Radiographic interpretation of unilocular radiolucent mandibular lesions

ABSTRACT

The main goal of this study was to identify the main distinctive radiographic characteristics of different unilocular radiolucent mandibular lesions based on the criteria used by different groups of specialists during the process of radiograph interpretation to arrive at a correct diagnosis. A total of 24 panoramic radiographs were selected exhibiting the following lesions ameloblastoma, keratocystic odontogenic tumor, dentigerous cyst and simple bone cyst. Six cases of each pathology were analyzed by 3 specialists from 4 related areas (pathologists, stomatologists, radiologists and oral surgeons). A number of important distinctive features and confounding characteristics that are liable to misinterpretation were pointed out by the specialists during the analysis. The method of generalized estimating equations (GEE) was used to estimate the probability of correct diagnosis according to the specialization of the examiner and the type of lesion and no significant relation was found (p>0.05 for all variables). The overall percentage of correct diagnosis among the specialists was around 56%, which shows that these lesions are of difficult radiographic diagnosis. Although the specialty of the examiners did not influence the results, i.e., the 4 different kinds of specialists showed the same diagnostic capacity, the criteria used for interpreting the same lesions were often different among the specialists. The compilation of these criteria enabled the identification and selection of some useful distinctive radiographic characteristics to formulate diagnostic hypothesis of unilocular radiolucent lesions. The radiographic diagnosis of the unilocular radilucent mandibular lesions is particularly difficult and the histopathological examination is essential to make the definitive diagnosis.

RESUMO

O objetivo deste estudo foi identificar as principais caracteristicas radiograficas para a diferenciacao de lesoes radiolucidas uniloculares mandibulares, por meio dos criterios utilizados por diferentes grupos de especialistas durante o processo de interpretacao radiografica para a obtencao dos diagnosticos corretos das lesoes. Vinte e quatro radiografias panoramicas foram selecionadas exibindo as seguintes lesoes ameloblastoma, tumor odontogenico queratocistico, cisto dentigero e cisto osseo simples. Seis casos de cada entidade patologica foram analisados por 3 especialistas de 4 areas diretamente relacionadas a diagnostico (patologistas, estomatologistas, radiologistas e cirurgioes buco-maxilo-faciais). Inumeras caracteristicas importantes tanto para a correta distincao quanto para a ocorrencia de confusao entre as lesoes, foram levantadas pelos especialistas durante a analise. O metodo de equacoes de estimacao generalizada (EEG) foi utilizado para estimar a probabilidade do acerto do diagnostico segundo a especialidade do examinador e o tipo de lesao, nao sendo encontrada relacao significativa (p>0.05 para todas as variaveis). A porcentagem geral de diagnostico correto entre os especialistas ficou em torno de 56%, o que mostra que estas lesoes sao de dificil diagnostico radiografico. Embora a especialidade dos examinadores nao tenha influenciado os resultados, isto e, os 4 tipos de especialistas mostraram a mesma capacidade diagnostica, os criterios utilizados para a interpretacao das mesmas lesoes foram frequentemente diferentes entre os especialistas. A compilacao desses criterios possibilitou a identificacao e selecao de algumas caracteristicas radiograficas distintivas uteis na formulacao de hipoteses diagnosticas de lesoes radiolucidas uniloculares. O diagnostico radiografico das lesoes radiolucidas uniloculares mandibulares e particularmente dificil e a analise histopatologica e essencial para a obtencao do diagnostico definitivo.