Concordance between clinical and histopathological diagnoses of oral hard tissue lesions in Isfahan over a 24-year period

Differential diagnosis and understanding the nature of lesions are effective in the treatment process and help reach a final diagnosis of pathological lesions. In this regard, 24-year data of Isfahan Dental School patients’ (1988 to 2011) were assessed and the concordance between clinical and histopathological diagnoses of oral hard tissue lesions was evaluated.

In this descriptive/analytical study, 2745 hard tissue pathology reports were reviewed. The frequencies of concordance between clinical and histopathological diagnoses, age, gender, locations of lesions, radiographic views, and benign and malignant nature of the lesions were reported. Data were analyzed with SPSS 20 using Kruskal-Wallis and chi-squared (α=0.05).

In 57% of cases the histopathological diagnosis was consistent with the first clinical diagnosis while in 5.7% of cases histopathological diagnosis was consistent with the second clinical diagnosis. In addition, concordance between clinical and histopathological diagnoses was mostly observed in the hard palate lesions (81.2%) and in benign lesions (63%). There was no clear correlation between the age and sex of the patients and diagnosis concordance. The most significant radiological change observed was periapical radiolucency (13.6%) while the least sign noted was the absence of radiologic changes (1%<). Solitary well-defined radiolucent lesions exhibited the most accurate diagnosis (69.9%).

In this study, almost half of the investigated records had no clinical diagnosis while one-third of the records with clinical diagnosis suffered from lack of concordance between clinical and histopathological diagnosis, indicating clinicians’ lack of knowledge about the importance of clinical and radiological surveys. As a consequence, this study suggests more comprehensive educational programs for students and continuous education programs to enhance the clinicians’ understanding about the importance of diagnosis of oral diseases, especially in osseous lesions.