Accuracy of leukoplakia diagnoses: a retrospective study

Area of Science:

• Oral Medicine
• Oral Pathology
• Diagnostic Accuracy

Background:

• Leukoplakia is a potentially malignant oral lesion, necessitating accurate clinical identification.
• Diagnostic terminology and clinician accuracy in identifying leukoplakia are crucial for timely and appropriate management.
• Previous studies highlight variability in diagnostic accuracy for oral lesions.

Purpose of the Study:

• To evaluate the diagnostic accuracy of clinicians in identifying oral leukoplakia.
• To analyze the diagnostic terminology used for oral lesions at the University of Nebraska Medical Center (UNMC) oral biopsy service.
• To assess trends in diagnostic accuracy over time.

Main Methods:

• Retrospective review of biopsy archives from 1983, 1995, 2005, and 2015 at UNMC College of Dentistry.
• Inclusion criteria: clinical diagnosis of leukoplakia, white plaque, hyperkeratosis, dysplasia, or carcinoma.
• Descriptive statistics were used to analyze demographic, clinical, and histological data.

Main Results:

• Of 6113 cases, 517 (8.46%) met inclusion criteria. Mean patient age was 56.87 years (286 males, 222 females).
• 195 cases (37.72%) were clinically diagnosed as leukoplakia; 133 (68.21%) were accurate.
• Diagnostic accuracy improved from 46.15% in 1983 to 76.00% in 2015, but misclassifications of other pathoses and misuse of terms like hyperkeratosis and dysplasia persisted.

Conclusions:

• Clinician accuracy in diagnosing oral leukoplakia has improved but remains suboptimal.
• Misclassification of other oral pathoses and misuse of histological terms as clinical diagnoses continue to be issues.
• Standardized diagnostic terminology and enhanced training are recommended to improve accuracy in oral lesion identification.