title: Comparison between Radiographic (2-dimensional and 3-dimensional) and Histologic Findings of Periapical Lesions Treated with Apical Surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate the concordance of 2- and 3-dimensional radiography and histopathology in the diagnosis of periapical lesions.
  
  
  METHODS
  Patients were consecutively enrolled in this study provided that preoperative periapical radiography (PR) and cone-beam computed tomographic imaging of the tooth to be treated with apical surgery were performed. The periapical lesional tissue was histologically analyzed by 2 blinded examiners. The final histologic diagnosis was compared with the radiographic assessments of 4 blinded observers. The initial study material included 62 teeth in the same number of patients.
  
  
  RESULTS
  Four lesions had to be excluded during processing, resulting in a final number of 58 evaluated cases (31 women and 27 men, mean age = 55 years). The final histologic diagnosis of the periapical lesions included 55 granulomas (94.8%) and 3 cysts (5.2%). Histologic analysis of the tissue samples from the apical lesions exhibited an almost perfect agreement between the 2 experienced investigators with an overall agreement of 94.83% (kappa = 0.8011). Radiographic assessment overestimated cysts by 28.4% (cone-beam computed tomographic imaging) and 20.7% (periapical radiography), respectively. Comparing the correlation of the radiographic diagnosis of 4 observers with the final histologic diagnosis, 2-dimensional (kappa = 0.104) and 3-dimensional imaging (kappa = 0.111) provided only minimum agreement.
  
  
  CONCLUSIONS
  To establish a final diagnosis of an apical radiolucency, the tissue specimen should be evaluated histologically and specified as a granuloma (with/without epithelium) or a cyst. Analysis of 2-dimensional and 3-dimensional radiographic images alike results only in a tentative diagnosis that should be confirmed with biopsy.
authors: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Center for Oral Medicine and Community Dentistry, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. Electronic address: michael.bornstein@zmk.unibe.ch.
authors: Michael M
authors: MM
authors: Bornstein
authors: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors: Andreas C
authors: AC
authors: Bingisser
authors: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors: Peter A
authors: PA
authors: Reichart
authors: Institute for Clinical Epidemiology & Biostatistics, Basel University Hospital, Basel, Switzerland.
authors: Pedram
authors: P
authors: Sendi
authors: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors: Dieter D
authors: DD
authors: Bosshardt
authors: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors: Thomas
authors: T
authors: von Arx
mesh_terms: D000328:Adult; D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010483:Periapical Diseases / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D019252:Radiography, Dental, Digital / Q000379:methods*
keywords: Apical surgery; cone-beam computed tomographic imaging; cyst; granuloma; periapical lesion; periapical radiography