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Histpathologic diagnosis of exophytic lesions is occasionally influenced by clinical and radiograph-ic diagnosis and even the surgeon's observation during biopsy. The aim of this study was to evaluate the cases with failure in clinical diagnosis.
A total of 73 patients with peripheral exophytic lesions were evaluated in Zahedan Faculty of Den-tistr...
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Context 1
... total of 81.7% (62 subjects) of clinical diagnoses were consistent with histopathologic reports. In 18.3% (11 subjects) the clinical diagnosis was not confirmed histopathologically (Table 1). ...
Context 2
... some subjects, this occurs superficially and only from epithelial changes located on the sur- face of submucosal and non-epithelial lesion (pseu- doepithelial hyperplasia) in which the probability of SCC report is high. 10 Improper clinical diagnosis in this investigation was due to similarities between SCC and verrucous carci- noma (7 subjects), pyogenic granuloma and peripheral giant cell granuloma (3 subjects), and finally a periph- eral lesion with irregular surface with a histopa- thologic report of fibroma but clinically misdiagnosed as verrucous vulgaris (Table 1). ...
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... El diagnóstico temprano de las lesiones orales es importante en cuanto a que un tratamiento tardío de una lesión, particularmente premaligna o maligna, puede conducir a serias consecuencias, de ahí la relevancia del examen de la cavidad oral, coadyuvado cuando sea necesario de imágenes u otros exámenes complementarios, para actuar en el momento preciso y confirmar, así, la impresión clínica diagnóstica de una patología, mediante el estudio histopatológico (Kondori et al., 2011;Tatli et al., 2013;Mesadi, 2013;Fattahi et al., 2014;Allen & Farah, 2015;Forman et al., 2015;Mendez et al., 2016;Soyele et al., 2019;Maheshwari & Kharkar, 2020;Boza-Oreamuno & López-Soto, 2020, 2021Navas-Aparicio & Hernández-Rivera, 2021;Farzinnia et al., 2022;Tarakji, 2022), el cual es el estándar oro para definir el diagnóstico definitivo de la lesión, lo que obliga a tener una completa historia médica y dental, un examen de la cavidad oral (inspección, palpación y percusión) y una descripción clínica precisa de la lesión, pues el diagnóstico clínico complementa el diagnóstico histopatológico, conduciendo a que ambas herramientas sean decisivas en patología oral (Tatli et al., 2013;Soyele et al., 2019), y reafirmando que el papel del odontólogo es esencial para ello (Bokor-Bratic´ et al., 2004;Sarabadani et al., 2009;Kondori et al., 2011;Meiller et al., 2012;Sixto-Requeijo et al., 2012;Tatli et al., 2013;Bacci et al., 2014;Fattahi et al., 2014;Allen & Farah, 2015;Forman et al., 2015;Mendez et al., 2016;Azmoodeh et al., 2017;Soyele et al., 2019;Emamverdizadeh et al., 2019;Gbolahan et al., 2019;Maheshwari & Kharkar, 2020;Boza-Oreamuno & López-Soto, 2020, 2021Navas-Aparicio & Hernández-Rivera, 2021;Farzinnia et al., 2022;Tarakji, 2022). ...
... Dicha concordancia entre ambos diagnósticos ha sido evaluada en muchos estudios (Fattahi et al., 2014;Soyele et al., 2019), como por ejemplo el de Forman et al. (2015), que demostraron un 61 % de correspondencia en un grupo de 1003 lesiones y quienes además señalaron que la exactitud diagnóstica cuando se sospechaba de una lesión benigna fue mayor a 95,9 % y cuando correspondía a una lesión premaligna o maligna fue 66,7 %. Fattahi et al. (2014) encontraron un 80,7 % de coincidencia en un grupo de 311 pacientes, Sarabadani et al. (2009) hallaron un 81,7 % en 73 pacientes con lesiones exofíticas, Soyele et al. (2019) mostraron un 54,6 % en 592 biopsias, y Navas-Aparicio & Hernández-Rivera (2021) registraron un 52,6 % en 35 pacientes. ...
... La lesión que presentó mayor frecuencia de congruencia diagnóstica fue la hiperplasia fibrosa focal, pero así aconteció, también, cuando las lesiones no coincidieron en su diagnóstico, sospechando que pudo ser debido a la similaridad de las características clínicas de diferentes lesiones (Sarabadani et al., 2009;Kondori et al., 2011;Tatli et al., 2013;Fattahi et al., 2014;Mendez et al., 2016;Azmoodeh et al., 2017;Maheshwari & Kharkar, 2020;Navas-Aparicio & Hernández-Rivera, 2021;Boza-Oreamuno & López-Soto, 2021;Farzinnia et al., 2022). En comparación a otros estudios, se destacan otras lesiones con mayor congruencia diagnóstica, por ejemplo, liquen plano (Fattahi et al., 2014), ulceración traumática (Forman et al., 2015), mucocele (Maheshwari & Kharkar, 2020), granuloma piógeno (Sarabadani et al., 2009), entre otros. ...
