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Consistency Rates of Clinical and Histopathologic Diagnoses of Oral Soft Tissue Exophytic Lesions

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Javad Sarabadani at Mashhad University of Medical Sciences
Javad Sarabadani
Maryam Ghanbariha
Maryam Ghanbariha
Maryam Ghanbariha
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Saeedeh Khajehahmadi at Mashhad University of Medical Sciences
Saeedeh Khajehahmadi
Masoumeh Nehighalehno
Masoumeh Nehighalehno
Masoumeh Nehighalehno
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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-tistry in 2006. Specialists gave their differential diagnoses based on the criteria of oral medicine texts. Then a biopsy was taken and the histopathologic diagnosis was determined. Finally, consistency rates of clinical and histopathologic diagnoses were de-termined. Statistical analysis was carried out with SPSS software using Chi-Square and Fisher's exact tests. In the present study 73 subjects with oral soft tissue (peripheral) exophytic lesions were orally examined and biopsies were taken. Forty-four subjects (60.35%) were females and 29 (39.7%) were males. A total of 81.7% (62 subjects) of clinical diagnoses were consistent with histopathologic reports. In 18.3% (11 subjects) of the cases clinical diagnoses were not con-firmed by histopathologic reports. In order to reach a diagnostic agreement, conformity of clinical and histopathologic diagnoses is necessary.
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Consistency Rates of Clinical and Histopathologic Diagnoses of Oral Soft Tissue Exophytic Lesio
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Journal of
Dental Research, Dental Clinics, Dental Prospects
Original Article
Introduction
he oral cavity and jaws can be the location of
many diseases including exophytic lesions with a
prevalence of 25.8%,
1
which may arise from osseous
(central) or extraosseous (peripheral) tissues. The term
exophytic lesion means any pathologic growth that
projects above the normal contours of the oral sur-
face.
2
Exophytic lesions are often difficult to diagnose
clinically due to different histopathologic processes,
which can lead to similar lesions. For example, tumors
appear similar to cysts, hyperplasia similar to tumors,
and benign tumors similar to malignant types.
For correct diagnosis obtaining medical history,
Consistency Rates of Clinical and Histopathologic Diagnoses of
Oral Soft Tissue Exophytic Lesions
Javad Sarabadani
1*
• Maryam Ghanbariha
2
• Saeedeh Khajehahmadi
3
• Masoumeh Nehighalehno
4
1
Assistant Professor, Department of Oral Medicine, Faculty of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2
Assistant Professor,
Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
3
Assistant, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
4
Dentist, Private Practice, Mashhad, Iran
*
Corresponding Author; E-mail: j.sarabadani@gmail.com
Received: 23 January 2009; Accepted: 13 June 2009
J Dent Res Dent Clin Dent Prospect 2009; 3(3):86-89
This article is available from:
http://dentistry.tbzmed.ac.ir/joddd
© 2009 The Authors; Tabriz University of Medical Sciences
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
http://creativecommons.org/licenses/by/3.0), which
p
ermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A
bstract
B
ack
g
round and aims. Histpathologic diagnosis of exophytic lesions is occasionally influenced by clinical and radio-
graphic diagnosis and even the surgeon’s observation during biopsy. The aim of this study was to evaluate the cases with failure
in clinical diagnosis.
M
aterials and methods. A total of 73 patients with peripheral exophytic lesions were evaluated in Zahedan Faculty of Den-
tistry in 2006. Specialists gave their differential diagnoses based on the criteria of oral medicine texts. Then a biopsy was taken
and the histopathologic diagnosis was determined. Finally, consistency rates of clinical and histopathologic diagnoses were de-
termined. Statistical analysis was carried out with SPSS software using Chi-Square and Fisher’s exact tests.
R
esults. In the present study 73 subjects with oral soft tissue (peripheral) exophytic lesions were orally examined and biopsies
were taken. Forty-four subjects (60.35%) were females and 29 (39.7%) were males. A total of 81.7% (62 subjects) of clinical
diagnoses were consistent with histopathologic reports. In 18.3% (11 subjects) of the cases clinical diagnoses were not con-
firmed by histopathologic reports.
Conclusion.
In order to reach a diagnostic agreement, conformity of clinical and histopathologic diagnoses is necessary.
K
e
y
words: Clinical diagnosis, exophytic lesion, histopathologic diagnosis.
T
JODDD, Vol. 3, No. 3 Summer 2009
Clinical Diagnosis Consistency with Histopathologic Diagnosis 87
dental history and physical examination of the oral
cavity (inspection, palpation, percussion and ausculta-
tion) are necessary.
3
Although the histopathologic di-
agnosis is the basis of treatment for most lesions,
comprehensive radiographic and clinical evaluation is
required to reach a definite diagnosis.
