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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