Elsevier

Journal of Endodontics

Volume 36, Issue 3, March 2010, Pages 423-428
Journal of Endodontics

Clinical Research
Evaluation of Pathologists (Histopathology) and Radiologists (Cone Beam Computed Tomography) Differentiating Radicular Cysts from Granulomas

https://doi.org/10.1016/j.joen.2009.11.005Get rights and content

Abstract

Introduction

This study investigated the differentiation of radicular cysts from granulomas. Cone beam computed tomography (CBCT) imaging was compared with the existing standard, biopsy and histopathology.

Methods

Forty-five patients scheduled for an apicoectomy received a CBCT scan of the involved arch. Two oral and maxillofacial radiologists, working independently and using the same criteria, categorized the CBCT images as one of the following: cyst, likely cyst, likely granuloma, granuloma, or other. After apicoectomies, two oral pathologists, working independently and using the same criteria, diagnosed the surgical specimens as one of the following: radicular cyst, granuloma, or other. We examined the following: (1) interrater agreement between pathologists as to the biopsy diagnosis, (2) interrater agreement between radiologists as to the CBCT diagnosis, and (3) accuracy of radiologists' diagnostic assessments using histopathology as the standard.

Results

Findings showed strong interrater reliability between pathologists (κ = 0.79, z = 5.46, p < 0.0001) and weak interrater reliability between radiologists (κ = 0.14, p = not significant). Accuracy (true-positives plus true-negatives) for the two radiologists was 51% and 63%.

Conclusion

Under the conditions of this study, based on the inconsistency of the radiologists' reports as evidenced by statistical analyses, it was concluded that CBCT imaging is not a reliable diagnostic method for differentiating radicular cysts from granulomas. Surgical biopsy and histopathological evaluation remain the standard procedure for differentiating radicular cysts from granulomas.

Section snippets

Materials and Methods

Forty-five patients referred to New York University College of Dentistry's Department of Endodontics and treatment planned for endodontic surgery between February and August 2008 were eligible to participate in the study. Inclusion criteria were patients with a minimum age of 18 and a minimum average diameter of the periapical lesion of 5 mm. Exclusion criteria were lesions associated with teeth considered to have a poor prognosis and any patient classified American Society of Anesthesiologists

Results

Three separate analyses were performed: (1) interpathologist, (2) interradiologist, and (3) radiologist diagnoses compared with the pathologist diagnoses. Fourteen of the 45 cases resulted in a coincident diagnosis of all four evaluators (pathologists and radiologists), whereas the remaining 31 cases showed variance in their diagnoses.

To determine interrater reliability between the two radiologists and also between the two pathologists, we calculated the Cohen kappa (κ). Cohen kappa is a

Discussion

The standard means of differentiating radicular cysts from granulomas is surgical biopsy and histopathological examination. The desire to preoperatively diagnose an apical lesion has led to research attempting to develop a nonsurgical alternative.

CBCT imaging has been suggested to be one such method, and one study suggested it might even be more accurate than histopathological analysis (1). In that study, the analysis of CBCT images was performed by equating lower grayscale values to air (sinus

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