Knowledge of oral pathology and its correct diagnosis is fundamental in Dentistry, since a late diagnosis, particularly in cases of premalignant or malignant lesions, can lead to serious consequences for the patient. The objective of this study was to establish the clinical- histopathological diagnostic consistency of lesions in the oral cavity in patients who attended the Faculty of Dentistry, Universidad de Costa Rica, and who underwent a biopsy of the lesion, during the period 2016-2019. The study was descriptive and retrospective, based on data from histopathological reports in the mentioned population, due to presenting some lesion, soft or hard tissue, in the oral cavity. The statistical sample was for convenience, non- probabilistic nor random. The statistical techniques used were descriptive for the analysis of the information, which was based on frequency distribution and crossing of variables. The statistical processing of the data was designed in a database created in Excel. The sample collects 160 histopathological reports, of which 14 were excluded. The average age of the patients was 42 years (range between 2 - 78 years old).The male:female ratio corresponded to 1:1.4, with a predominance of the female sex at 58.9 %.The congruence of the histopathological diagnosis with the clinical diagnosis corresponded to 55.8 %. Diagnostic consistency demonstrates knowledge of the professional in correctly identifying the lesion clinically, which allows acting at the precise moment and confirming the diagnostic clinical impression of the pathology via histopathological study which is the gold standard. The problem lies in those cases in which there is a diagnostic discrepancy, since it requires having knowledge of the underlying factors and therefore, requires searching for solutions, reinforcing and redirecting the academic training of professionals and students to recognize and describe these lesions.
... Moreover, it is well understood that early detection and treatment of these lesions would greatly lead to the improvement of patients' survival rates and quality of life [4]. Although each oral lesion has di erent characteristics and clinical features aiding in diagnosis, clinical diagnosis errors occur due to the similarities in clinical presentations, lack of precise de nitions for these characteristics, incompatibility of the signs and symptoms in patients, and the presence of multiple manifestations for a lesion [5,6]. erefore, in order to minimize misdiagnoses and to achieve more accurate ones, it is necessary to consider the patients' chief complaints, medical and dental histories' records, clinical manifestations, imaging diagnostic techniques, and various tests like laboratory tests that include biopsies with microscopic evaluations and blood tests [6]. ...
... Although each oral lesion has di erent characteristics and clinical features aiding in diagnosis, clinical diagnosis errors occur due to the similarities in clinical presentations, lack of precise de nitions for these characteristics, incompatibility of the signs and symptoms in patients, and the presence of multiple manifestations for a lesion [5,6]. erefore, in order to minimize misdiagnoses and to achieve more accurate ones, it is necessary to consider the patients' chief complaints, medical and dental histories' records, clinical manifestations, imaging diagnostic techniques, and various tests like laboratory tests that include biopsies with microscopic evaluations and blood tests [6]. Histopathologic examination, which is known as the gold standard in diagnostic oral pathology, is used to con rm the clinical diagnosis [7]. ...
... Moreover, it should not miss any oral potentially malignant disorders (OPMDs) or malignant lesions, and a close collaboration between the clinician and the pathologist is required in this regard, in order to reach a definitive and right diagnosis [2]. Various studies have previously investigated the concordance of clinical and pathologic diagnoses, and as a result, they reported concordance rates of approximately between 50 and 80% [3,[5][6][7][8]. Due to the reported discrepancy in the concordance rates between clinical and histopathological diagnoses in numerous studies performed in various places, the present study aimed to determine the rate of discrepancy between clinical and histopathological diagnoses. ...
Objective:
Proper diagnosis plays a key role in the treatment and prognosis of all diseases. Although histopathological diagnosis is still known as the gold standard, final diagnosis becomes difficult unless precise clinical descriptions are obtained. So, this study aimed to evaluate the concordance of the clinical and histopathological diagnoses of all oral and maxillofacial biopsy specimens in a 12-year duration.
Materials and methods:
Archive files and clinical findings related to 3001 patients who had been referred to the Department of Oral Pathology during a 12-year period were reviewed. The recorded information in files included age, sex, lesion's location, clinical and histopathological diagnoses, and specialty of dentists.
