ASSOCIATION OF CLINICAL DIAGNOSIS WITH HISTOPATHOLOGY IN VARIOUS SKIN DISEASES
AbstractBackground: Dermatological diagnosis are mainly clinical; however, skin biopsies are frequently done to support clinical diagnosis when in doubt. Aim of this study is to relate the clinical diagnosis of various dermatological conditions with histopathological diagnosis. Methods: In this descriptive prospective study, 223 patients were enrolled from dermatology OPD at Benazir Bhutto Hospital through non-probability consecutive sampling. Patients were diagnosed clinically and skin biopsies of all patients were taken after informed consent and clinical data was sent to a histopathologist. Results: Patients between ages of 2–85 years were evaluated. Mean age was 39.65±19.43 years. Out of total 223 patients 112 were males and 111 were females. Clinical diagnosis was same as histopathological diagnosis in 180 (80.7%). Out of 80.7% cases, most common disorder was Eczema, 18 cases (10%). The diseases lying in the inflammatory dermatosis group have highest sensitivity, specificity, PPV and NPV, i.e., 91.2%, 90.8%, 84.1% and 86.8% respectively. The discordance between clinical and histological diagnosis was highest in infectious disease group. The concordance between clinical and histological diagnosis in infectious diseases was just 28%. Conclusion: Documenting a histological diagnosis is essential in dermatology as most of the dermatosis have mimicking clinical presentation. The inflammatory lesions have superior clinical and histopathological correlation as compared to infectious diseases and therefore dermatologists should try to biopsy infective dermatosis more often rather than relying on clinical judgment solely.
Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006;55(3):490–500.
Sleiman R, Kurban M, Abbas O. Maximizing diagnostic outcomes of skin biopsy specimens. Int J Dermatol 2013;52(1):72–8.
Werner B. Skin biopsy and its histopathologic analysis: Why? What for? How? Part 1. An Bras Dermatol 2009;84(4):391–5.
Umarji S, Ravikumar G, Antony M, Tirumalae R. Comparison of clinical diagnosis with histopathology in inflammatory skin diseases: a retrospective study of 455 cases. Egypt J Dermatol Venerol 2018;38(1):37–41.
Mehregan DA, al-Sabah HY, Mehregan AH. Basal cell epithelioma arising from epidermoid cyst. J Dermatol Surg Oncol 1994;20(6):405–6.
Dini M, Innocenti A, Romano GF. Basal cell carcinoma arising from epidermoid cyst: a case report. Dermatol Surg 2001;27(6):585–6.
López-Ríos F, Rodríguez-Peralto JL, Castaño E, Benito A. Squamous cell carcinoma arising in a cutaneous epidermal cyst: case report and literature review. Am J Dermatopathol 1999;21(2):174–7.
Mustonen A, Mattila K, Leino M, Koulu L, Tuominen R. Psoriasis causes significant economic burden to patients. Dermatol Ther (Heidelb) 2014;4(1):115–24.
Aslan C, Göktay F, Mansur AT, Aydıngöz IE, Güneş P, Ekmekçi TR. Clinicopathological consistency in skin disorders: a retrospective study of 3949 pathological reports. J Am Acad Dermatol 2012;66(3):393–400.
García-Solano J, López-Avila A, Acosta J, Pérez- Guillermo M. Diagnostic cost-effectiveness of the skin biopsy in inflammatory diseases of the skin. Actas Dermosifiliogr 2005;96(2):92–7.
Longo C, Piansa S, Lallas A, Moscarella E, Lombardi M, Raucci M, et al. Routine clinical-Pathologic correlation of pigmented skin tumors can influence patient management. PloS One 2015;10(9):e0136031.
Metin MS, Atasoy M. The importance of clinical and histopathological correlation in the diagnosis of skin disease: An eleven years’ experience. Ann Med Res 2019;26(3):304–8.
Carrera C, Segura S, Aguilera P, Takigami CM, Gomes A, Barreiro A, et al. Dermoscopy improves the diagnostic accuracy of melanomas clinically resembling seborrheic keratosis: Cross-sectional study of the ability to detect Seborrheic Keratosis-Like melanomas by a group of dermatologists with varying degree of experience. Dermatology 2017;233(6):471–9.
Korfitis C, Gregoriou S, Antoniou C, Katsambas AD, Rigopoulos D. Skin biopsy in the context of dermatological diagnosis: a retrospective cohort study. Dermatol Res Pract 2014;2014:734906.
Heal CF, Raasch BA, Buettner PG, Weedon D. Accuracy of clinical diagnosis of skin lesions. Br J Dermatol 2008;159(3):661–8.
Morton CA, Mackie RM. Clinical accuracy of the diagnosis of cutaneous malignant melanoma. Br J Dermatol 1998;138(2):283–7.
Cooper SM, Wojnarowska F. The accuracyof clinical diagnosis of suspected premalignant and malignant skin lesions in renal transplant recipients. Clin Exp Dermatol 2002;27(6):436–8.
Cerroni L, Argenyi Z, Cerio R, Facchetti F, Kittler H, Kutzner H, et al. Influence of evaluation of clinical pictures on the histopathologic diagnosis of inflammatory skin disorders. J Am Acad Dermatol 2010;63(4):647–52.
Sellheyer K, Bergfeld WF. A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology. J Am Acad Dermatol 2005;52(5):823–30.
Yap B, Boon F. Dermatopathology of 400 skin biopsies from Sarawak. Indian J Dermatol Venereol Leprol 2009;75(5):518–51.