Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Meenakshi Ammal Dental College, Chennai, India.
Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Meeankshi Ammal Dental College, Chennai, India.
Int Endod J. 2021 May;54(5):693-711. doi: 10.1111/iej.13465. Epub 2021 Jan 17.
Differentiating periapical lesions is important for treatment planning and subsequent treatment outcome.
To assess the diagnostic accuracy of ultrasound imaging for the differentiation of periapical lesions in comparison with histopathology.
PubMed, Scopus, Embase, Web of Science and ProQuest databases were searched for clinical studies published until June 2020 that evaluated the use of ultrasound (US) imaging for differential diagnosis of periapical lesions and used histopathology as the reference standard. Animal studies, laboratory-based studies, reviews and clinical studies not using a reference standard were excluded. Risk of bias (RoB) assessment was performed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The random effects model was used for quantitative analysis of the data, and the Deeks test was used for calculating publication bias. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Twelve articles were included in the systematic review, out of which ten articles were quantitatively assessed. All the articles had a high RoB and concerns regarding applicability in the patient selection domain. For the index test domain, seven articles had low and the remaining five had unclear RoB and concerns regarding applicability. In the reference standard domain, low RoB and concerns regarding applicability were observed for all the articles. The RoB was low in flow and timing domains in all the articles except for one, where it was high. Summary estimates of sensitivity and specificity of US to diagnose periapical granulomas were 0.94 and 0.98, whereas for periapical cysts it was 0.98 and 0.99, respectively. Area under the curve for diagnosis of both periapical granulomas and periapical cysts was 0.99. All the included articles had inherent publication bias. Quality of evidence using GRADE, for sensitivity, was moderate for periapical granulomas and high for periapical cysts, whereas for specificity, it was high for periapical granulomas and low for periapical cysts.
The available evidence is considered to be of low quality due to the observational nature of the studies and inherent publication bias.
Although the sensitivity and specificity for differentiating periapical cysts and periapical granulomas using US were high, taking the quality of evidence into consideration, it can serve as an additional tool in differential diagnosis of periapical lesions.
鉴别根尖病变对于治疗计划和后续治疗结果至关重要。
评估超声成像在鉴别根尖病变方面的诊断准确性，并与组织病理学进行比较。
检索 PubMed、Scopus、Embase、Web of Science 和 ProQuest 数据库，纳入截至 2020 年 6 月评估超声（US）成像用于鉴别诊断根尖病变并以组织病理学为参考标准的临床研究。排除动物研究、基于实验室的研究、综述以及未使用参考标准的临床研究。使用改良的诊断准确性研究质量评估工具（QUADAS-2）对偏倚风险（RoB）进行评估。使用随机效应模型对数据进行定量分析，并使用 Deeks 检验计算发表偏倚。使用推荐评估、制定与评价分级（GRADE）评估证据质量。
系统评价纳入 12 篇文章，其中 10 篇文章进行了定量评估。所有文章的 RoB 均较高，且在患者选择方面存在适用性问题。在索引测试方面，7 篇文章的 RoB 较低，其余 5 篇的 RoB 不明确，且存在适用性问题。在参考标准方面，所有文章的 RoB 较低，适用性问题也存在。除了一篇文章 RoB 较高外，所有文章的流动和时间域的 RoB 均较低。US 诊断根尖肉芽肿的敏感性和特异性汇总估计值分别为 0.94 和 0.98，而对于根尖囊肿则分别为 0.98 和 0.99。诊断根尖肉芽肿和根尖囊肿的曲线下面积均为 0.99。所有纳入的文章均存在固有的发表偏倚。使用 GRADE 评估的敏感性证据质量为中等质量，适用于根尖肉芽肿，高质量，适用于根尖囊肿，而特异性证据质量为高质量，适用于根尖肉芽肿，低质量，适用于根尖囊肿。
由于研究的观察性质和固有的发表偏倚，现有证据质量被认为较低。
尽管 US 区分根尖囊肿和根尖肉芽肿的敏感性和特异性较高，但考虑到证据质量，可以将其作为根尖病变鉴别诊断的附加工具。