Results:
Out of 3001 cases included and reviewed in this study, 2167 cases (72.2%) were consistent between clinical and histopathologic diagnoses. Age, sex, and clinician's specialty were indicated to have no significant effect on diagnosis (p values = 0.520, 0.310, 0.281, respectively), but location and type of lesion affected that (p values = 0.040 and 0.022, respectively). In regard to location, the highest concordance of clinical and histopathologic diagnoses was observed in mouth floor lesions, and the lowest one was in gingival mucosa. In terms of lesion category, the highest and the lowest concordance rates belonged to white and red lesions and pigmented lesions, respectively.
Conclusion:
The results of the present study show that the consistency of clinical and histopathological diagnoses was three times more than their inconsistency, and the accuracy of the clinicians was largely acceptable.
... A study found a consistency rate of 81.7% between clinical and histopathologic diagnoses of oral soft tissue exophytic lesions and an inconsistency rate of 18.3%. 2 The most likely clinical differential diagnoses in this patient include the most frequent exophytic gingival lesions, namely, pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma. They are considered reactive/ inflammatory hyperplastic lesions resulting from chronic trauma or low-grade injuries/irritation including calculus, dental plaque, bite trauma, fractured tooth, and iatrogenic factors like ill-fitting dentures and insufficient dental restorations. ...
... Estos resultados concuerdan con lo reportado por Vaz y colaboradores (17). Sin embargo, otros estudios han mostrado porcentajes de concordancia del diagnóstico clínico/histopatológicos mayores al 80%, lo que significa una excelente asociación (18). Estas lesiones tumorales no son neoplásicas, pero indican un proceso crónico en el que se produce una reparación exagerada. ...
The objective of this study is to determine the existing concordance between the clinical and histopathological diagnosis of lesions in the oral mucosa at the Faculty of Dentistry of the University of Costa Rica (UCR). A retrospective study of 261 reports of oral lesions recovered from the biopsy archive of the UCR Faculty of Dentistry from 2008 to 2015. Of the total reports 165 were included in the analysis, 96 (36.8%) did not have any diagnostic hypotheses. The concordance between the clinical and histopathological diagnosis was verified by the Kappa test. Concordance with the first diagnostic hypothesis was presented in 114 (69.1%) cases, the value of kappa was 0.663 (substantial agreement) and 36.8% without clinical diagnosis only a description of the lesion. The premalignant lesions presented an excellent concordance (kappa=0.902). The concordance of the group of non-neoplastic proliferative lesions was moderate (kappa=0.504) and the dermatological and autoimmune conditions with negligible concordance (0.157). Concordance occurred in the majority of the patients investigated with a value corresponding to a substantial agreement, however, the percentage of reports that did not have a clinical hypothesis should be improved.
... Hence exact role of the virus in the etiopathogenesis of these lesions is yet unclear. [8,9,10]. ...
... now, breast cancer accounts for 1.3 of all cancers in women and is responsible for 19% of cancer-related deaths. (1,2,3) Like most developing and developed countries, breast cancer is the most common cancer in Iran and is ranked the first in the country, (4,5,6,7). There are totally 40,000 patients in Iran and more than seven thousand are added to this figure annually. ...
... A study in the United States showed that they occurred in almost 27.9% of patients aged ≥17 and in 10.3% of children and adolescents 2-17 years of age [1,2]. Each oral lesion has characteristics and clinical features that help clinicians diagnose them; however, similarities in clinical manifestations, lack of accurate definition of these characteristics, incompatibility of the signs and symptoms in different patients and the presence of different manifestations for a lesion leads to errors in clinical diagnosis [3,4]. ...
... In order to diagnose oral lesions, it is necessary to take into account the patients' chief complaints, medical and dental histories, clinical manifestations, and various tests, including paraclinical tests such as biopsies with microscopic evaluations and blood tests [4]. Microscopic evaluation of biopsies taken from the lesions is the most accurate technique compared to other paraclinical diagnostic techniques; however, in some cases pathologists face ambiguities during histopathological evaluation of lesions because some lesions have similar microscopic views. ...
... Therefore, close cooperation is necessary between the clinician and the pathologist to reach a definitive and correct diagnosis. Wrong diagnosis, for example mistaking an inflammatory lesion such as a radicular cyst for a tumor or an aggressive odontogenic tumor, with subsequent inappropriate treatments, will lead to irreparable damage to patients [4][5][6]. ...
