Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas.
BACKGROUND
The purpose of this study was to evaluate the reliability and accuracy of cone-beam computed tomographic (CBCT) imaging against the histopathologic diagnosis for the differential diagnosis of periapical cysts (cavitated lesions) from (solid) granulomas.


METHODS
Thirty-six periapical lesions were imaged using CBCT scans. Apicoectomy surgeries were conducted for histopathological examination. Evaluator 1 examined each CBCT scan for the presence of 6 radiologic characteristics of a cyst (ie, location, periphery, shape, internal structure, effects on surrounding structure, and perforation of the cortical plate). Not every cyst showed all radiologic features (eg, not all cysts perforate the cortical plate). For the purpose of finding the minimum number of diagnostic criteria present in a scan to diagnose a lesion as a cyst, we conducted 6 receiver operating characteristic curve analyses comparing CBCT diagnoses with the histopathologic diagnosis. Two other independent evaluators examined the CBCT lesions. Statistical tests were conducted to examine the accuracy, inter-rater reliability, and intrarater reliability of CBCT images.


RESULTS
Findings showed that a score of ≥4 positive findings was the optimal scoring system. The accuracies of differential diagnoses of 3 evaluators were moderate (area under the curve = 0.76, 0.70, and 0.69 for evaluators 1, 2, and 3, respectively). The inter-rater agreement of the 3 evaluators was excellent (α = 0.87). The intrarater agreement was good to excellent (κ = 0.71, 0.76, and 0.77).


CONCLUSIONS
CBCT images can provide a moderately accurate diagnosis between cysts and granulomas.
Ostrow School of Dentistry, University of Southern California, Los Angeles, California.
Jing
J
Guo
James H
JH
Simon
Parish
P
Sedghizadeh
Osman N
ON
Soliman
Travis
T
Chapman
Reyes
R
Enciso
D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology; D001047:Apicoectomy / Q000706:statistics & numerical data; D019540:Area Under Curve; D001706:Biopsy / Q000706:statistics & numerical data; D002784:Cholesterol / Q000032:analysis; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data*; D003238:Connective Tissue / Q000473:pathology; D003937:Diagnosis, Differential; D004848:Epithelium / Q000473:pathology; D004912:Erythrocytes / Q000473:pathology; D015726:Giant Cells / Q000473:pathology; D006097:Granulation Tissue / Q000473:pathology; D006485:Hemosiderin / Q000032:analysis; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D007633:Keratins / Q000032:analysis; D015588:Observer Variation; D010484:Periapical Granuloma / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D011842:Radicular Cyst / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D007633:Keratins; D006485:Hemosiderin; D002784:Cholesterol
Biopsy; cone-beam computed tomography; differential diagnosis; granuloma; periapical cyst