4,5
However, occasionally, a surgeon does not obtain
the specimen from a proper level; therefore, the nature
of the lesion cannot be identified. In such cases, bi-
opsy should be taken from the deeper parts of the le-
sion.
4
Similarities in clinical, radiographic and micro-
scopic characteristics of some oral exophytic lesions
give rise to some difficulties in the proper diagnosis of
exophytic lesions. The aim of the present study was to
evaluate the cases with failure in clinical diagnoses.
Materials and Methods
In this descriptive cross-sectional study, 73 patients
with peripheral exophytic lesions were evaluated in
the Department of Oral Medicine, Faculty of Den-
tistry, Zahedan University of Medical Sciences, in
2006.
The sample size in this study was estimated accord-
ing to the ratio estimation in a community. In addi-
tion, preliminary studies showed that on average 7
patients suffering from peripheral exophytic lesions
were referred to Zahedan Faculty of Dentistry every
month. Therefore, 73 patients with peripheral oral ex-
ophytic lesions were evaluated in this study, consider-
ing P = 0.5, α = 0.05, and d = 0.1. Specialists gave
their differential diagnoses based on the criteria of
oral medicine references. Moreover, if necessary,
laboratory tests, aspirations, and occasionally com-
plementary radiographs were taken from each subject.
After biopsy, the specimens were sent to the Oral
Pathology Department at Zahedan Faculty of Den-
tistry for histopathologic diagnosis. Then the consis-
tency rates for clinical diagnosis were defined by
histopathologic diagnosis (gold standard). Statistical
analysis was carried out with SPSS software, using
Chi-Square and Fisher’s exact tests.
Results
In the present study 73 subjects with oral soft tissue
(peripheral) exophytic lesions were evaluated; 44 sub-
jects were females (60.3%) and 29 were males
(39.7%). The subjects were orally examined and biop-
sies were taken. Female subjects were 8-80 years old
(with a mean age of 32) and male subjects were 5-80
years old (with a mean age of 43).The duration of le-
sions in females was between 14 days and 5 years
(mean = 10 months) and in males between 21 days
and 10 years (mean = 16 months).
A 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).
The greatest consistency was observed for pyogenic
granuloma (22 cases), whereas squamous cell carci-
noma (SCC) and verrucous carcinoma (7 cases) re-
vealed the least consistency.
Discussion
The aim of this study was to identify the cases with
failure in clinical and histopathologic diagnoses.
In the present study histopathologic diagnoses con-
firmed initial clinical diagnoses in 62 (81.7%) but did
not do so in 11(18.3%) subjects.
Oral medicine focuses on diagnosis and treatment of
oral soft tissue lesions and represents the clinical arm
of oral pathology while oral pathology deals with mi-
croscopic diagnosis of oral maxillofacial lesions.
6
There are not any exactly similar studies. However,
Sardellah et al
7
compared the accuracy rates of oral
medicine prior to referring the patients with histopa-
thologic diagnoses to an Oral Medicine Department. It
was a retrospective investigation on the patients’ re-
ferral forms from 2005 to 2007, conducted by family
physicians with no dental degree, other categories of
physicians, and general dental practitioners. Of 678
Table 1. Subjects whose clinical diagnosis was not confirmed by histopathologic report
Clinical Diagnosis Histopathologic Diagnosis Location
1
Verrucous Vulgaris
Irritation Fibroma Maxillary Facial Gingiva
2
Verrucous Carcinoma Squamous Cell Carcinoma (SCC) Floor of the Mouth
3
Peripheral Giant Cell Granuloma (PGCG) Pyogenic Granuloma (PG) Mandibular Gingiva
4
Verrucous Carcinoma SCC Mandibular Gingiva
5
Verrucous Carcinoma SCC Maxillary Facial Gingiva
6
PG PGCG Buccal Mandibular Gingiva
7
Verrucous Carcinoma SCC Maxillary Gingiva
8
PGCG PG Maxillary Gingiva
9
SCC Verrucous Carcinoma Mandibular Gingiva
10
SCC Verrucous Carcinoma Lower Lip
11
Verrucous Carcinoma SCC Mandibular Gingival
JODDD, Vol. 3, No. 3 Summer 2009
88 Sarabadani et al.
subjects, 305 (45%) had clinical diagnoses and no ra-
diographic diagnoses of lesions had been given. Fi-
nally, it was purported that Italian physicians and den-
tists had limited information in oral medicine field.
7
Deihimi et al
3
worked on old files in a retrospective
study in which only the title was somehow similar to
this study. Thirty-four of them did not have definite
clinical or histopathologic diagnosis. In fact, only the
accuracy rates of clinical diagnoses with histopa-
thologic diagnoses were consistent, although the au-
thors did not mention the types of misdiagnosis and
the reasons for that.
Sometimes there are controversies over definite
pathologic reports among oral pathologists, which
lead to difficulties in treatment planning.
