Diagnostic dilemma at preoperative biopsy diagnosis of oral cavity lesions with recommendations
Keywords:
BIOPSY, ORAL CAVITY, PROBLEMS, PITFALLS
Abstract
Background: Oral cavity lesions of varied nature present in varying patterns from a plaque to a proliferative growth. Biopsy is an important preoperative diagnostic tool for the diagnosis of lesions ranging from simple tumour like lesions to malignancies and deciding the treatment and extent of surgery. At times it becomes difficult for a pathologist, to decide exact nature of the growth at biopsy. The authors share their experience and dilemma during reporting and views to solve them.Methods: All the punch biopsies and subsequent surgical resections of oral cavity received in department of pathology, were reviewed over a period of two years. They were subjected to routine tissue processing in automatic tissue processor, 4-5 microns section cutting and routine H& E staining. Histopahology was evaluated. All the tumours were classified according to WHO classification of Head and Neck tumours.Tumor like lesions were evaluated on the basis of features described by various authors in the literature. Specificity, sensitivity, accuracy, percentage of false negative and false positive, and positive and negative predictive value of the oral cavity biopsy was evaluated.Result: Majority of the oral cavity lesions irrespective of nature, presented as exophytic proliferative growth (83.9%). The diagnostic accuracy of biopsy for evaluating oral cavity lesions was 95.1%. There were 6.9% false negative reports. Sensitivity and positive predictive value of the method to detect malignant and premalignant lesions was 93.1% and 100% respectively, whereas, specificity and negative predictive value was 100% and 85 %. In total 19 cases, problem of histopathology assessment was encountered.Conclusion: To prevent problems and pitfalls in assessing the nature of oral cavity lesion prior to surgery, the reporting pathologist should take utmost care in proper orientation and processing of the tiny oral cavity biopsies, be aware of accurate definitions , characteristic features and criteria of malignancy and should have a close co-ordination with the treating surgeon.Keywords : biopsy, oral cavity, pitfalls, problemsReferences
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2. Barnes L., Everson J.W., Reichart P., Sidransky D. (Eds.): World Health Organization Classification of Tumors. Pathology and Genetics of Head and Neck Tumors. IARC Press: Lyon 2005:168.
3. Peter AH, Louis PD, John DP (Eds.): Washington manual of Surgical Pathology. Oral cavity and oropharynx. 1st ed. Lippincott Williams and Wilkins: USA 2008.
4. Noel W., Kurt M., Richard J.C., Suster S., Lawrence MW. (Eds.): Modern Surgical Pathology. Head and Neck. 2nd ed. (1). WB Saunders: Philadelphia 2009:1.
5. Crispian S., Oslei PA, Jose B, Pedro DD, Adalberto MT (Eds.): Oral Medicine and Pathology at glance. Swellings: reactive lesions. 1st ed. Wiley Blackwell: UK 2010.
6. Barnes L (Ed.): Surgical Pathology of Head and Neck. Benign and non neoplastic disease. 2nd ed. (1). Marcel dekker inc.: New York 2001: 239.
7. Glaros AG, Kline RB. Understanding of the accuracy of tests with cutting scores: The sensitivity,specificity, and predictive value model. Journal of clinical psychology, 1988:44(6); 1013-24.
8. Woolgar JA, Triantafyllou A. Pitfalls and procedures in the histopathological diagnosis of oral and oropharyngeal squamous cell carcinoma and a review of the role of pathology in prognosis. Oral Oncol, 2009:45; 361-85. doi: 10.1016/j.oraloncology.2008.07.016. Epub 2008 .Available from http://www.ncbi.nim.nih.gov/pubmed/18849188.
9. Kumaraswamy K L, Vidhya M, Rao PK, Mukunda A. Oral biopsy: Oral pathologist's perspective. J Can Res Ther, 2012:8(2):192-8. Doi: 10.4103/0973-1482.98969 Available from http://www.cancerjournal.net/text.asp?2012/8/2/192/98969.
10. Poh CF, Ng S, Berean KW, Williams PM, Rosin MP, Zhang L. Biopsy and histopathologic diagnosis of oral premalignant and malignant lesions. J Can Dent Assoc 2008;74(3):283-8.
11. Mills SE, Carter D.(Eds): Sternberg’s diagnostic surgical pathology. The jaws and oral cavity. 5th ed. (1). Wolters Kluwers/ Lippincot Williams &Willkins, Philadelphia 2010;789-90.
12. Santoro A, Pannone G, Contaldo M, Sangueddce F, Esposito V,Serpico R et al. A Troubling Diagnosis of Verrucous Squamous Cell Carcinoma (“the Bad Kind” of Keratosis) and the Need of Clinical and Pathological Correlations: A Review of the Literature with a Case Report. Journal of skin cancer, 2011. Available from http://dx.doi.org/10.1155/2011/370605
13. Weing BM. Squamous cell carcinoma of the upper aerodigestive tract: precursors and problematic variants. Mod Pathol 2002;15(3):229-54.
Published
2016-08-17
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Section
Original Article
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