Objective: To determine compatibility between clinical diagnosis and the pathological reports of biopsies from oral lesions. Material and Methods: In this descriptive study, 1146 clinical files of patients referring to Tabriz Faculty of Dentistry from 2004 to 2016 were retrieved and evaluated. The kappa coefficient was calculated for each file for compatibility of clinical and pathological diagnosis. Results: In relation to clinical (40.2%) and pathological (39.2%) diagnosis, irritational lesions of soft tissues exhibited the highest frequency. In 72.3% of cases, the clinical and pathological diagnosis were compatible and in 27.7% of cases these diagnosis were not compatible. The highest compatibility rates were detected for irritational lesions of soft tissues (81.5%) and mucocutaneous lesions (76.9%). There was no compatibility for osseous malignant tumors, inflammatory tissues, granulation tissues, metastatic lesions and hematologic disorders. Conclusion: Approximately one-third of clinical and histopathological diagnosis were not compatible. Therefore, to reach a correct diagnosis, the clinical, radiographic and histopathological views should be evaluated simultaneously. © 2019, Association of Support to Oral Health Research (APESB). All rights reserved.
... In the oral cavity this would be any lesion that projects above the surface of the gingiva or mucosa. 3 Epulis is a descriptive term for a localized exophytic growth on the gingiva and is not a definitive diagnosis. There are two categories of epulides: reactive and peripheral odontogenic tumours but strictly speaking, any growth present on the gingiva may be described as an epulis including malignancies. ...
Peripheral giant cell granuloma is considered rare in the dog with little known about the clinicopathologic features. There are few reports in the veterinary literature concerning this benign, reactive lesion, formerly known as giant cell epulis. In humans, the four most commonly described reactive epulides are focal fibrous hyperplasia (fibrous epulis), pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma. This case report describes the diagnosis and surgical management of a peripheral giant cell granuloma in a dog.
Swellings of the oral mucosa can occur due to accumulation of fluid (e.g. saliva, pus og oedema) or due to soft tissue enlargement. Soft tissue enlargements can be non-neoplastic or neoplastic. Non-neoplastic swellings are most common, and
are often reactive, irritation-induced hyperplasias (e.g. the pyogenic granuloma and focal fibrous hyperplasia). They can also be related to systemic diseases, medication-intake or of developmental origin. Infection with human papilloma-virus
can lead to development of papillomas, and mucocele can occur due to trauma to salivary gland tissue. Swellings may be seen in Crohn’s disease in terms of mucosal tags with granulomatous inflammation. Gingival hyperplasias are the most common drug-induced swellings. The neoplastic swellings are characterized by abnormal and uncontrolled growth of tumor cells, and can be benign (e.g. fibroma) or malignant (e.g. fibrosarcoma) tumors. Neoplasias occur less frequently, but are important differential diagnoses. Reactive hyperplasias can be difficult to distinguish clinically from actual neoplasias. The excised tissue should therefore always be examined histologically for final verification of the diagnosis. The different oral mucosa tumors can also be difficult to separate clinically. A biopsy is therefore required and obviously crucial for further treatment. It is important for dentists to have insight in the different types of oral mucosa swellings in order to make relevant clinical tentative diagnoses, and to know when there is a basis for biopsy and further referral to a specialist within the field. This article reviews the most common swellings of the oral mucosa and relevant differential diagnostic considerations.
Background: Proper diagnosis plays key roles in the treatment and prognosis of all diseases. Although histopathological diagnosis is still known as the gold standard, final diagnosis becomes difficult unless precise clinical descriptions are obtained. So, this study aimed to evaluate the consistency of the clinical and histopathological diagnoses of all oral and maxillofacial biopsy specimens in a 12–year duration.
Methods: After receiving the ethical approval from Shiraz University of Medical Sciences, archive files and clinical findings related to 3001 patients who had been referred to the Department of Oral Pathology during a 12-year period, were reviewed. The recorded information in files included age, sex, lesion’s location, clinical and histopathological diagnoses, and specialty of dentists.
Results: Out of 3001 cases included and reviewed in this study, 2167 cases (72.2%) were consistent between clinical and histopathologic diagnoses. The highest frequency of oral lesions was found in the mandibular bone and the lowest one was in the floor of mouth. Age, sex, and clinician’s specialty were indicated to have no significant effect on diagnosis (p> 0.05), but location and type of lesion affected that (p <0.05). In regard to location, the highest consistency of clinical and histopathologic diagnoses was observed in mouth floor lesions and the lowest one was in gingival mucosa. In terms of lesion category, the highest and the lowest consistency rates belonged to white and red lesions and pigmented lesions, respectively.
Conclusions: The results of the present study show that the consistency of clinical and histopathological diagnoses was three times more than their inconsistency, and the accuracy of the clinicians was largely acceptable.
