A Retrospective Analysis of the Diagnostic Accuracy in Diagnosing OPMD and Benign Oral Lesions

Objective: The clinical suspicion of a neoplastic lesion necessitates prompt diagnostic assessment through oral biopsy. However, the failure to accurately recognize an oral potentially malignant disorder (OPMD) or the misdiagnosis of a benign lesion can lead to diagnostic delays with significant impact on the patient's health. This study aimed to evaluate the diagnostic accuracy of clinical diagnosis compared to the histopathological diagnosis, focusing on OPMDs and suspected benign lesions in an Italian university hospital. Methods: A retrospective analysis was conducted on patients with a clinical diagnosis of benign lesions or OPMDs at the Oral Medicine and Pathology Unit (Maggiore Hospital, Trieste, Italy). Expert clinicians performed the clinical assessment, followed by biopsy and histopathological analysis. Diagnostic accuracy was evaluated through sensitivity, specificity, positive predictive value, and negative predictive value. Cohen's kappa (κ) coefficient was used to determine concordance between clinical and histological diagnoses. Results: The histopathological analysis diagnosed the presence of benign lesions in 74.7% of cases and OPMDs in 25.3%. Sensitivity was highest for odontogenic cysts and tumors (92.06%) and lowest for ulcerative lesions/TUGSE (37.50%). Specificity exceeded 95% across most considered categories. The overall concordance between clinical and histological diagnoses was substantial (κ = 0.70). Conclusion: The misdiagnosis of OPMDs or benign lesions leads to diagnostic delays which seriously impact on the patient's therapeutic process. This survey highlights both high diagnostic accuracy and strong concordance between clinical and histological diagnoses. Integrating advanced diagnostic tools and constant clinicians' training is essential to minimize misdiagnoses.