Clinico-Histopathological Consistency in Dermatological Diseases

M. Mahmud, Md Abdullah Al Mamun, S. C. Hazra, R. B. Habib, M. Chowdhury
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Abstract

Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%.  In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34
皮肤病的临床-组织病理学一致性
皮肤病理活检是诊断皮肤病最可靠的方法。皮肤活检的主要目的是确认临床诊断,但皮肤科医生通常寻找与组织病理学报告的一致性。本研究的目的是观察皮肤疾病的临床和组织病理学诊断的一致性。2018年1月至2019年1月,Bangabandhu Sheikh Mujib医科大学皮肤病和性病学系对630名接受皮肤活检的患者进行了一项观察性研究。门诊和住院部建议进行活检并进行活检的患者被纳入研究。最终,当组织病理学报告可用时,确认纳入。在数据收集表中记录人口统计信息、临床诊断、活检程序类型、采集和送组织病理程序的标本类型以及组织病理诊断。评估组织病理学诊断及其与临床诊断的相关性的一致性,这是研究的主要结局指标。行活检患者的平均年龄为35.14±16.57岁,年龄范围为5 ~ 82岁。男性患者多于女性,男女比例为1.15:1。三种类型的活检,其中切口活检是最常见的类型(93.5%)。大部分标本为皮肤标本(94.76%),其他类型标本为粘膜标本(2.6%),甲基质标本(1.9%),毛囊标本(0.6%)。临床确诊病例占71.43%。临床活检常见诊断为银屑病及其分型17.77%,扁平苔藓及其变异14.12%,结缔组织病6.19%,感染性疾病5.39%。79.52%的病例进行了组织病理学诊断,68.22%的病例诊断与临床诊断一致。膀胱大泡性疾病的临床病理一致性最高,为93.33%。其次是结缔组织疾病79.48%,血管血管疾病75%,苔藓样疾病73.56%。皮肤活检是一个决定性的工具,以克服诊断困境在皮肤病。临床病理一致性被认为低于皮肤科医生的期望,但皮肤科医生和病理学家的共同努力可以提高活检样本的诊断能力。孟加拉国Med . 2020年9月;49(3): 29-34
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