Identifying factors associated with diagnostic concordance/discordance in oral lichen planus.

PURPOSE: To identify factors associated with concordance and discordance between clinical and histopathologic diagnoses of oral lichen planus lesions. MATERIALS AND METHODS: A retrospective analysis was conducted on all study cases derived from archival oral pathology reports generated from all cases of oral lichen planus accessioned by the Faculty of Dentistry, University of Malaya. These study cases were diagnosed from January 1980 through December 2010. Predictor variables were diagnosis year, demographics, experience of the examiner, clinical appearance and diagnosis, and final histopathologic diagnosis; these were recorded for each study case. The outcome variable was agreement between the clinical and histopathologic diagnoses, and this was classified as concordant or discordant. Descriptive statistics and multiple linear regression analyses were computed to identify associations between predictors and outcomes. Statistical significance was set at P ≤ .05. RESULTS: The sample was composed of 441 study cases with 593 oral mucosal lesions that met the inclusion criteria. The mean age of the sample was 47.5 ± 13.07 years (range, 12 to 82 yr) and 64.4% were female. The mean concordance was 83.2%. Diagnosis year and demographics showed no influence on concordance or discordance. The multiple linear regression model included experience of the examiner, clinical appearance and diagnosis, and final histopathologic diagnosis (R(2) = 0.82). Except for experience of the examiner (P = .12), clinical appearance and diagnosis and final histopathologic diagnosis were the variables statistically associated with concordance (P ≤ .01). CONCLUSIONS: The present results suggest that concordance is governed primarily by the clinical appearance and diagnosis of the lesion and the final histopathologic diagnosis.

Neoplasia/dysplasia surveillance of oral lichen planus in Malaysia: a preliminary study using topography maps.

BACKGROUND: Conventional methods for writing case notes detailing the progress of oral lichen planus (OLP), a precancerous condition that requires long-term surveillance, is both time-consuming and tedious for the busy clinician. OBJECTIVES: To design and perform a simple surveillance on OLP patients based on colour-coded topography mouth maps (TMM). MATERIALS AND METHODS: Three colour-coded TMM were employed: red for OLP in high risk oral mucosal sites, yellow for cases showing improvement and green for asymptomatic lesions at each recall visit. In this preliminary study, these were applied on 30 histologically confirmed OLP individuals attending the Oral Medicine Clinic at the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya. The sites and extent of OLP lesions were charted on either red, yellow or green TMM based on defined criteria. This surveillance evaluated OLP in relation to patientandapos;s age, race, gender, underlying systemic conditions, oral habits, initial onset of OLP, oral manifestations and presence/absence of clinically suspicious areas. RESULTS: Study sample comprised 4 (13.3%) Malays, 9 (30.0%) Chinese and 17 (56.7%) Indians. Most OLP patients belong to the green TMM (n= 14, 46.6%) group followed by red (n= 11, 36.7%) and yellow (n= 5, 16.7%) groups. Of the 11 cases with red TMM, rebiopsy was performed on 4 cases but no dysplasia was detected. Any local confounding factors namely periodontal disease or faulty dental restorations were managed accordingly. CONCLUSIONS: TMM is simple to use and aided the clinicians in terms of time saving and patient management. Hence, follow-up of OLP patients can be carried out more efficiently and appropriately. TMM can be used for surveillance of other oral precancerous lesions and conditions.