Abbey et al
8
evaluated 6 dentists on the Oral Pa-
thology Board in order to determine the histologic
diagnoses of 120 oral specimens. Their diagnoses var-
ied from simple hyperkeratosis to severe dysplasia.
The agreement, when final diagnosis was mild to
moderate dysplasia, was only 50.5% while these pa-
thologists gave only a 50.8% approval in their re-
investigations. Approximately in 20% of the subjects,
pathologists could not confirm their previous opinions
regarding presence of dysplasia.
8
Powsner et al
9
showed surgeons had an improper
concept from pathology reports in 30% of the cases.
Surgical experience and better cooperation between
surgeons and pathologists reduce this gap.
Basically, the ideal to reach a final diagnosis de-
pends on the evaluation of all the clinical and radio-
graphic findings and histopathology of the lesion,
leading to a diagnostic agreement, acceptable to all.
Clinical diagnosis of some exophytic lesions neces-
sitates radiographic interpretation. It is followed by
removal of bone from the upper layer of the lesion for
biopsy by a surgeon and determining its exact location
and nature. In 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).
It has also been reported in other studies that there
are many similarities among exophytic lesions. Such
similarities can be seen in comparing with SCC and
verrucous carcinoma, pyogenic granuloma and pe-
ripheral giant cell granuloma, respectively.
In a well-developed case of verrucous carcinoma,
the clinical pathologic diagnosis is relatively easy to
understand.
11
A differential diagnosis would also in-
clude papillary squamous cell carcinoma which re-
sembles verrucous carcinoma.
11
Verrucous carcinoma,
which is characterized by a bulbous growth that
pushes into the underlying stroma rather than invading
it, is typical of SCC.
12
It is a low-grade variation of
SCC.
13,14
Interestingly, in about 20% of the cases, histopa-
thologically identifiable foci of SCC occur within a
lesion that look otherwise like a verrucous carcinoma.
These hybrid (verrucous-squamous) tumors are said to
be associated with a higher recurrence rates than pure
verrucous carcinomas.
3
Peripheral giant cell granuloma is, for all practical
purposes, a site-specific variant of pyogenic granu-
loma (Figure 1).
13
Generally, this lesion is clinically
indistinguishable from a pyogenic granuloma and bi-
opsy findings are definitive in establishing the diagno-
sis.
11
Therefore, 98.85 (72 subjects) of clinical diag-
noses were consistent with histopathologic reports and
in 1.3% (1 subject) the clinical diagnosis was not con-
firmed histopathologically.
b
Figure 1. (a) P
y
o
g
enic
g
ranuloma: clinical dia
g
nosis was
peripheral giant cell granuloma. (b) Peripheral giant
cell
g
ranuloma: clinical dia
g
nosis was p
y
o
g
enic
granuloma.
JODDD, Vol. 3, No. 3 Summer 2009
Clinical Diagnosis Consistency with Histopathologic Diagnosis 89
Conclusion
The clinical, radiographic, and histopathologic simi-
larities between various oral and jaw exophytic le-
sions sometimes make the diagnostic agreement im-
possible. Moreover, expert specialists can arrive at the
best treatment plan when considering the importance
of lesion characteristics. According to some failures
reported in clinical diagnosis, attention to details in
clinical examination and taking history is recom-
mended to reach a correct diagnosis.
Acknowledgement
This study was supported in part by a grant from the
Vice Chancellor for Research of Zahedan University
of Medical Sciences.
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JODDD, Vol. 3, No. 3 Summer 2009
... 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. ...
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Full-text available
  • Nov 2020
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.
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... 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. ...
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Non-neoplastiske og neoplastiske hævelser i mundslimhinden/Non-neoplastic and neoplastic swellings in the oral mucosa
Article
Full-text available
  • Oct 2023
  • Tandlaegebladet
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.
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Correlation Between Clinical and Histopathological Diagnoses in Oral Cavity Lesions: a 12-year Retrospective Study
Preprint
Full-text available
  • Sep 2021
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.
