Diagnostic concordance characteristics of oral cavity lesions

Evaluating the Harmony Between Clinical Observations and Pathological Findings in Oral Soft Tissue Lesions: A Two-Decade Retrospective Study of Diagnostic Consistency

Aim

This study aims to evaluate the concordance rate between clinical diagnoses and pathological findings of oral soft tissue lesions.

Methods

In this retrospective descriptive-analytical study, we analyzed 7901 cases of oral tissue lesions referred to the pathology department at Shahid Beheshti Faculty of Dentistry from 1996 to 2022. Data extracted from archived records included age, sex, lesion location, and both clinical and histopathological diagnoses.

Results

A total of 2592 samples of oral soft tissue lesions meeting the inclusion criteria were evaluated. The concordance rate between clinical and pathological diagnoses was 65.3%. A significant relationship was found between the anatomical location of the lesion and the matching rate (p < 0.001), with the lips exhibiting the highest matching rate at 77.3% and the sinus presenting the lowest at 45.4%. Additionally, the type of lesion significantly correlated with the concordance rate (p < 0.001), with connective tissue lesions showing the highest concordance at 83.3% and nonodontogenic lesions the lowest at 46.1%. However, no significant associations were found between gender/age (p > 0.743/p > 0.506) and the concordance rate.

Conclusion

The findings underscore the need for enhanced training for clinicians, greater attentiveness to clinical symptoms, and improved collaboration between dentists and pathologists to facilitate accurate diagnoses and effective treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-025-02447-x.

The Accuracy of Clinical Diagnosis in Biopsied Premalignant and Malignant Oral Lesions

Objectives

Due to the importance of clinical impression in accurate final diagnosis of oral pathologic lesions, this study evaluated the agreement rate between clinical and histopathological diagnosis in of oral premalignant (PML) and malignant lesions, over a period of 22 years.

Materials and Methods

In this retrospective and cross-sectional study, 861 cases were reviewed. Patients' clinical data, type of biopsy, clinical appearance of the lesion, as well as clinical impression and histopathological diagnosis were noted using the archived medical files. Descriptive statistics and Chi-square test were used for analyzing the data.

Results

Overall, the agreement rate between histopathological and clinical diagnoses was 71.9%. This rate was 71.8% in PML and 75.7% in malignant lesions. The highest agreement among all lesions was found in OLP, in the mouth floor and by oral medicine specialists.

Conclusion

The results showed a relatively high agreement rate between clinical and histopathologic diagnosis of PML and malignant lesions. Clinical presentation, site and type of biopsy, as well as clinicians' specialty were associated with this rate. More education, careful clinical examination, and more cooperation between the surgeon and pathologist are necessary for accurate diagnosis and management.

A Retrospective Analysis of Concordance Between Clinical and Histopathologic Diagnoses and Completeness of Oral Biopsy Forms at a Tertiary Dental Hospital in Eastern Nepal

Introduction: Histopathological diagnosis remains the gold standard tool for the diagnosis, yet accurate and detailed clinical descriptions are necessary to facilitate the final diagnosis. Histopathologists believe that clinicians are unaware of how histopathology departments operate, partly because of the less information on requisition forms. The objective of the present study is to assess the concordance of clinical and histological diagnoses of all oral and maxillofacial biopsy samples, along with the completion of the requisition form provided with the biopsy sample. Methods: A retrospective study was conducted at the Department of Oral Pathology. The biopsy request forms of year 2018-2019 were retrieved from the archive of the department and were analyzed for clinicopathological concordance. Descriptive and analytical statistics were performed using SPSS. Results: Of 338 forms, 243 (71.89%) forms had total concordance between clinical and histopathologic diagnosis; 20 forms (5.92%) had concordance with the histopathological diagnosis, but only after the clinical diagnosis had been refined. Of all the forms analyzed, 36 (10.65%) forms lack habit history in cases suspected of oral cancer and oral potentially malignant disorder, and 24 (7.10%) cases lack radiographic details. The categories of clinicohistopathological concordance and the different clinical information groups showed a statistically significant relationship. We also found that the sign-out time for histopathological reports depend on the extent of clinical information provided which was statistically significant too. Conclusions: The current study concluded a sufficient level of concordance between clinical and histopathological diagnosis. A high completion rate of biopsy forms indicated that the clinicians/operating surgeons perceive the significance of clinical information in histopathological diagnosis. We also recommend, irrespective of the type of suspected oral lesions, submitted for biopsy, a detailed clinical information is the backbone for accurate and timely reporting of the histopathological diagnosis.

Correlation between Clinical and Histopathological Diagnoses in Oral Cavity Lesions: A 12-Year Retrospective Study

Objective

Proper diagnosis plays a key role in the treatment and prognosis of all diseases. Although histopathological diagnosis is still known as the gold standard, final diagnosis becomes difficult unless precise clinical descriptions are obtained. So, this study aimed to evaluate the concordance of the clinical and histopathological diagnoses of all oral and maxillofacial biopsy specimens in a 12-year duration.

