UWA Dental School, The University of Western Australia, Nedlands, WA, Australia.
Australian Centre for Oral Oncology Research and Education, Nedlands, WA, Australia.
J Oral Pathol Med. 2021 May;50(5):520-527. doi: 10.1111/jop.13170. Epub 2021 Apr 8.
Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined malignant transformation potential. There have been many attempts at providing a specific definition of OLP without conclusive outcomes. A new set of diagnostic criteria was proposed in 2016 by the American Academy of Oral and Maxillofacial Pathology (AAOMP) in an endeavour to resolve this issue, and this has not yet been evaluated. This study aimed to assess the utility of AAOMP proposed criteria for the diagnosis of OLP.
Five pathologists blindly assessed a cohort of 215 digital whole slide images (WSI) obtained from haematoxylin and eosin-stained microscopic slides. Forty-six WSI were included twice to assess the intra-observer agreement. Included cases were diagnosed clinically as either OLP or oral lichenoid reaction. Each pathologist was asked to utilize the AAOMP histopathological criteria while assessing slides. The variations in diagnoses were assessed by unweighted kappa statistics.
The level of intra-observer agreement was very good (0.801 to 0.899). The level of inter-observer agreement among the observers varied from good (0.658) to very good (0.842) when the responses were categorized as evident/compatible OLP versus no OLP and was good (0.62 to 0.725) when the responses were categorized as evident OLP, versus compatible OLP, versus no OLP. The clinico-pathological correlation was 87.6%.
A reliable level of agreement can be achieved by pathologists for the diagnosis of OLP using the AAOMP criteria for differentiation between lichenoid and other conditions. There are still limitations in discriminating OLP from oral lichenoid lesions microscopically.
口腔扁平苔藓（OLP）是一种常见的慢性炎症性疾病，其恶性转化潜能尚未明确。人们曾多次尝试对 OLP 进行明确定义，但均未得出明确结论。为了解决这一问题，美国口腔颌面病理学会（AAOMP）于 2016 年提出了一套新的诊断标准，但这些标准尚未得到评估。本研究旨在评估 AAOMP 提出的诊断 OLP 的标准的实用性。
五名病理学家对 215 张苏木精和伊红染色显微镜载玻片的数字全玻片图像（WSI）进行了盲法评估。46 张 WSI 被重复评估两次，以评估观察者内的一致性。纳入的病例经临床诊断为 OLP 或口腔扁平苔藓样反应。要求每位病理学家在评估切片时使用 AAOMP 组织病理学标准。通过未加权 kappa 统计评估诊断差异。
观察者内的一致性水平非常好（0.801 至 0.899）。当将反应分为明显/相容 OLP 与无 OLP 时，观察者之间的观察者间一致性水平为良好（0.658）至非常好（0.842），而当将反应分为明显 OLP、相容 OLP、无 OLP 时，观察者间一致性水平为良好（0.62 至 0.725）。临床病理相关性为 87.6%。
病理学家使用 AAOMP 标准区分苔藓样和其他疾病，可实现 OLP 诊断的可靠一致性水平。在显微镜下区分 OLP 和口腔扁平苔藓样病变仍存在局限性。
