Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications

Introduction: Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation was to study the correlation between the clinical and histopathologic assessment of OLP, and to propose diagnostic refinements, if appropriate. Methods: Clinical and histopathologic data of two previously published studies were used for this purpose. The number of clinical cases in which all clinicians agreed as well as the number of microscopic slides on which all reviewing pathologists agreed were calculated and compared with each other in order to assess the clinicopathologic correlation. Results: In 42% of the cases in which all clinicians agreed about the clinical diagnosis being diagnostic of OLP, there appeared to be no consensus on the histopathologic diagnosis. Conversely, in 50% of the cases in which all pathologists agreed about the histopathologic diagnosis being diagnostic of OLP there was a lack of consensus on the clinical diagnosis. Conclusion: Based on the findings of the present study, there appears to be a lack of clinicopathologic correlation in the diagnostic assessment of OLP. We therefore propose a set of revised diagnostic criteria of OLP and oral lichenoid lesions, based on the WHO definition of OLP, including clinical as well as histopathologic aspects.