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Introduction: Oral white lesions are one of the most frequently diagnosed lesions of the oral cavity. These lesions, though aetiologically different, may appear similar clinically. However, they vary remarkably in histopathological findings ranging from benign hyperkeratosis to invasive malignancy.

Objective: To determine the agreement between the clinical and histopathological diagnoses of oral keratotic lesions

Materials and Method: A descriptive cross-sectional study using secondary data was carried out in the Department of Oral Pathology at Kantipur Dental Hospital from 10th March, 2022 to 12th April 2022.The study included 112 clinically diagnosed cases of oral keratotic lesions subjected to biopsy and histological examination. The measure of agreement between the clinical and histopathological diagnoses was evaluated.

Result: The most common histological diagnosed cases were of Oral Lichen Planus (OLP) 41(36.6%), Oral Submucous Fibrosis (OSF) 19 (17%) and leukoplakia which is histopathologically diagnosed as dysplasia 15(13.4%) among all the lesions included. Out of 32 clinical cases of leukoplakia, clinicopathological agreement as dysplasia was only 28%, 12.5% was diagnosed as OSF and 6.25% was diagnosed as carcinoma whereas 53.3% cases were diagnosed as other keratotic lesions indicating the least clinicopathological agreement.

Conclusion: The measure of agreement between the clinical and pathological diagnosis was variable among different oral keratotic lesions suggesting confirmation with histopathology is a must despite each lesion having its specific clinical features.

Biopsy; histological examination; keratosis; leukoplakia; oral lichen planus; oral submucous fibrosis.