Materials and Methods

Archive files and clinical findings related to 3001 patients who had been referred to the Department of Oral Pathology during a 12-year period were reviewed. The recorded information in files included age, sex, lesion's location, clinical and histopathological diagnoses, and specialty of dentists.

Results

Out of 3001 cases included and reviewed in this study, 2167 cases (72.2%) were consistent between clinical and histopathologic diagnoses. Age, sex, and clinician's specialty were indicated to have no significant effect on diagnosis (p values = 0.520, 0.310, 0.281, respectively), but location and type of lesion affected that (p values = 0.040 and 0.022, respectively). In regard to location, the highest concordance of clinical and histopathologic diagnoses was observed in mouth floor lesions, and the lowest one was in gingival mucosa. In terms of lesion category, the highest and the lowest concordance rates belonged to white and red lesions and pigmented lesions, respectively.

Conclusion

The results of the present study show that the consistency of clinical and histopathological diagnoses was three times more than their inconsistency, and the accuracy of the clinicians was largely acceptable.

Concordance between clinical and histopathologic diagnosis and an audit of oral histopathology service at a Nigerian tertiary hospital

Introduction

Although histopathological diagnosis remains the gold standard; good clinical impression is potentially a key diagnostic tool in rural resource-limited settings. Thus, good concordance between clinical impression and histopathological diagnosis is thus a very crucial diagnostic oral pathology tool in low- and middle-income countries (LMICs).

Methods

This retrospective study was performed at the Oral pathology and Oral diagnoses units of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Osun state. Clinicopathological reports of all biopsies between the period of 2008-2017 were retrieved and analyzed. Descriptive analysis of data was done using Stata 14. Frequency of oral lesions and rates of accurate clinical diagnoses were evaluated for lesional sites and clinician's qualification/specialization.

Results

In 592 biopsied cases, the mean age was 36.1years with higher female predilection (54.4%). Odontogenic tumors (OTs) were the most prevalent category of lesions (25.3%, n=149), followed by reactive lesions (12%, n=71). Absolute concordance was recorded for 54.6% (k=0.5) of the cases; with highest concordance observed in fibro-osseous lesions (65.6%, k=0.43), and least in pulp/periapical lesions (3.5%). Concordance was higher in females (59.5%, k=0.53) than males (48.3%, k=0.44). Oral medicine specialists had the highest concordance index (62.5%, k=0.59).

Conclusion

The findings in this research indicate that, on a general note, the degree of concordance between clinical and histopathological diagnosis is poor. Hence, improvement in diagnostic skills (irrespective of clinical specialty) is important to improve treatment outcomes, particularly in LMICs. Continuous personnel training and utilization of advanced diagnostic techniques can potentially help bridge the diagnostic gaps.

The Agreement Rate between Radiographic Interpretation and Histopathologic Diagnosis of Jaw Lesions

Background

To determine the agreement rate between histopathologic diagnosis and radiographic interpretation of jaw lesions.

Methods

Cases with jaw pathologies that have diagnostically adequate histopathologic samples and radiographic examinations were reviewed retrospectively. Two board-certified oral and maxillofacial pathologists (OMFP) independently determined the histopathologic diagnosis, while two board-certified oral and maxillofacial radiologists (OMFR) determined the radiographic interpretations independently. Then the histopathologic diagnosis and the radiographic interpretation were compared for agreement.

Results

A total of 104 cases (53% females) were included with a mean age of 31 years. The agreement rate between histopathologic diagnosis and radiographic interpretation was 49%. OMFP required OMFR consultations to reach a diagnosis in 16% of cases. The most commonly encountered lesions were by far odontogenic cysts of inflammatory origin and the agreement for this disease category was 49.1%. However, agreement rates were highest for the disease category of tumors (62.5%).

Conclusion

The agreement rate between OMFP and OMFR was higher for tumors than cysts. Agreement rates between OMFP and OMFR improved with efficient consultation between the two disciplines.

Demographic Profile of Non-Odontogenic Jaw Lesions in an Iranian Population: A 30-Year Archive Review

OBJECTIVES

The frequency of non-odontogenic lesions of the jawbones is lower than that of odontogenic lesions; however, study of the epidemiologic data of these lesions is required for health care programs. This study aimed to assess the relative frequency and demographic profile of non-odontogenic jaw lesions in an Iranian population over a 30-year period.

MATERIALS AND METHODS

This archive review was performed using demographic and biopsy information of all patients with non-odontogenic lesions of the jawbones submitted to the Oral Pathology Department of Dental School of Tehran University of Medical Sciences from 1984 to 2014. Demographic data included in the study were: age at diagnosis, gender and location of lesion. The lesions were divided into three groups of group 1: cystic lesions, group 2: tumors and tumor-like lesions, and group 3: infectious/inflammatory/reactive lesions. Frequency and clinical data were analyzed using SPSS 22.

