Clinico-pathological correlation in dermatological disorders: A retrospective audit of 332 skin biopsies from a tertiary care center

Background: Skin biopsy is a frequently employed tool by the dermatologists with several factors that are known to influence its diagnostic yield as well as interpretation. The objective of our study was to analyze the clinico-pathological concordance and discordance rates in various dermatological conditions and study the factors affecting the same. Materials and Methods: We retrospectively analyzed 332 biopsies conducted over a period of 1 year and looked for clinico-pathological correlation and tabulated the results. Results: The overall concordance rate observed in the present study was 70.48% (234 out of 332). Out of 234 concordant cases, 175 of them (74.8%) were concordant with the first differential diagnosis mentioned on the histopathology requisition form, thus revealing an acceptable level of clinico-pathological correlation. The concordance was observed to be 66.87% when only one differential was mentioned on the requisition forms, whereas it increased to 73.96% when more than one diagnosis was offered (P = <0.00001). However, the adequacy of clinical description on the histopathological requisition form was not observed to significantly impact the clinico-pathological correlation in the present study. Conclusion: An acceptable level of clinico-pathological concordance was observed in the present study thus reinforcing skin biopsy as an indispensable tool in the dermatological practice. However, continuous effort in the form of regular audits in the department, interdepartmental discussions between pathologists and clinicians, and repeat biopsies in case of discordancy would help in identifying and addressing the deficiencies that impact the diagnostic yield of histopathology and which would ultimately result in better patient care.