AGREEMENT BETWEEN CLINICAL AND HISTOPATHOLOGICAL DIAGNOSIS OF ORAL LESIONS: EVIDENCE FROM TEACHING CLINICS

Abstract

The diagnosis of oral lesions represents a challenge in dental practice, requiring integration between clinical evaluation and histopathological confirmation. Histopathological examination is the gold standard for definitive diagnosis, while the clinical hypothesis guides the initial approach. Objective: To systematically review the available scientific evidence on the agreement between clinical and histopathological diagnoses of oral lesions in dental teaching clinics, identifying concordance rates, factors associated with disagreements, and implications for professional training. Methods: A literature review was conducted in the BVS, PubMed, and SciELO databases, including retrospective and cross-sectional studies published between 1990 and 2025 that evaluated diagnostic concordance in dental and teaching clinics. Results: Concordance rates ranged from 44% to 94%, with most falling between 50% and 80%. Non-neoplastic proliferative processes were the most frequent histopathological diagnoses. The greatest disagreement was observed in potentially malignant lesions and neoplasms. The Kappa index ranged from 0.03 (minimal agreement) to 0.75 (substantial agreement). Conclusion: Clinicopathological agreement in teaching clinics shows considerable variation, highlighting the need for biopsy and histopathological examination as essential steps in the diagnostic process. Improving training in semiology, stomatology, and oral pathology directly contributes to greater diagnostic accuracy.