van der Meij E H, Schepman K P, Plonait D R, Axéll T, van der Waal I
Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry Amsterdam (ACTA)/Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
J Oral Pathol Med. 2002 Feb;31(2):95-8. doi: 10.1046/j.0904-2512.2001.00174.x.
In 1978, a clinical definition of OLP was formulated by the WHO. To date, the validation results of this clinical definition have not been published. The aim of this study was to evaluate interobserver and intraobserver variability in the clinical assessment of oral lichen planus (OLP).
Four clinicians examined a set of 159 clinical pictures of a white lesion in a group of 60 patients. Each reviewing examiner was asked to apply the WHO definition of OLP from 1978, and to categorise each case as either: (i) diagnostic of OLP, (ii) other definable lesion, or (iii) leukoplakia. After three months, each of the four reviewing clinicians was given the clinical pictures of 45 randomly retrieved cases from the original 60. Interobserver and intraobserver variability were assessed by calculation of unweighted kappa statistics.
Interobserver agreement varied from 0.43 (moderate) to 0.77 (substantial), while the intraobserver agreement varied from 0.62 (substantial) to 0.92 (good).
Although the clinical WHO definition of OLP seems to be more reproducible than the histopathological one, there is still a significant amount of subjectivity in using this definition. A set of clinical and histopathological diagnostic criteria with good interobserver and intraobserver agreements (kappa values > 0.8) is very important in enabling reproducible and reliable studies on OLP to be performed.
1978年，世界卫生组织（WHO）制定了口腔扁平苔藓（OLP）的临床定义。迄今为止，该临床定义的验证结果尚未发表。本研究的目的是评估口腔扁平苔藓（OLP）临床评估中的观察者间和观察者内变异性。
四名临床医生检查了一组60例患者的159张白色病变临床图片。要求每位审阅检查者应用1978年WHO的OLP定义，并将每个病例分类为：（i）OLP诊断，（ii）其他可定义病变，或（iii）白斑。三个月后，四名审阅临床医生中的每一位都收到了从最初的60例中随机抽取的45例病例的临床图片。通过计算未加权kappa统计量来评估观察者间和观察者内变异性。
观察者间一致性从0.43（中等）到0.77（实质性）不等，而观察者内一致性从0.62（实质性）到0.92（良好）不等。
虽然WHO的OLP临床定义似乎比组织病理学定义更具可重复性，但使用该定义仍存在大量主观性。一套具有良好观察者间和观察者内一致性（kappa值>0.8）的临床和组织病理学诊断标准对于开展关于OLP的可重复且可靠的研究非常重要。
