Clinico-Histopathological Correlation in Premalignant and Malignant Oral Mucosal Lesions: Experience from a Tertiary Care Center in the Konkan Region

Abstract

Background: Oral cancer remains a major health concern in India, particularly in regions with high tobacco consumption. Premalignant lesions such as leukoplakia, erythroplakia, and oral submucous fibrosis often precede malignancy, making clinico-histopathological correlation essential for accurate diagnosis and management.

Aim: To establish clinico-histopathological correlation in premalignant and malignant oral mucosal lesions in patients attending a tertiary care center in the Konkan region.

Materials and Methods: This prospective observational study included 88 patients with clinically suspected premalignant and malignant oral mucosal lesions. Clinical data regarding demographics, personal habits, and lesion characteristics were recorded. Biopsy specimens were processed and examined histopathologically. The correlation between clinical and histopathological diagnosis was assessed using concordance rates, Cohen’s κ, and ROC curve analysis.

Results: The mean age of patients was 49.1 ± 7.2 years, with a male predominance (67%). Most participants resided in rural areas (58%), and tobacco use was highly prevalent (chewing 83%, smoking 75%). The buccal mucosa was the most frequently involved site (62.5%). Clinico-histopathological concordance was 84.1%, with a Cohen’s κ of 0.68 (p<0.001), indicating substantial agreement. Sensitivity and specificity of clinical diagnosis for malignancy were 88.7% and 76.9%, respectively, while the ROC AUC was 0.93. Histologically, well-differentiated squamous cell carcinoma was the predominant malignant subtype (77.4%). Lesion size was significantly larger in malignant cases compared to premalignant lesions (p<0.001).

Conclusion: Clinico-histopathological correlation is vital for accurate diagnosis of oral mucosal lesions. While clinical evaluation demonstrates substantial reliability, histopathology remains indispensable for confirmation and grading. Routine biopsy of suspicious lesions is essential for early detection and timely management, particularly in high-risk populations with widespread tobacco exposure.