Diagnostic Accuracy of Clinical Criteria for Oral Lichen Planus Compared With Histopathological Diagnosis
Patrayu Taebunpakul, Patiporn Ariyalardphunya, Pannita Phengcham, Raksina Polhiranrat, Ubonwan Thanyawatsawat, Sineepat Talungchit
Abstract
Objective:
Oral lichen planus (OLP) is a chronic inflammatory disease affecting the oral mucosa. Several lesions may clinically mimic OLP but differ in etiology and management. Accurate diagnosis is essential for appropriate management. Therefore, this study evaluated the diagnostic accuracy of clinical criteria for OLP, comparing the modified World Health Organization (WHO) criteria and the American Academy of Oral and Maxillofacial Pathology (AAOMP) criteria with histopathological diagnosis.
Methods:
A retrospective study of 123 patients with suspected OLP was conducted. Clinical photographs were assessed using the modified WHO and AAOMP criteria, with histopathology as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both criteria.
Results:
According to the modified WHO criteria, 31 patients were diagnosed clinically with OLP, with 26 confirmed by histopathology. This yielded a sensitivity of 29.21% (95% confidence interval [CI]: 20.05–39.81), specificity of 85.29% (95% CI: 68.94–95.05), PPV of 83.87% (95% CI: 68.50–92.56), and NPV of 31.52% (95% CI: 21.00–39.80). In contrast, 115 patients met the AAOMP clinical diagnostic criteria, with 86 confirmed histopathologically, showing a sensitivity of 96.63% (95% CI: 90.46–99.30), specificity of 14.71% (95% CI: 4.95–31.06), PPV of 74.78% (95% CI: 66.80–82.70), and NPV of 62.50% (95% CI: 29.63–86.84). Chronic mucositis was the most common histopathological feature in false-positive cases for both criteria.
Conclusion:
The high sensitivity of the AAOMP criteria supports their use for OLP screening, whereas the higher specificity of the modified WHO criteria provides greater clinical diagnostic certainty. Clinical criteria aid initial screening but require histopathological confirmation for accurate diagnosis and management.