1Faculty of Dental Sciences, IMS, BHU, Varanasi, (Uttar Pradesh), India
2Institute of Dental Sciences, Bareilly, (Uttar Pradesh), India
3Institute of Dental Sciences, Bareilly, (Uttar Pradesh), India
4Faculty of Dental Sciences, IMS, BHU, Varanasi, (Uttar Pradesh), India
5General practitioner, Bareilly, (Uttar Pradesh), India
6Department of Oral Pathology and Microbiology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
*Correspondence to: Dr Rahul Agarwal Assistant Professor, Faculty of Dental Sciences, IMS, BHU, Varanasi, (U.P.) Pin- 221005. drahulag@rediffmail.com Phone: 095596-76629.
Background & Objectives: Lichen planus (LP) is fairly distinctive mucocutaneous disease. Clinically diagnosed oral lichen planus (OLP) is usually advised to confirm by means of histopathologic study of biopsy specimen. Studies have reported subjective variability in diagnosing OLP. The purpose of present study was to evaluate interobserver and intraobserver variability in the histopathologic diagnosis of OLP and also to check clinico-pathologic correlation, since these may influence the outcome of studies on epidemiology, treatment and prognosis of OLP.
Methodology: 30 clinically diagnosed patients with OLP (cases) and 30 ‘controls’ with no clinical OLP lesion were included in the study. Biopsy was received from all the 60 patients and microscopic slides were evaluated by two oral pathologists, not being informed about clinical presentation or any patient's data. Each pathologist was asked to apply WHO (1978) definition of OLP to categorize each microscopic slide as either category A (evident OLP), B (compatible with OLP), or C (no histologic support for OLP). After 60 days, both the pathologists were asked to categorize all 60 microscopic slides again in the same manner. Interobserver and intraobserver variability was evaluated by unweighted kappa statistics and clinico-pathologic correlation was assessed.
Results: Interobserver agreement varied from 0.20 to 0.25 (poor) while intraobserver agreement ranged from 0.33 (poor) to 0.53 (moderate). In 20% cases in which clinician agreed about clinical diagnosis being diagnostic of OLP, there appeared tobe no consensus on the histopathologic diagnosis. Conversely, in 22.5% cases in which both the pathologists agreed about histopathologic features being diagnostic of OLP, there was a lack of consensus on the clinical diagnosis.
Conclusion: Histologic assessment of OLP, based on the WHO (1978) definition is a rather subjective and insufficiently reproducible process. Based on the findings of the present study, there appear to be a lack of clinico-pathologic correlation in diagnosisof OLP. Strict diagnostic criteria are required in order to obtain a more reproducible diagnosis of OLP.
