Su L, Weathers D R, Waldron C A
Department of Pathology, Emory University School of Medicine, Atlanta, Ga., USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Nov;84(5):540-9. doi: 10.1016/s1079-2104(97)90271-7.
The distinguishing histopathologic features of focal cemento-osseous dysplasia (FCOD) (including lesions occurring in both anterior and posterior jaws) and cemento-ossifying fibroma (COF) (ossifying fibroma and cementifying fibroma) were demonstrated in our earlier work. The aim of the current study was to further refine their clinical and radiographic features. We have assessed 18 clinical and radiographic parameters by univariate comparisons (chi-squared and Student t tests), and a multivariate assessment (logistic regression) in 241 cases of FCOD and 75 of COF. These cases were diagnosed from a combination of clinical, radiographic, and histopathologic information. FCOD was seen predominantly in black women, with a peak incidence in the fourth and fifth decades, whereas COF showed no female predilection except in the fourth decade (p < 0.005). COF occurred in patients an average of 10 years younger than patients with FCOD (p < 0.0001). Most patients with FCOD were asymptomatic (62%); the average lesion size was 1.8 cm. More than half of patients with COF displayed jaw expansion and a considerably larger size lesion (mean 3.8 cm, p < 0.001). The mandible was the most frequent site for both FCOD (86%) and COF (70%). Radiographically, a well-defined border was observed in 53% of cases of FCOD and 85% of cases of COF (p < 0.01). Cases of FCOD mostly demonstrated an irregularly mixed radio-opacity (69%), whereas 53% of COFs presented as a radiolucency (p < 0.005). In FCOD, there was a close association with tooth apices (70.6%, p < 0.0001) or with previous extraction sites (21%, p < 0.05); however, the majority of COF cases (86%) showed no relationship with either. Combining the radiographic feature of a periapical location with the pathology of multiple curetted fragments and "ginger root" bony trabeculae, allowed 90% sensitivity and 89% specificity in a logistic regression model to predict the lesion to be an FCOD. These findings provide guidelines not only to distinguish these two entities clinically, but also aid in reaching an accurate diagnosis histopathologically.
局灶性牙骨质骨发育异常（FCOD）（包括发生于上下颌前部和后部的病变）与牙骨质化纤维瘤（COF）（骨化纤维瘤和牙骨质化纤维瘤）独特的组织病理学特征已在我们早期的研究中得到证实。本研究的目的是进一步细化它们的临床和影像学特征。我们通过单因素比较（卡方检验和Student t检验）以及多因素评估（逻辑回归），对241例FCOD病例和75例COF病例的18项临床和影像学参数进行了评估。这些病例是根据临床、影像学和组织病理学信息综合诊断的。FCOD主要见于黑人女性，发病高峰在第四和第五个十年，而COF除在第四个十年外无女性偏好（p < 0.005）。COF患者的平均年龄比FCOD患者小10岁（p < 0.0001）。大多数FCOD患者无症状（62%）；病变平均大小为1.8 cm。超过一半的COF患者出现颌骨膨胀，病变尺寸大得多（平均3.8 cm，p < 0.001）。下颌骨是FCOD（86%）和COF（70%）最常见的发病部位。影像学上，53%的FCOD病例和85%的COF病例观察到边界清晰（p < 0.01）。FCOD病例大多表现为不规则混合性不透光区（69%），而53%的COF表现为透光区（p < 0.005）。在FCOD中，与根尖密切相关（70.6%，p < 0.0001）或与既往拔牙部位相关（21%，p < 0.05）；然而，大多数COF病例（86%）与两者均无关联。在逻辑回归模型中，将根尖部位的影像学特征与多个刮除碎片的病理学特征及“姜根”样骨小梁相结合，预测病变为FCOD的敏感性为90%，特异性为89%。这些发现不仅为临床区分这两种病变提供了指导，也有助于在组织病理学上做出准确诊断。
