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Year : 2018  |  Volume : 38  |  Issue : 1  |  Page : 37-41

Comparison of clinical diagnosis with histopathology in inflammatory skin diseases: a retrospective study of 455 cases

1 Department of Pathology, St John's Medical College and Hospital, Bangalore, Karnataka, India
2 Department of Dermatology, St John's Medical College and Hospital, Bangalore, Karnataka, India

Correspondence Address:
Seema Umarji
Department of Pathology, St John’s Medical College and Hospital, Sarjapur Road, Koramangala, Bangalore, Karnataka, 560019
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejdv.ejdv_62_16

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Background Skin biopsies are performed to support the clinical diagnosis of inflammatory skin diseases. Clinical information is conveyed to the pathologist as a list of differential diagnosis. Aims The aims of this article are to correlate the clinical diagnosis with histopathologic diagnosis and to determine the correlation rank order of differentials with histopathologic diagnosis. Methods Four hundred and fifty-five skin biopsies signed out as inflammatory lesions were identified using the laboratory information system. Clinical differential diagnosis from the biopsy requisition forms were tabulated and compared with the final histopathologic diagnosis. Results Out of the 455 individuals considered, 237 (52.08%) were men and 218 (47.9%) were women. The clinical diagnosis with more than 40 mentions included vasculitis, lichenoid dermatitis, discoid lupus erythematosus, psoriasis and eczema. The histopathologic diagnosis with more than 20 mentions included lichenoid dermatitis, cutaneous vasculitis, pemphigus vulgaris, psoriasis and Hansen’s disease. The median number of differential diagnosis per patient was 3 (range: 1–5). The final diagnosis was included in the differentials in 412 (90.5%) and absent in 43 (9.5%) cases. In 339/412 (82.3%) cases, the final diagnosis was the first differential. In 70/412 (16.9%) cases, the final diagnosis was listed as the second or third differential and in 3/412 (0.007%) cases as the fourth and fifth. Among the 37 discordant cases where the clinical details were available, the clinical description correlated with the final diagnosis in 15 cases; clinical and histopathologic diagnoses fell under the same broad disease category in 19 cases. Only 3/37 cases were truly discordant. Limitations The sample size and the possibility of lesions being overbiopsied are the only possible limitations. Conclusion The overall concordance between the first three clinical diagnosis and histopathology was a good 98%. A longer list of differential diagnosis is not helpful. In situations where a specific clinical diagnosis is deferred, an accurate description of the lesions aids the pathologist.

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