title: Oral leukoplakia - is biopsy at the initial appointment a must?
abstract: BACKGROUND
  Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient's initial visit.
  
  
  METHODS
  Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination.
  
  
  RESULTS
  A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia.
  
  
  CONCLUSIONS
  The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.
authors.affiliation: Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry, International Medical University , Jalan Jalil Perkasa, Kuala Lumpur, Malaysia .
authors.forename: Sunil
authors.initials: S
authors.lastname: Mutalik
authors.affiliation: Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry, International Medical University , Jalan Jalil Perkasa, Kuala Lumpur, Malaysia .
authors.forename: Vimi S
authors.initials: VS
authors.lastname: Mutalik
authors.affiliation: Professor and Head, Department of Oral Medicine and Radiology, MCODS , Manipal, India .
authors.forename: Keerthilatha M
authors.initials: KM
authors.lastname: Pai
authors.affiliation: Professor and Head, Department of Oral Medicine and Radiology, SDM college of dental sciences , Dharwad, India .
authors.forename: Venkatesh G
authors.initials: VG
authors.lastname: Naikmasur
authors.affiliation: Professor and Associate Dean, Division of Oral Diagnostic Sciences, International Medical University , Malaysia .
authors.forename: Khoo Suan
authors.initials: KS
authors.lastname: Phaik
keywords: Biopsy; Dysplasia; Histopathology; Leukoplakia