Correlation of Clinico Pathologic Diagnosis of Skin Diseases in a Tertiary Health Centre in South- South Nigeria

Abstract

Background: Clinical diagnosis of several skin diseases is mostly supported by skin biopsies, a follow up on the clinicopathological correlation to improve the accuracy in diagnosing skin diseases. Aims: The aim of this study is to correlate the clinical diagnosis with histopathologic findings, find factors that affect its correlation such as clinical history and differential diagnosis. Methods: This is a retrospective study of patients seen in the Dermatology Out-Patient Clinic in a Tertiary Hospital in South-South Nigeria, who had skin biopsies done between January 2016 and November 2019. Data collection was by convenience sampling, and recordings of clinical notes and results of skin biopsies of suitable cases seen at the out-patient clinic between January 2016 and November 2019 were collated. Details of patient’s age, gender, folder number, clinical history and diagnosis, histologic report as well as histologic diagnosis were documented.  The results were seen as correlating when the provisional clinical diagnosis or any of the differential diagnosis agreed with the histopathologic diagnosis and discordant when the provisional clinical diagnosis or differential diagnosis varied with the histopathologic diagnosis. Results: Skin biopsies done on 60 patients was recorded and reviewed. Sixteen (26.7%) were men and 44 (73.3%) women, mean age of patients was 35.5 years + 16.8. The frequency of cases were papulosquamous diseases 24 cases (40%), tumors 12 (20%), eczematous dermatoses 8 cases (13.3%) infections 2 cases (3.3%), vesiculobullous dermatoses 2 cases (3.3%) and miscellaneous diseases 12 (20.1%). Concerning papulosquamous dermatoses they were made up of 45.8% lichen planus, 41.7% psoriasis, 8.3% pityriasis rubra pilaris and 4.2% lichen nitidus. A few patients 4 (6.6%) had a provisional diagnosis with differential, while 56 (94.4%) had just the clinical diagnosis. There was clinicopathologic correlation in 43 patients (71.7%) and discordance in 17 patients (28.3%). A p value of 0.012 and kappa coefficient of 0.44 was obtained, showing  significance. Conclusion: The overall correlation between clinical and histopathologic diagnosis was good. An accurate description of the lesion with the best probable clinical diagnosis aids the pathologist.