DIAGNOSTIC CONCORDANCE CHARACTERISTICS OF OROFACIAL LESIONS SEEN IN LAGOS UNIVERSITY TEACHING HOSPITAL

Diagnostic concordance of orofacial lesions

Abstract

OBJECTIVE:  This study aimed to compare clinical diagnosis with 
histopathologic diagnosis of orofacial lesions.  
METHODS: Clinical and histopathological reports from orofacial   
biopsy records (2009 to 2013) of the Departments of Oral and 
Maxillofacial Pathology / Biology, and Oral and Maxillofacial 
Surgery clinic, Lagos University Teaching Hospital (LUTH) were 
retrieved. Data analyzed were patients’ gender, age, orofacial sites, 
clinical and histopathological (incisional and excisional) diagnoses 
of biopsied orofacial lesions. The lesions were classified into: 
odontogenic 
cysts 
(OC), 
non-odontogenic cysts (NOC), 
odontogenic tumours (OT), non-odontogenic tumours (NOT), and 
malignant tumours (MT). For each patient, clinical diagnosis was 
matched with histopathologic diagnosis, and concordance was 
calculated using kappa value (κ), which were rated as: Poor = 0.0
0.4, good = 0.41- 0.7, very good = 0.71- 0.8, excellent = 0.81-1.   
RESULTS: From a total of 620 cases, histopathologic diagnosis did 
not match in 35.5% but matched in 64.5% (κ = 0.45 and CI = 0.65). 
The highest misdiagnosis rate of 44.5% was observed in NOT, 
followed by NOC (37.0%), OC (35.7%), OT (29.6%) and MT 
(25.7%). With κ = 0.45 and CI = 0.65, the diagnostic concordance 
in this study was good. Clinicians in this study, were however 
more accurate in the diagnosis of malignant tumours (k= 0.65) and odontogenic tumours (k=0.58).   

CONCLUSION: The rate of clinical misdiagnosis among clinicians in LUTH though low can be improved. We recommend   improvement in diagnostic skills in dental practice by continuous training in recent clinical and histopathological diagnostic 
techniques. Also, affordable and accessible pathology support services should be provided to general dentists / general dental 
practitioners and dental specialists in Nigeria.