Int J Stomatol

Int J Stomatol ›› 2025, Vol. 52 ›› Issue (4): 490-497.doi: 10.7518/gjkq.2025075

• Original Articles • Previous Articles     Next Articles

Cone beam computed tomography and immunohistochemical staining for the diagnosis and differential diagnosis of periapical cysts

Meichang Huang(),Hongjie Jiang,Yaling Tang,Lihong Yao()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-06-17 Revised:2024-11-13 Online:2025-07-01 Published:2025-06-20
  • Contact: Lihong Yao E-mail:hmcscu@163.com;yaolihongsansan@126.com
  • Supported by:
    Clinical Research Project Funded by West China Hospital of Stomatology, Sichuan University(LCYJ-MS-202308)

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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

CLC Number: 

  • R781.34

TrendMD: 

Tab 1

Comparison of pathology and CBCT diagnosis results"

诊断结果诊断方式χ2值P值
病理CBCT
根尖周囊肿1431234.6040.042
根尖周肉芽肿4565

Tab 2

Consistency analysis of CBCT and pathological diagnosis results"

病理学诊断结果CBCT诊断结果Kappa值P值
灵敏度/%特异度/%
根尖周囊肿68.544.40.1420.044
根尖周肉芽肿44.468.5

Fig 1

ROC curve for CBCT diagnosis"

Tab 3

The conformity of CBCT diagnosis of periapical cysts and its correlation with clinical pathological indicators"

临床病理指标病例数CBCT诊断根尖周囊肿结果P值
符合不符合
发病部位上颌前牙7961180.033
上颌后牙261412
下颌前牙1082
下颌后牙281513
上皮剩余有12570.036
无1319338
胆固醇裂隙有4231110.122
无1016744
泡沫细胞有363060.027
无1076839
出血有9162290.892
无523616
钙化有8354290.293
无604416
急慢性炎症有3221110.688
无1117734
炎症程度轻度4430190.946
中度362412
重度634414

Fig 2

IHC staining of periapical cysts SABC × 200"

Fig 3

IHC staining of odontogenic keratocyst SABC × 200"

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