Mutalik Sunil, Mutalik Vimi S, Pai Keerthilatha M, Naikmasur Venkatesh G, Phaik Khoo Suan
Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry, International Medical University , Jalan Jalil Perkasa, Kuala Lumpur, Malaysia .
Professor and Head, Department of Oral Medicine and Radiology, MCODS , Manipal, India .
J Clin Diagn Res. 2014 Aug;8(8):ZC04-7. doi: 10.7860/JCDR/2014/8717.4659. Epub 2014 Aug 20.
Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient's initial visit.
Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination.
A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia.
The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.
口腔白斑是一种口腔潜在恶性疾病。由于存在发育异常改变而有恶变可能的白斑在临床上可能无法与无发育异常的白斑区分开来。本研究旨在评估活检在患者初诊时评估口腔白斑临床病理相关性的作用。
对临床诊断为口腔白斑的医院记录进行回顾性分析。所有这些患者在初诊时均接受了活检。组织病理学切片由一名病理学家进行复查并报告。如果临床诊断与组织病理学诊断相符，则认为存在诊断一致性。如果临床诊断与组织病理学诊断不相符，则认为是误诊，而当组织病理学检查发现恶性肿瘤时则认为是漏诊。
共有115例患者临床诊断为口腔白斑。根据白斑斑块的临床表现分为三种类型，即均质型白斑（n = 24，即20.87%）、斑点型白斑（n = 76，即66.08%）和疣状白斑（n = 15，即13.04%）。组织病理学检查在88例中证实了临床诊断（诊断一致性为76.52%）。19例的组织病理学检查显示诊断不同，因此归类为误诊（占16.52%），8例有意外的恶性肿瘤，占漏诊病例的6.96%。在组织病理学确诊的白斑病例中，45例（51.13%）有发育异常。
可疑白色病变的临床表现并不能反映其疾病状态的真实性质，可能会漏诊恶性变化。
