Clinico-histopatholoical concordance in leprosy

Histopathological examination of biopsies from 111 patients with clinically diagnosed leprosy was carried out in order to observe the clinico-histopat hological correlation. Clinical diagnosis was based on Ridley and Jopling ( R-J) classification and World Health Organization (WHO) classification. The concordance rate between the two clinical classifications was 73.8%. Secti ons were stained with haematoxylin and eosin (H&E) and Ziehl-Neelsen's (Z-N ) stains. The histological classification was as per the R-J criteria. Skin biopsy showed evidence of leprosy in 104 cases (93.69%). Overall concordan ce was observed in 58.6% (R-J) and 85.6% (WHO classification). The kappa te st, when applied, showed significant agreement between clinical and histopa thological diagnosis (Z=11.775; P<0.001). Individual subtypes showed variab le concordance rates which were again higher using WHO classification. When some of the subtypes were combined, the concordance rate was 83.02% for TT +BT; 72.58% for BT+BB+BL; 73.91% for BL+LL; 80.77% for BL+HL and 100% for L L+HL. (See Introduction for definitions of abbreviations.) The present study highlights the importance of histopathological examinatio n for exact subtyping of leprosy, so as to facilitate the institution of ac curate mode of therapy and regular follow-up of patients to prevent undesir able complications.