title: Excisional biopsy for management of lateral tongue leukoplakia.
abstract: BACKGROUND
  Leukoplakia of the lateral tongue is frequently associated with the risk of malignancy. Although incisional biopsy is accepted as a standard technique for evaluation, the possibility of underdiagnosis, and therefore missed diagnosis of malignancy, remains at all times. The aim of this study was to determine the rate of underdiagnosis by incisional biopsy for leukoplakia of the lateral tongue and to elucidate the underlying cause of for underdiagnosis.
  
  
  METHODS
  Twenty-two patients with leukoplakia in the lateral tongue who had undergone excisional biopsy for suspicion of malignancy were included in the study. Pathology was reviewed and classified into 'no dysplasia,''dysplasia,' and 'carcinoma'. Underdiagnosis was defined as a change of diagnosis to a graver classification following excisional biopsy. To analyze the factors contributing to underdiagnosis, incisional and excisional biopsy specimens were re-evaluated.
  
  
  RESULTS
  Of the 22 patients with leukoplakia of the lateral tongue, 59.1% had coexistent malignancy, including nine squamous cell carcinomas and four verrucous carcinomas. Incisional biopsy resulted in underdiagnosis in 73.3% of the cases. Underdiagnosis was attributable to three common errors, which were mis-selection of sampling site within a large area of leukoplakia, error in pathology specimen preparation owing to small specimen size, and superficial biopsy frequently associated with punch biopsy.
  
  
  CONCLUSIONS
  Leukoplakia of the lateral tongue is highly coexistent with malignancy, and incisional biopsy frequently leads to underdiagnosis. Therefore, complete excision with adequate margin is warranted for leukoplakia of the lateral tongue, preferably under general anesthesia, which could be performed with minimal morbidity and function preservation.
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Jeong
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Paik
authors.forename: Sung-Woo
authors.initials: SW
authors.lastname: Cho
authors.forename: Myung-Whun
authors.initials: MW
authors.lastname: Sung
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Soon-Hyun
authors.initials: SH
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002648:Child; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000175:diagnosis*; D055815:Young Adult