Interobserver agreement in histopathologic diagnosis of oral lichen planus

IF 1.9 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology Pub Date : 2025-07-21 DOI:10.1016/j.oooo.2025.04.058

Leen AlQudah, Si On Lim, Valerie Murrah, Ricardo Padilla

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引用次数: 0

Abstract

Introduction

Oral lichen planus (OLP) is a chronic immune-mediated disorder with unknown etiology. Optimal OLP diagnosis takes both histopathological and clinical aspects into consideration. Diagnostic criteria for OLP have varied over the years. This study aimed to evaluate interobserver agreement using the 2016 American Academy of Oral and Maxillofacial Pathology (AAOMP) diagnostic criteria.

Methods

This retrospective observational cohort study included 102 archived tissue samples received at the UNC Oral and Maxillofacial Pathology Laboratory and diagnosed as OLP or oral epithelial dysplasia (OED). Seventy-four OLP and 28 OED cases were retrieved. Three board certified oral and maxillofacial pathologists assessed the blinded cases individually. Each observer (observer A, B, C) was provided with the following clinical information: anatomic location, number of lesions (multiple vs solitary), sex, and age. Statistical analyses were conducted using SAS (SAS Institute Inc.) version 9.4 with unweighted Cohen’s kappa (k) test utilized to measure interobserver agreement in pairs.

Results

Responses were categorized as OLP vs OED. This study demonstrated a concordance with signout diagnosis of OLP using the 2016 AAOMP criteria of 77%, 43%, 91% for observers A, B, and C, respectively; whereas the concordance with signout diagnosis of OED for all observers was 93%. Interobserver agreement using Cohen’s categories of k grading were as follows: Observers A and B: 0.42 (moderate), Observers B and C: 0.35 (fair), Observers A and C: 0.71 (substantial).

Conclusion

This study illustrates the range of variation that can occur between pathologists in the histopathologic diagnosis of OLP. Although some variation in interobserver agreement in OLP diagnosis was shown to occur in the study, the overall moderate agreement supports the use of 2016 AAOMP criteria. Importantly, the congruency of observers concerning the diagnosis of mild OED is significant as it supports the reliability of adequate existing histopathologic criteria for a premalignant condition.

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口腔扁平苔藓组织病理学诊断的观察一致性

口腔扁平苔藓（OLP）是一种病因不明的慢性免疫介导性疾病。最佳的OLP诊断需要考虑组织病理学和临床方面。多年来，OLP的诊断标准有所不同。本研究旨在使用2016年美国口腔颌面病理学学会（AAOMP）诊断标准评估观察者之间的一致性。方法本回顾性观察队列研究纳入102例在UNC口腔颌面病理学实验室被诊断为OLP或口腔上皮发育不良（OED）的存档组织样本。74例OLP和28例OED被检索。三名委员会认证的口腔颌面病理学家分别评估了盲法病例。每个观察者（观察者A、B、C）被告知以下临床信息：解剖位置、病变数量（多发还是单发）、性别和年龄。使用SAS (SAS Institute Inc.) 9.4版进行统计分析，使用未加权的Cohen 's kappa (k)检验来测量成对观察者之间的一致性。结果反应分为OLP和OED两类。本研究表明，观察者a、B和C使用2016年AAOMP标准诊断OLP的符合率分别为77%、43%和91%；而所有观察者与牛津英语词典诊断的一致性为93%。使用Cohen的k评分类别的观察者间协议如下：观察者A和B: 0.42（中等），观察者B和C: 0.35（一般），观察者A和C: 0.71（实质性）。结论本研究说明了病理医师对OLP组织病理诊断的差异范围。虽然在研究中出现了一些观察者之间对OLP诊断的一致意见，但总体上的中等一致意见支持使用2016年AAOMP标准。重要的是，观察者关于轻度OED诊断的一致性是重要的，因为它支持了足够的现有组织病理学标准的可靠性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral Surgery Oral Medicine Oral Pathology Oral Radiology DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.80

自引率

6.90%

发文量

1217

审稿时长

2-4 weeks

期刊介绍： Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology is required reading for anyone in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice dentistry. It is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas. Topics covered include such current issues as dental implants, treatment of HIV-infected patients, and evaluation and treatment of TMJ disorders. The official publication for nine societies, the Journal is recommended for initial purchase in the Brandon Hill study, Selected List of Books and Journals for the Small Medical Library.