Ultrasound imaging for the differential diagnosis of periapical lesions of endodontic origin in comparison with histopathology – a systematic review and meta‐analysis

Velmurugan, Natanasabapathy; Arul, Buvaneshwari; Mishra, Anisha; Varghese, Aswathi; Padmanaban, S; Elango, Subashini; Arockiam, Selva

doi:10.1111/iej.13465

Cited by 11 publications

(16 citation statements)

References 58 publications

(189 reference statements)

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“…Periapical radiographs are used in routine dental practice to determine pulpal involvement in cases [ 46 ]. They have been used to determine the nature of the periapical lesion depending upon the size, shape, location, and effect on peripheral structures [ 17 , 47 ]. Ultrasound, on the other hand, is a newer imaging modality that will require training and investment from dentists to apply in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review

et al. 2021

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Background: Ultrasonography is a non-invasive method of diagnosing periapical lesions while radiologic methods are more common. Periapical lesions due to endodontic infection are one of the most common causes of periapical radiolucency that need to be distinguished to help determine the course of treatment. This review aimed to examine the accuracy of ultrasound and compare it to radiographs in distinguishing these lesions in vivo. Methods: This review process followed the PRISMA guidelines. A literature search of databases (PubMed, Scopus, Embase, and Web of Science) was conducted without any restrictions on time. Articles available in English were included. The selection was done according to the inclusion and exclusion criteria. The QUADAS-2 tool was used to assess the quality of the studies. Results: The search provided a total of 87 articles, out of which, five were selected for the final review. In all the studies, ultrasound had higher accuracy in distinguishing periapical lesions. All the studies indicated a risk of bias, especially in patient selection. Conclusion: Within limitations, the study indicates that ultrasound is a better diagnostic tool to distinguish periapical lesions compared to radiographs but further studies with well-designed, rigorous protocols and low risk of bias are needed to provide stronger evidence.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review

et al. 2021

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“…have proposed that some periapical cysts can heal after root canal treatment as no difference exists between a true and a pocket cyst. [ 9 19 ] However, in that article, the initial diagnosis was made using only radiographic images. Furthermore, the assumption that a true cyst might heal after nonsurgical endodontics can be only authenticated through outcome-based studies and literature is sparse in this regard.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 5 6 7 ] Ionizing radiations, higher cost, and subjectiveness in the interpretation of the number of greyscale values in the images are its limitations. [ 8 9 ]…”

Section: Introductionmentioning

confidence: 99%

Reliability of Ultrasonography in differentially diagnosing periapical lesions of endodontic origin in comparison with Intra-oral periapical radiography and Cone-beam computed tomography: An in vivo study

Das

Adhikari

2021

J Conserv Dent

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Background: Periapical granuloma, radicular cyst, and periapical abscess represent periapical changes of frequent occurrence. Addressing this diagnostic dilemma is a matter of great concern, as it aids in governing the treatment planning and predicting its outcome. Aim: To evaluate the comparative accuracy of ultrasonography (USG), intraoral periapical (IOPA) radiography, and cone-beam computed tomography (CBCT) in differentially diagnosing periapical lesions of endodontic origin. Methods: Thirty-five patients having periapical lesions associated with anterior teeth requiring endodontic therapy were included in the study. The lesions were analyzed using IOPA radiographs, CBCT scans, and USG with color Doppler (CD). Periapical surgery ensued and enucleated tissue samples were subjected to histopathological analysis. To evaluate the accuracy, diagnoses made by each of the three modalities were compared with the gold standard histopathological reports, and the diagnostic accuracy, sensitivity, and specificity of each were calculated. Statistical Analysis: Cohen kappa (κ) was used for interrater reliability, and Pearson's contingency coefficient (C) was used for correlating findings of USG with histopathology. Results: USG showed good concordance with histopathological findings (contingency coefficient: 0.664). It also showed a higher accuracy rate compared to IOPA radiography and CBCT in differentially diagnosing periapical lesions. Conclusion: USG with CD holds the potential to be used as a noninvasive adjunct in periapical diagnostics.

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“…Periapical cysts (PCs) evolve from epithelial remnant cells within periapical granulomas (PGs), with the formation of the cystic lumen caused by a chronic inflammatory reaction [ 4 ]. The accurate diagnosis of a periapical lesion as a cyst or granuloma helps dentists choose a precise treatment strategy [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Interplay of collagen and mast cells in periapical granulomas and periapical cysts: a comparative polarizing microscopic and immunohistochemical study

et al. 2022

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Objectives This pilot study aimed to establish the interrelationship between collagen and mast cells in periapical granulomas and periapical cysts. Materials and Methods An observational cross-sectional study was conducted on the paraffin-embedded tissue sections of 68 specimens (34 periapical granulomas and 34 periapical cysts). The specimens were stained with picrosirius to observe collagen fiber birefringence and anti-tryptase antibody to evaluate the mast cell count immunohistochemically. The mean number and birefringence of collagen fibers, as well as the mean number of mast cells (total, granulated, and degranulated), and the mean inflammatory cell density were calculated. The data obtained were analyzed using the Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test ( p < 0.05). Results The mean number of thick collagen fibers was higher in periapical cysts, while that of thin fibers was higher in granulomas ( p = 0.00). Cysts emitted orange-yellow to red birefringence, whereas periapical granulomas had predominantly green fibers ( p = 0.00). The mean inflammatory cell density was comparable in all groups ( p = 0.129). The number of total, degranulated, and granulated mast cells exhibited significant results ( p = 0.00) in both groups. Thick cyst fibers showed significant inverse correlations with inflammation and degranulated mast cells ( p = 0.041, 0.04 respectively). Conclusions Mast cells and inflammatory cells influenced the nature of collagen fiber formation and its birefringence. This finding may assist in the prediction of the nature, pathogenesis, and biological behavior of periapical lesions.

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Ultrasound imaging for the differential diagnosis of periapical lesions of endodontic origin in comparison with histopathology – a systematic review and meta‐analysis

Abstract: Conclusion 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.

Cited by 11 publications

References 58 publications

Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review

Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review

Reliability of Ultrasonography in differentially diagnosing periapical lesions of endodontic origin in comparison with Intra-oral periapical radiography and Cone-beam computed tomography: An in vivo study

Interplay of collagen and mast cells in periapical granulomas and periapical cysts: a comparative polarizing microscopic and immunohistochemical study

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