Department of Endodontics, New York University College of Dentistry, New York, NY 10010-4086, USA.
J Endod. 2010 Mar;36(3):423-8. doi: 10.1016/j.joen.2009.11.005.
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.
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.
Findings showed strong interrater reliability between pathologists (kappa=0.79, z=5.46, p<0.0001) and weak interrater reliability between radiologists (kappa=0.14, p=not significant). Accuracy (true-positives plus true-negatives) for the two radiologists was 51% and 63%.
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.
本研究旨在探讨根囊肿与肉芽肿的鉴别。我们比较了锥形束 CT（CBCT）成像与现有的标准，即活检和组织病理学。
45 名计划接受根尖切除术的患者接受了受累弓的 CBCT 扫描。两名口腔颌面放射科医生独立工作，并使用相同的标准，将 CBCT 图像归类为以下之一：囊肿、可能的囊肿、可能的肉芽肿、肉芽肿或其他。根尖切除术后，两名口腔病理学家独立工作，并使用相同的标准，将手术标本诊断为以下之一：根囊肿、肉芽肿或其他。我们检查了以下内容：（1）病理学家对活检诊断的组间一致性，（2）放射科医生对 CBCT 诊断的组间一致性，以及（3）使用组织病理学作为标准的放射科医生诊断评估的准确性。
研究结果表明，病理学家之间具有很强的组内一致性（kappa=0.79，z=5.46，p<0.0001），而放射科医生之间的组内一致性较弱（kappa=0.14，p=无统计学意义）。两位放射科医生的准确性（真阳性加真阴性）分别为 51%和 63%。
在本研究的条件下，根据统计分析表明放射科医生的报告不一致，可以得出结论，CBCT 成像不是区分根囊肿与肉芽肿的可靠诊断方法。手术活检和组织病理学评估仍然是区分根囊肿与肉芽肿的标准程序。
