Clinicopathological Concordance in Panniculitis: A Prospective Study of 48 Cases.

BACKGROUND: Retrospective studies suggest that clinicopathologic concordance rates in panniculitis vary significantly, leading to potential misdiagnoses, delayed treatments, and suboptimal patient outcomes. However, prospective data systematically evaluating the concordance between clinical impressions and histopathologic findings in panniculitis is lacking. This study aimed to determine the concordance between the clinical and histopathological diagnoses in cases with clinical suspicion of panniculitis. METHODS: In this prospectively conducted cross-sectional study at a tertiary-care center in North India, patients' clinical data were recorded, and a deep skin biopsy was performed. Histopathological slides were evaluated for panniculitis features such as the septal or lobular pattern of involvement, presence of vasculitis, type of infiltrates, and fat necrosis. RESULTS: Most cases (71%) were diagnosed with erythema nodosum leprosum (ENL) based on clinical evaluation and a predominantly lobular pattern of panniculitis (73%) based on histopathological evaluation. We reached a single clinical diagnosis in 41 cases (85%), while the remaining cases had more than one clinical diagnosis. Overall, there was a 69% concordance between clinical and histopathological findings. CONCLUSION: This study underscores the importance of integrating clinical and histopathological data for an accurate diagnosis of panniculitis rather than relying solely on one or the other.