PERIAPICAL PATHOLOGY: COMPARISON OF CLINICAL DIAGNOSIS AND HISTOPATHOLOGICAL FINDINGS

Periapical lesions are often diagnosed on clinical and radiological basis that may be different from the histological finding. The purpose of this study was to compare clinical and radiographic features with histological diagnosis of periapical pathology.

A 22 year retrospective analysis of records of teeth diagnosed with periapical lesions that had periradicular surgery and the specimen sent for histopathological examination. Cases with incomplete records were excluded. Age, gender, site of lesion, clinical diagnosis, radiographic report and histopathological diagnosis etc were extracted from the records. The data were analyzed using SPSS version 20.0. Chi square test was used to test association between clinical and histological diagnosis at 95% level of confidence (i.e. p=0.05).

Nineteen cases were analyzed in patients within age range of 17 to 57years with a mean age of 32.2±11.7 years and male to female ratio of 1.1:1. All the affected teeth were upper incisors. Majority (n= 13; 68.4%) of the cases were clinically diagnosed to be periapical cyst. While on histological analysis, majority (n=16; 84.2%) of the total cases were diagnosed as periapical granuloma. Ten cases (76.9%) out of 13 diagnosed clinically to be periapical cyst had sclerotic border (p=0.003).

This study showed sensitivity and specificity of radiographs in detecting periapical lesions were reduced when compared with histology. The insufficiency of conventional radiography in diagnosing periapical lesions could lead to unnecessary surgery for the patient, thus the need for advanced imaging to provide improved quality of diagnosis, treatment planning and prognosis.