A STUDY OF CONCORDANCE BETWEEN CLINICAL AND HISTOPATHOLOGICAL DIAGNOSIS IN CASES OF LEPROSY WITH RELEVANCE TO THERAPY

Abstract

AIMS AND OBJECTIVES:To achieve the goal of WHO new global strategy of 2016-20 to decrease the case load, early and proper diagnosis for\ntreatment and avoiding disability. Examination of a biopsy specimen of skin or nerve biopsies for histopathology can be a valuable aid for reaching\ncon\uf001rmatory diagnosis of leprosy and its subtypes, differential diagnosis, prognosis of the disease and assessment or regression of the disease in\npatient under treatment and also for research, especially in early and borderline cases. The aim of this study was to correlate histopathological\ndiagnosis of skin biopsies with clinical diagnosis of leprosy. This study was conducted to seek out and highlight the ef\uf001cacy of the test and therefore\nits importance in current diagnostic scenario. MATERIALS AND METHODS: The retrospective study was carried out on the skin biopsies from\nuntreated cases of leprosy seen in the Department of Dermatology and reported in the histopathology section of the Department of Pathology,\nSchool of Tropical Medicine, Calcutta between August 2016 to June 2019. HE sections of skin biopsies of all the cases of leprosy were examined\nfor Epidermal atrophy, epithelioid granulomas, number & distribution of lymphocytes, histiocytes & foam cells; In\uf001ltration of nerves, blood\nvessels and adnexa; Grenz zone. Sections stained with ZN were examined for lepra bacilli in all cases. Histopathological \uf001ndings were graded\ninto (TT), (BT), (BB), (BL) and (LL) according to Ridley and Jopling scale. Clinical diagnosis of the leprosy cases (as provided by department of\nDermatology) using Ridley & Jopling scale was correlated with the results of histopathologic examinaton of their respective biopsies. RESULTS:\nOut of total cases in the OPD over Aug 2016 to June 2019,115 were sent for biopsy with conclusive clinical diagnosis of Leprosy out of which 45\ncases came with the positive diagnosis of leprosy out of which TT(12) , BT(12), BB(3), BL(2),LL(8), Histoid(8). In 2016-17 the accuracy of clinichistopathological correlation was 35.4% ,41.3%in 2018 ,36.36% till mid 2019 . The discrepancy with the HPE refuting clinical diagnosis was\n48.38% in 2017 ,58.62% in 2018 ,63.63% in mid 2019}. Histoid leprosy and ENL were 10 out of 31 cases in 2018-19 while 2cases were\nhistopathologically diagnosed as leprosy despite having Sarcoidosis / Gr. Annulare clinically. Although the clinico- CONCLUSION:\nhistopathological agreement in this study leaves much to be desired for prompt diagnosis, the disparity in correlation does decrease the chances of\nfalse positives and helps in better \uf001nalising the diagnosis for better treatment, Prognosis, follow-up and monitoring of the diseases are also aided by\ncorrect histopathological diagnosis especially in case of early and borderline cases of leprosy