A STUDY OF CONCORDANCE BETWEEN CLINICAL AND HISTOPATHOLOGICAL DIAGNOSIS IN CASES OF LEPROSY WITH RELEVANCE TO THERAPY

Abstract

AIMS AND OBJECTIVES:To achieve the goal of WHO new global strategy of 2016-20 to decrease the case load, early and proper diagnosis for treatment and avoiding disability. Examination of a biopsy specimen of skin or nerve biopsies for histopathology can be a valuable aid for reaching conrmatory diagnosis of leprosy and its subtypes, differential diagnosis, prognosis of the disease and assessment or regression of the disease in patient under treatment and also for research, especially in early and borderline cases. The aim of this study was to correlate histopathological diagnosis of skin biopsies with clinical diagnosis of leprosy. This study was conducted to seek out and highlight the efcacy of the test and therefore its importance in current diagnostic scenario. MATERIALS AND METHODS: The retrospective study was carried out on the skin biopsies from untreated cases of leprosy seen in the Department of Dermatology and reported in the histopathology section of the Department of Pathology, School of Tropical Medicine, Calcutta between August 2016 to June 2019. HE sections of skin biopsies of all the cases of leprosy were examined for Epidermal atrophy, epithelioid granulomas, number & distribution of lymphocytes, histiocytes & foam cells; Inltration of nerves, blood vessels and adnexa; Grenz zone. Sections stained with ZN were examined for lepra bacilli in all cases. Histopathological ndings were graded into (TT), (BT), (BB), (BL) and (LL) according to Ridley and Jopling scale. Clinical diagnosis of the leprosy cases (as provided by department of Dermatology) using Ridley & Jopling scale was correlated with the results of histopathologic examinaton of their respective biopsies. RESULTS: Out of total cases in the OPD over Aug 2016 to June 2019,115 were sent for biopsy with conclusive clinical diagnosis of Leprosy out of which 45 cases came with the positive diagnosis of leprosy out of which TT(12) , BT(12), BB(3), BL(2),LL(8), Histoid(8). In 2016-17 the accuracy of clinichistopathological correlation was 35.4% ,41.3%in 2018 ,36.36% till mid 2019 . The discrepancy with the HPE refuting clinical diagnosis was 48.38% in 2017 ,58.62% in 2018 ,63.63% in mid 2019}. Histoid leprosy and ENL were 10 out of 31 cases in 2018-19 while 2cases were histopathologically diagnosed as leprosy despite having Sarcoidosis / Gr. Annulare clinically. Although the clinico- CONCLUSION: histopathological agreement in this study leaves much to be desired for prompt diagnosis, the disparity in correlation does decrease the chances of false positives and helps in better nalising the diagnosis for better treatment, Prognosis, follow-up and monitoring of the diseases are also aided by correct histopathological diagnosis especially in case of early and borderline cases of leprosy