Clinico-pathological study to evaluate oral lichen planus for the establishment of clinical and histopathological diagnostic criteria.

Santhosh Hiremath,Alka D Kale,Seema Hallikerimath

doi:10.5146/tjpath.2014.01285

Abstract

Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Out of the 100 cases, 50 were prospective and 50 were retrospective cases. Prospective cases were collected based on the clinical diagnosis of oral lichen planus and oral lichenoid lesion. Retrospective cases were collected based on the histopathological diagnosis of oral lichen planus. Both the clinical and histopathological analyses were performed based on a proposal for a set of modified diagnostic criteria of oral lichen planus and oral lichenoid lesion. A final diagnosis of oral lichen planus was made only after the correlation of the clinical diagnosis with the histopathological diagnosis. The interobserver agreement among three observers for both prospective and retrospective cases in the final diagnosis of oral lichen planus was found to be "good" to "very good" indicating high reproducibility. However, the final diagnoses of true oral lichen planus after clinico-pathological correlation in prospective and retrospective study groups appeared to be 38.0% and 54.0% respectively. The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively.

Highlights

Oral Lichen Planus (OLP) is a chronic inflammatory disorder affecting the stratified squamous epithelium [1]
The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively
Lichen Planus can be confused with other lichenoid conditions both clinically and histopathologically

Summary

Introduction

Oral Lichen Planus (OLP) is a chronic inflammatory disorder affecting the stratified squamous epithelium [1]. The disease is relatively common, affecting approximately two percent of the total population and constitutes nine percent of all the white lesions of the oral cavity [2]. Oral Lichen Planus can be present anywhere in the oral cavity and is almost invariably a bilateral disease on the buccal mucosa. Oral Lichen Planus and Oral Lichenoid lesions (OLL) pose a major diagnostic problem since their clinical and histopathological features overlap with each other. Distinguishing OLP and OLL from one another with only limited data may create a major diagnostic challenge, with considerable implications for patient management and follow up. Lichen Planus can be confused with other lichenoid conditions (such as Nonspecific Lichenoid Reactions, Atypical Lichenoid Stomatitis, Graft Versus Host Reactions [GVHRs], Drug Reactions, Lupus Erythematosus [LE], Erythema Multiforme [EM], and Oral Lichenoid Dysplasia [OLD]) both clinically and histopathologically. It is important to familiarize oneself with the clinicopathological patterns of OLP and OLL, so as to develop an accurate diagnostic and prognostic assessment [4]

Methods

Results

Discussion

Conclusion