Diagnostic consistency between clinical and histopathologic diagnoses of oral and maxillofacial lesions in a tertiary health facility

Abstract

Background: Clinical features of most oral and maxillofacial lesions are not pathognomonic. Histopathology remains the gold standard for diagnosis. However, some of these patients are treated based on clinical diagnosis without recourse to histopathology.

Objective: To assess the degree of consistency between clinical and histopathologic diagnosis of oral and maxillofacial lesions in a tertiary health facility, South- South, Nigeria.

Method: Clinical information and request forms of patients whose pathology specimen were submitted to the Oral Pathology unit were retrieved. Data was analyzed using SPSS version 23.0 software and comparison was made between the clinical and histopathologic diagnoses. The degree of consistency between the clinical diagnoses and the histopathologic diagnoses was determined using the Cohen’s Kappa statistics by assessing the Kappa coefficient. p-value< 0.05 taken as significance.

Results: A total of 500 cases were retrieved among which were 456 cases with available request forms. Out of the 456 (100%) cases with request forms, 245 (56.1%) had clinical diagnoses and complementary histopathologic diagnoses. Out of the 245 (100%) cases, 136 (55.5%) cases had diagnostic consistency with an overall Cohen’s kappa rating of 0.54 (p=0.000) The benign non- odontogenic tumours had the highest diagnostic concordance, with a kappa value of 0.74, closely followed by the inflammatory lesions (k=0.70). Among the different orofacial sites studied, the highest diagnostic concordance was observed among the pre-auricular lesions (k=0.56). The diagnostic concordance characteristics were similar in both genders (k= 0.54). Among the requesting specialties, Oral Medicine had the highest concordance rate (k=0.56).

Conclusion: The study showed a moderate level of consistency between clinical and histopathologic diagnosis. This emphasizes the need for a confirmatory histopathologic diagnosis before treatment.

Keywords: consistency, concordance, histopathology, clinical diagnosis, kappa rating, oral and maxillofacial lesions