RESULTS

Of 972 non-odontogenic jaw lesions, the ratio of mandibular to maxillary lesions was 1.63:1. Female to male ratio was 1.33:1 and the mean age of patients was 29.09±16.90 years. The most common non-odontogenic jaw lesion was central giant cell granuloma (CGCG). In groups 1, 2 and 3, nasopalatine duct cyst, CGCG, and osteomyelitis were the most frequent lesions, respectively.

CONCLUSIONS

Non-odontogenic lesions of the jawbones are a diverse group of lesions with different frequency and behavior. This study demonstrated that tumors and tumor-like lesions of the jaws were more common than cystic and infectious/inflammatory/reactive lesions. Overall, the most common non-odontogenic jaw lesion was CGCG.

Ability of Oral and Maxillofacial Surgery Residents in Diagnosing Jaw Cysts: A Retrospective 20 Years Study

INTRODUCTION

Diagnosis of odontogenic cysts despite of their benign nature is a critical and challenging problem especially among undergraduate and postgraduate students.

AIM

This study aimed to evaluate the capability of oral and maxillofacial surgery residents in diagnosing odontogenic cysts.

MATERIALS AND METHODS

This cross-sectional study was executed on 312 patient records over the past 20 years since October 1995 till December 2014 in Taleghani Hospital, Tehran, Iran. All recorded data was based on 2005 World Health Organization (WHO) classifications. The differential diagnosis was made by 65 residents based on clinical and paraclinical evaluations established in the charts. Differential diagnoses made by the residents were compared to the histopathological examination as the gold standard for identifying the nature of the cysts. Weighted kappa test was used to show the degree of agreement.

RESULTS

Data extracted from 312 records were analyzed. The mean age of examined patients was 27.6 years. The accuracy of diagnosis among the residents was moderate (k_w=0.5). The diagnosis made by the residents was significantly related to the radiographic view of the cysts (p<0.05). The residents were able to identify odontogenic keratocysts and dentigerous cysts in most cases.

CONCLUSION

There are several factors associated with the occurrence of pathologic odontogenic cysts which could help either the clinician or the pathologist in diagnosing the odontogenic cysts of the jaws. The surgeons should consider these related factors before the final diagnosis and choosing the appropriate treatment plan.

Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades

BACKGROUND

Early diagnosis of odontogenic cysts due to their silent progression is always a challenging problem for clinicians.

OBJECTIVES

The current study aimed to evaluate the frequency of odontogenic cysts and related factors in a selected Iranian population.

PATIENTS AND METHODS

The current cross-sectional study was conducted on 312 patients' recorded data in Taleghani Hospital, Tehran, Iran, from April 1993 to December 2013. All related data were extracted from the records and categorized in tables. The correlation between the variables was analyzed by either chi-square or multinominal logistic regression tests. The P values < 0.05 were considered significant.

RESULTS

Evaluation of 312 patients' records (185 males and 127 females) with the mean age of 27.6 showed that Odontogenic Keratocyst (OKC) was the most common odontogenic cyst of all followed by the dentigerous cyst as the second most common lesion. Most of the patients were in the second or third decades of their lives, although there was no statistically significant age distribution. The finding of the current study showed that calcifying odontogenic cyst (COC) occurrence was significantly related to the history of trauma. Enucleation and curettage of the odontogenic cysts were the most common treatment plans of all.

CONCLUSIONS

The current study showed that clinicians should consider the many factors associated with the occurrence of odontogenic cysts.

Oral and maxillofacial pathologies in young- and middle-aged adults

OBJECTIVE

To evaluate the distribution of oral and maxillofacial pathologies (OMFPs) and its association with patient age in young- and middle-aged adults.

METHODS

Distribution of histopathologically diagnosed OMFPs (n = 385) treated during 2007-2010 was recorded and the association with patient age was retrospectively analyzed.

RESULTS

The main diagnostic categories included benign exophytic lesions (45.3%), white benign lesions (13.5%), potentially malignant lesions/disorders (10.1%), intrabony lesions (9.8%), mucosal discoloration (7.8%), benign pigmented lesions (7.3%), chronic trauma/inflammation (3.9%), and oral malignancy (2.1%). Potentially malignant lesions/disorders as a diagnostic category were positively associated with age (OR = 1.07 for 1 year; P < 0.001) and specifically the diagnoses of oral lichen planus (OR = 1.04 for 1 year; P = 0.037) and dysplastic changes (OR = 1.08 for 1 year; P = 0.013) that comprised this category. Pigmented melanocytic lesions were negatively associated with age (OR = 0.94 for 1 year; P = 0.039) as well as benign/reactive exophytic lesions (OR = 0.98 for 1 year; P = 0.038), the latter included the histopathological diagnosis of benign salivary gland pathologies (OR = 0.90 for 1 year; P < 0.001).

CONCLUSION

This study provided baseline information regarding the distribution OMFPs among young- and middle-aged adults. It is important to highlight the high frequency of potentially malignant lesions/disorders and oral malignancy in young- and middle-aged adults, as these lesions require lifelong follow-up.