Jolehar Maryam, Mohseni Roghieh, Farhadi Sareh
Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
Int J Prev Med. 2021 Sep 29;12:126. doi: 10.4103/ijpvm.IJPVM_566_18. eCollection 2021.
Oral lichen planus (OLP) is a relatively common chronic autoimmune disease. In the present study, we tried to correlate the histopathological criteria of WHO and modified WHO (mod.WHO) classification systems using two methods, namely, intraobserver and interobserver observations in these samples.
This cross-sectional study was performed on 64 microscopic slides with the diagnosis of the OLP lesions, based on both clinical and histopathological features. At first, each pathologist individually (as intraobserver) examined microscopic slides based on both histopathologic diagnostic criteria. Later, three pathologists in a group (as interobserver) reevaluated microscopic slides 2 months later in the second phase of the study, based on both systems. Eventually, the findings were statistically analyzed with Cohen's kappa coefficient (κ) and reported.
According to the results, the lichen planus was detected in 8 cases using the WHO method, and in 41 cases using the Mod.WHO method. Intrarater Kappa coefficients were κ = 0.114, = 0.299; κ = 0.181, = 0.012; and κ = 0.062, = 0.424 for three pathologists, respectively. The findings showed no reproducibility (κ = 0.148, = 0.024) and there was no correlation between the two systems. Statistical analysis revealed that the histopathological criteria of the WHO classification for detecting the lichen planus microscopy were more sensitive but the Mod.WHO classification criteria were more specific for detecting the lichen planus.
Due to the higher specificity of the histopathological criteria of Mod.WHO classification rather than WHO classification, it seems that Mod.WHO classification has more important and useful criteria for histopathological diagnosis. Finally, we can conclude that the use histopathologic criteria of the Mod.WHO classification is more useful in the diagnosis of lichen planus, although it should be in combination with clinical information.
口腔扁平苔藓（OLP）是一种相对常见的慢性自身免疫性疾病。在本研究中，我们尝试使用两种方法，即对这些样本进行观察者内和观察者间观察，来关联世界卫生组织（WHO）和改良世界卫生组织（mod.WHO）分类系统的组织病理学标准。
本横断面研究基于临床和组织病理学特征，对64张诊断为OLP病变的显微切片进行。首先，每位病理学家单独（作为观察者内）根据两种组织病理学诊断标准检查显微切片。之后，在研究的第二阶段，三名病理学家组成一组（作为观察者间）在2个月后根据这两种系统重新评估显微切片。最终，用科恩卡方系数（κ）对结果进行统计学分析并报告。
根据结果，使用WHO方法在8例中检测到扁平苔藓，使用mod.WHO方法在41例中检测到扁平苔藓。三位病理学家的观察者内卡方系数分别为κ = 0.114，= 0.299；κ = 0.181，= 0.012；κ = 0.062，= 0.424。结果显示无重复性（κ = 0.148，= 0.024），且两种系统之间无相关性。统计分析表明，WHO分类的组织病理学标准在检测扁平苔藓显微镜检查方面更敏感，但mod.WHO分类标准在检测扁平苔藓方面更具特异性。
由于mod.WHO分类的组织病理学标准比WHO分类具有更高的特异性，似乎mod.WHO分类在组织病理学诊断方面具有更重要和有用的标准。最后，我们可以得出结论，尽管应结合临床信息，但使用mod.WHO分类的组织病理学标准在扁平苔藓的诊断中更有用。
