The appearance of oral lichen planus (OLP) is often not pathognomonic and therefore, the diagnosis is challenging. Differences in stringency of the criteria used to diagnose OLP at the histopathological level lead to substantial variability among examiners. Direct immunofluorescence (DIF) is a procedure that has been reported to increase the ability to diagnose OLP.
Objectives: To determine the specificity and sensitivity of the clinical, histopathological and DIF techniques for OLP diagnosis.
Methods: This is a retrospective study of 196 consecutive cases (1999-2000) taken from the files of IMMCO Diagnostics Laboratory. The clinical diagnosis was established by the contributing clinician. The histopathological diagnosis was established by consensus of three Oral and Maxillofacial Pathologists. The DIF diagnosis was established by staining for fibrin, immunoglobulins and C3. The specificity and sensitivity for the clinical, histopathological and DIF diagnosis were calculated.
Results: The sensitivity and specificity for each diagnostic technique was calculated in relation to histopathology, then to DIF as the gold standard. Results are shown in the table.
Conclusion: The histopathologic and DIF specificity were higher than the clinical in establishing OLP diagnosis, yet, the three diagnostic tests were roughly equal in sensitivity.
| Gold Standard | Diagnostic test | Sensitivity | Specificity |
| Histology | Clinical | 0.66 | 0.68 |
| Histology | DIF | 0.72 | 0.81 |
| DIF | Histology | 0.67 | 0.85 |
| DIF | Clinical | 0.67 | 0.70 |
Supported by NIDCR Grant 07106-22.