THE EFFECT OF CLINICAL INFORMATION ON THE HISTOPATHOLOGIC DIAGNOSIS OF ORAL EPITHELIAL DYSPLASIA

Objectives. The purpose of this study was to test the hypothesis that clinical information submitted with biopsy specimens helps pathologist s be more consistent and accurate in diagnosing oral epithelial dyspla sia. Study Design, Each of six board-certified oral and maxillofacial pathologists examined the same set of 120 oral biopsies (involving dia gnoses ranging from hyperkeratosis to severe epithelial dysplasia); th ey had examined these same biopsies in a previous study, but this time the clinical information was provided for each case. The examiner's d iagnosis was compared to the sign-out diagnosis for each case. Results , Rates of exact agreement with the sign-out diagnosis averaged 38.5%, and there was 85.4% agreement within one histologic grade. The rate o f agreement in distinguishing epithelial dysplasia from no dysplasia w as 71.4%. These results, when compared to those from a previous study in which the same examiners had evaluated the same slides but without clinical histories, represent a 2.5% to 20% decrease for exact agreeme nt among the six pathologists, a 0% to 8.5% decrease for agreement wit hin one histologic grade, and a 0% to 23.4% decrease for agreement reg arding the presence or absence of epithelial dysplasia. Conclusions, W hen clinical information was used. accuracy and consistency among boar d-certified oral and maxillofacial pathologists in the diagnosis of or al epithelial dysplasia was not improved. In fact there was a decrease in accuracy.