Potentially malignant epithelial oral lesions: discrepancies between clinical and histological diagnosis

Abstract

OBJECTIVE: To evaluate the discrepancy index between the clinical and histological diagnosis and the prevalence of epithelial dysplasia and carcinoma in 45 patients with potentially malignant epithelial oral lesions (PMEL).PATIENTS AND METHODS: We submitted 45 patients with PMEL to clinical examination and obtained a biopsy from each. The results of histological diagnosis were compared to the clinical diagnosis. RESULTS: Clinical diagnosis showed that the most common PMEL was leukoplakia followed by lichen planus and by actinic cheilitis associated with leukoplakia. The most common site was the buccal mucosa. Histological diagnosis revealed that 46.7% of the PMEL were lichen planus. The discrepancy index between clinical and histological diagnosis was 24.4%. The higher discrepancy index occurred among leukoplakias. The prevalence of epithelial dysplasia and carcinoma was 17.8%. CONCLUSIONS: We conclude that all PMEL should be submitted to a microscopic analysis because the discrepancy between clinical and histological diagnosis was present in a quarter of these lesionS. Otherwise, the epithelial dysplasia and carcinoma were more frequent in the leukoplakias.

Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions

“…38 The high degree of accuracy and high positive and negative predictive values (81.9% and 98.9%, respectively) for clinical diagnosis of PMD and malignant lip lesions in this study reflect clinicians' ability to discern the nature of these cases correctly. The overall accuracy and sensitivity of clinical diagnosis found in this study are greater than reported in previous studies, 20,26 but this difference must be interpreted with caution, given that our sample included only lip lesions. On the other hand, the sensitivity of clinical diagnosis of malignant lesions and disorders of epithelial maturation separately was lower (57% and 52%, respectively).…”

“…Microscopic evaluation is understood to be required to establish the final diagnosis and, thus, the appropriate treatment in all cases of PMD and malignant lesions. 19,20 In many clinical cases, the lines dividing diagnoses of benign, PMD, and malignant lesions are very thin; clinicians face the challenges of formulating diagnostic hypotheses and predicting which PMD lesions will progress to malignancy. 33 A recent systematic review assessed the diagnostic accuracy of adjunctive tests combined with oral examination for oral cancer; due to the overall poor quality of studies included, the authors failed to identify a replacement for biopsy and histological assessment for final diagnosis.…”

“…However, oral examination alone is not sufficient for the detection and accurate distinction of benign, PMD, and malignant lesions. 19,20 Clinical screening followed by histopathological analysis is crucial, given the estimated annual number of new lip cancer cases worldwide and the wide range of lesions that occur in this location. 21,22 Biopsy, paired with clinical examination, is recommended for final diagnosis; in addition, this approach is recommended when lesions persist despite treatment or the removal of local irritants (of traumatic or inflammatory origin), when lesions do not recede in 2 weeks, when malignancy is suspected, and when lesions interfere with function or impair aesthetics.…”

Prevalencia de lesiones mucosas en población anciana de la Región de Murcia

“…Las diferencias encontradas en los diversos estudios pueden ser debidas a la distinta metodología utilizada, al tamaño y selección de la muestra, a la variabilidad interexaminador, experiencia del explorador así como al número de indicadores usados en su diagnostico (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Nanotechnology-based drug delivery systems for treatment of oral cancer: a review

“…Diagnostic confirmation is only possible by biopsy and histopathological analysis prior to treatment [22][23][24][25][26][27][28] with possible prior cytological evidence, [29][30][31] and lengthy and expensive diagnostic investigations that only delay the initiation of treatment should be avoided. Nevertheless, the delay in the diagnosis of oral cancer has resulted in increasing the time to treatment initiation and a consequent decrease in the survival rate of patients.…”