1570 cases that were reported to our institute over a period of 10 years were evaluated from the histopathology registry. Out of these, 1300 cases met our inclusion criteria. Discrepancies were charted as major and minor discrepancies and discrepancy indices were calculated. Lesions were divided into malignant and nonmalignant groups and were subjected to diagnostic-screening test evaluation to assess the discrepancies. Results: Total discrepancy value (discrepancy index) obtained was 12.9%, out of which 9.23% showed major discrepancies and 3.69% showed minor discrepancies. Ninety-five percent confidence interval (CI) was calculated, and was found in the range of 11.18 to 14.83. Sensitivity and specificity values for the study group of malignant and nonmalignant lesions were 90.09% and 98.35% respectively. Positive predictive value of 91.39%, negative predictive value of 98.08% and Cohen's kappa value of 0.8895 was obtained. Diagnostic accuracy was 97% and bias index of -0.002308 was also calculated. Conclusion: To summarize, our results indicate that the discrepancy between clinical diagnosis and the histopathological interpretation of the various oral lesions studied is not very high. However, a thorough clinicopathological protocol can be designed to overcome this small but significant discrepancy, so as to avoid any inadvertent, inappropriate treatment to the patient.
- Publication
Oral & Maxillofacial Pathology Journal, 2016, Vol 7, Issue 1, p657
- ISSN
0976-1225
- Publication type
Academic Journal
- DOI
10.5005/jp-journals-10037-1061