Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, P.O. Box 80209, Jeddah, 21589, Saudi Arabia.
Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia.
BMC Oral Health. 2023 Jun 9;23(1):378. doi: 10.1186/s12903-023-03085-w.
An error in the diagnosis of an oral or maxillofacial lesion could potentially be detrimental to a patient's prognosis and management. Major discrepancies between the initial and subsequent diagnoses of head and neck pathologies range from 7 to 53%. This study determined the rate of discrepancies found in the diagnoses of oral and maxillofacial lesions after a second opinion in Saudi Arabia.
A retrospective single-center study was conducted by oral and maxillofacial pathology consultants to review all cases referred for a second opinion to the oral and maxillofacial pathology laboratory between January 2015 and December 2020. If the second-opinion diagnosis matched the original diagnosis, this was described as "agreement." If the second-opinion diagnosis did not match the original diagnosis but would not change the management or prognosis of a patient, this was classified as a "minor disagreement." If the second-opinion diagnosis resulted in the changing of a patient's management or prognosis, this was categorized as a "major disagreement." Chi-square test and Fisher's exact test were used to compare data between original and second-opinion diagnoses. A p-value of less than 0.05 was considered significant.
Of 138 cases, 59 (43%) had an initial diagnosis and a second-opinion diagnosis that were in major disagreement. The most common tumor for which there was a major disagreement was squamous cell carcinoma. No single factor influenced the occurrence of major disagreements.
Our evaluation reiterates the importance of obtaining a second opinion from a specialist in oral and maxillofacial pathology to improve the diagnostic accuracy for lesions. A formal system for this step, in addition to the obtaining of adequate clinical and radiographic information about a patient, is mandatory for the review of difficult cases.
口腔或颌面病变的诊断错误可能对患者的预后和治疗产生不利影响。头颈部病变的初始诊断和后续诊断之间存在 7%至 53%的重大差异。本研究旨在确定在沙特阿拉伯进行第二次诊断后，口腔和颌面病变诊断中差异的发生率。
口腔颌面病理顾问进行了一项回顾性单中心研究，以审查 2015 年 1 月至 2020 年 12 月期间向口腔颌面病理实验室转诊的所有病例。如果第二次诊断与原始诊断相符，则描述为“一致”。如果第二次诊断与原始诊断不符，但不会改变患者的治疗或预后，则归类为“次要不一致”。如果第二次诊断导致患者的治疗或预后发生变化，则归类为“主要不一致”。卡方检验和 Fisher 确切检验用于比较原始诊断和第二次诊断之间的数据。p 值小于 0.05 被认为具有统计学意义。
在 138 例病例中，59 例（43%）的初始诊断和第二次诊断存在主要不一致。主要不一致最常见的肿瘤是鳞状细胞癌。没有单一因素影响主要不一致的发生。
我们的评估再次强调了从口腔颌面病理专家那里获得第二次诊断的重要性，以提高对病变的诊断准确性。为了审查疑难病例，除了获取有关患者的充分临床和影像学信息外，还必须建立这一步骤的正式系统。