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Evaluation of the Effect of Different Herbal Tea on Discoloration of Different Kinds of Composite
Article
Full-text available
  • Sep 2016
Objectives: The aim of this study was to evaluate the effect of six herbal teas on the color stability of two types of nanohybrid and one microhybrid resin composite. Materials and Methods: 70 disc-shaped specimens, 210 in total (7*2mm), were fabricated from each of the following materials in metal mould : Tetric N ceram, Grandio, Gradia Direct Anterior. Specimens were stored in distilled water at 37°C for 24 hours in an incubator for completion of polymerization. After baseline evaluation (L*, a*, b*CIELAB scale), the specimens were divided into seven subgroups, according to the test and control storage solutions (n=10). Randomly selected specimens from each material were immersed in 20 ml of the test solutions (Borago, Green, Hibiscus, Thyme, Black and Lemon Verbena teas) at 37˚c for 24 hours and 48 hours. Solutions were refreshed every 24 hours. All samples were polished using Soflex discs with Medium, Fine, Superfine grit after storage in herbal teas. Specimens color was measured in 24, 48 hours and after polishing. The collected data was statistically analyzed using two-way analysis of variance with repeated measure and Tukey’s HSD at a significance level of 0.05. Results: All samples displayed color changes after immersion in the herbal teas. Hibiscus tea induced the highest level of discoloration after 24 hours immersion in all three composites. Black tea induced highest level of discoloration in (Grandio ΔE=7.44). Hibiscus tea and Thyme tea induced highest level of discoloration in (Tetric N ceram ΔE=11.) and (Gradia Direct ΔE=14.11), respectively, after 48 hours immersion. The least discoloration was found with Borage tea in 24 and 48 hours. After re-polishing the color change was reduced. Grandio showed the greatest color reduction in Black tea. Color improvement of Tetric N ceram was better than Gradia Direct. Conclusion: All tested restorative materials showed a color shift after immersion in herbal teas, which Tetric N ceram displayed the highest color change in Hibiscus tea and Borago tea induced lowest discoloration on Grandio after 24 h immersion. Thyme tea induced the highest level of discoloration on Gradia Direct and least discoloration was found in Borago tea on Grandio after 48 hours immersion.
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Differential Diagnosis in Surgical Pathology
Book
  • Jan 2010
Differential Diagnosis in Surgical Pathology, 2nd Edition, by Paolo Gattuso, MD, Vijaya B. Reddy, MD, Odile David, MD, and Daniel J. Spitz, MD, is skillfully designed to help you confidently sign out your most complex and challenging cases. Covering a complete range of tumors and tumor-like conditions in all organ systems, it provides a user-friendly road map to the main criteria you should consider in order to differentiate between a variety of potential diagnoses that all have a very similar appearance. Over 1,350 new full-color macro- and microphotographs provide a realistic basis for comparison to what you see under the microscope. Quick checklists cover all diagnostic possibilities to make sure nothing falls through the cracks. Full-text online access at expertconsult.com allows you to reference the book from any computer and download all of its images. A concise, bulleted textual format facilitates quick retrieval of essential facts. A consistent approach to diagnosis and interpretation expedites reference. Coverage of all relevant ancillary diagnostic techniques addresses all of the investigative contexts needed to formulate an accurate diagnosis. Expert "pearls" offer practical tips on what diagnostic criteria to consider or exclude. A comprehensive, yet manageable size allows for quick consultation. Online access at expertconsult.com allows you to quickly consult the book from any computer and download all of its images. Over 1,350 new full-color macro- and microphotographs provide a realistic basis for comparison to what you see under the microscope. Immunohistochemical and molecular techniques throughout enable you to review all of the latest diagnostic considerations in one place. Expanded coverage of non-neoplastic entities assists you in recognizing benign lesions that may mimic the appearance and characteristics of malignant ones. Extensive updates include the latest classification schemes and relevant diagnostic techniques. A brand-new, color-coded layout highlights key points more clearly and helps you turn to the sections you need more speedily. Your purchase entitles you to access the web site until the next edition is published, or until the current edition is no longer offered for sale by Elsevier, whichever occurs first. Elsevier reserves the right to offer a suitable replacement product (such as a downloadable or CD-ROM-based electronic version) should access to the web site be discontinued.
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Differential Diagnosis of Oral and Maxillofacial Lesions
Book
  • Jan 1997
Differential diagnosis of Oral and Maxillofacial lesions. Lon ; Mosby Publications. First edition. 1997.p 342-43.
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Rosai and Ackerman's Surgical Pathology
Article
  • Nov 2004
  • ADV ANAT PATHOL
An abstract is unavailable. This article is available as HTML full text and PDF.
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A national epidemiological survey of oral mucosal lesions in Malaysia
Article
  • Oct 1997
  • COMMUNITY DENT ORAL
Abstract The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11 707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+14.0. The sample comprised 40.2% males and 59.8% females; 55.8%. were Malays, 29.4% Chinese,10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%.) subjects. 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia. erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).
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Malignant transformation rate in oral submucous fibrosis over 17-year period
Article
  • Dec 1985
  • COMMUNITY DENT ORAL
Abstract Sixty-six patients with oral submucous fibrosis were followed-up for a period of 17 yr (median observation 10 yr) in Ernakulam District, Kerala, India. Oral cancer developed in five (7.6%) patients. The malignant transformation rate in the same sample was 4.5% over a 15-yr observation period (median 8 yr). These findings impart a high degree of malignant potential to this condition.
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Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia
Article
  • Sep 1995
  • ORAL SURG ORAL MED O
Pathologists differ in their definition of "dysplasia." This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.
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