锥形束CT及免疫组织化学染色在根尖周囊肿诊断与鉴别诊断中的应用

doi:10.7518/gjkq.2025075

摘要/Abstract

摘要：

目的探讨锥形束CT（CBCT）和免疫组织化学染色在根尖周囊肿、根尖周肉芽肿和牙源性角化囊肿鉴别诊断中的应用价值。方法收集143例根尖周囊肿和45例根尖周肉芽肿患者的临床病理及影像学资料，分析二者诊断结果的一致性；选取根尖周囊肿29例，牙源性角化囊肿24例，分别进行免疫组织化学染色（CK14、CK19、CD57和Ki-67），分析免疫组织化学染色在根尖周囊肿诊断中的价值。结果根尖周囊肿经CBCT诊断准确率为68.5%，根尖周肉芽肿经CBCT诊断准确率为44.4%，但CBCT诊断结果与病理学诊断结果的一致性较差（Kappa<0.4）。CBCT诊断根尖周囊肿的正确性与发病部位（P=0.033）、上皮剩余（P=0.036）和泡沫细胞（P=0.027）有相关性，而与胆固醇裂隙、出血、钙化、急慢性炎症以及炎症程度无相关性（P>0.05）。根尖周囊肿和牙源性角化囊肿中上皮标志物的表达：大部分病例CK14和CK19阳性表达，CD57阴性表达。细胞增殖活性标志物的表达：根尖周囊肿的Ki-67阳性细胞率为1%~3%，严重感染会增加至15%；牙源性角化囊肿Ki-67阳性细胞率为1%~3%或10%~80%。结论 CBCT诊断根尖周囊肿和根尖周肉芽肿的敏感性较好，而特异性较差。CBCT诊断根尖周囊肿的正确性与发病部位、上皮剩余以及泡沫细胞相关，而与胆固醇裂隙、出血、钙化、急慢性炎症以及炎症程度无关。牙源性角化囊肿患者Ki-67表达阳性细胞数高于根尖周囊肿，且主要定位于副基底细胞层。

关键词: 根尖周囊肿, 病理诊断, 锥形束CT, 免疫组织化学染色

Abstract:

Objective　This study aimed to investigate the diagnostic and differential diagnostic utility of cone beam computed tomography (CBCT) and immunohistochemical staining in distinguishing among periapical cysts, periapical granulomas, and odontogenic keratocysts. Methods　The clinicopathological and imaging data of 143 patients with periapical cysts and 45 patients with periapical granulomas were collected and analyzed. A total of 29 cases of paraffin-embedded periapical cysts and 24 cases of odontogenic keratocysts were selected. Immunohistochemical stai-ning for CK14, CK19, CD57, and Ki-67 was performed, and the relevant literature was reviewed. Results　The accuracy of CBCT in the diagnosis of periapical cyst was 68.5%, and the accuracy of CBCT in the diagnosis of periapical granuloma was 44.4%. However, CBCT diagnoses are inconsistent with the pathological results for periapical cysts and granulomas (Kappa<0.4). The accuracy of CBCT in the diagnosis of periapical cyst was related to the location of the lesion (P=0.033), residual epithelium (P=0.036), and foam cells (P=0.027) but not to cholesterol cleft, hemorrhage, calcification, acute and chronic inflammation, and the degree of inflammation (P>0.05). Expression of epithelial markers in periapical cysts and odontogenic keratocysts: CK14 and CK19 were positively expressed in most cases, and CD57 was negatively expressed. Expression of markers of cell proliferative activity: Ki-67 positivity in periapical cysts ranged from 1% to 3%, severe infection increased Ki-67 positivity to 15%, and Ki-67 positivity in odontogenic keratocysts ranged from 1% to 3% or 10% to 80%. Conclusion　The sensitivity of CBCT in the diagnosis of periapical cysts and periapical granulomas is good, but the specificity is poor. The accuracy of CBCT in the diagnosis of periapical cysts is related to the location of the lesion, residual epithelium, and foam cells but not to cholesterol cleft, hemorrhage, calcification, acute and chronic inflammation, and the degree of inflammation. The number of Ki-67-positive cells in patients with odontogenic keratocysts was higher than that in periapical cysts, and the positive cells were mainly located in the accessory basal cell layer.

Key words: periapical cyst, pathological diagnosis, cone beam computed tomography, immunohistochemical staining

中图分类号:

R781.34

黄美畅,蒋鸿杰,汤亚玲,姚莉洪. 锥形束CT及免疫组织化学染色在根尖周囊肿诊断与鉴别诊断中的应用[J]. 国际口腔医学杂志, 2025, 52(4): 490-497.

Meichang Huang,Hongjie Jiang,Yaling Tang,Lihong Yao. Cone beam computed tomography and immunohistochemical staining for the diagnosis and differential diagnosis of periapical cysts[J]. Int J Stomatol, 2025, 52(4): 490-497.

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