Discrepancy in the Histological Diagnoses of Oral Lichen Planus Based on WHO Criteria Versus the Newly Proposed Diagnostic Set of the American Academy of Oral and Maxillofacial Pathology.

Background/Objectives: The diagnosis of oral lichen planus (OLP) is challenging because many other oral diseases demonstrate similar clinical and microscopic features. Clinicopathological discrepancy and inter- and intraobserver variability in the histological assessment of OLP have been shown in the literature, as there are no unified diagnostic criteria for the disease. In 2016, the American Academy of Oral and Maxillofacial Pathology (AAOMP) proposed a new diagnostic set for OLP. The aim of the study was to assess the reliability of the AAOMP histological criteria in diagnosing OLP. Methods: In this retrospective study, 34 histological sections, once diagnosed as OLP, were revised by a second pathologist using the WHO criteria. Then, all specimens were analyzed for the presence (P) or absence (A) of the criteria listed in the AAOMP diagnostic set. The reproducibility of the histological diagnosis of OLP when applying the different sets of diagnostic criteria was assessed. Results: From the AAOMP diagnostic criteria, hydropic degeneration was found in 35.2%, lymphocytic exocytosis in 32.3%, mild epithelial dysplasia in 2.9%, verrucous epithelial architectural change in 0% and band-like lymphocytic infiltrate, confined to the epithelium-lamina propria interface in 55.8% of the samples. Reproducibility of the histological diagnosis of OLP was achieved in only 19.3% of the cases when applying the 1978 WHO criteria versus the newly proposed AAOMP criteria. Conclusions: A large number of OLP cases failed to meet the AAOMP histological criteria in the present study. Further studies are needed to assess the validity of the proposed diagnostic set.