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Hindawi Radiology Research and Practice Volume 2019, Article ID 4056359, 5 pages https://doi.org/10.1155/2019/4056359 Research Article The Agreement Rate between Radiographic Interpretation and Histopathologic Diagnosis of Jaw Lesions Soulafa Almazrooa, Nada O. Binmadi, Hanadi M. Khalifa ,FatimaM.Jadu , AhmedM.Jan,andDaliaE.Meisha Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Correspondence should be addressed to Fatima M. Jadu; firstname.lastname@example.org Received 23 December 2018; Revised 3 February 2019; Accepted 14 February 2019; Published 4 March 2019 Academic Editor: Paul Sijens Copyright © 2019 Soulafa Almazrooa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. To determine the agreement rate between histopathologic diagnosis and radiographic interpretation of jaw lesions. Methods. Cases with jaw pathologies that have diagnostically adequate histopathologic samples and radiographic examinations were reviewed retrospectively. Two board-certified oral and maxillofacial pathologists (OMFP) independently determined the histopathologic diagnosis, while two board-certified oral and maxillofacial radiologists (OMFR) determined the radiographic interpretations independently. en Th the histopathologic diagnosis and the radiographic interpretation were compared for agreement. Results. A total of 104 cases (53% females) were included with a mean age of 31 years. eTh agreement rate between histopathologic diagnosis and radiographic interpretation was 49%. OMFP required OMFR consultations to reach a diagnosis in 16% of cases. eTh most commonly encountered lesions were by far odontogenic cysts of inflammatory origin and the agreement for this disease category was 49.1%. However, agreement rates were highest for the disease category of tumors (62.5%). Conclusion. The agreement rate between OMFP and OMFR was higher for tumors than cysts. Agreement rates between OMFP and OMFR improved with efficient consultation between the two disciplines. 1. Introduction The overall concordance between clinical findings and histopathologic diagnosis ranges between 50 and 99% [2– eTh oral and maxillofacial area is a complex region with 4]. However, there is no data on the concordance between many tissues andstructuresandisthusthesiteofmuch radiographic interpretation and histopathologic diagnosis of diverse pathology. Some of these pathologies aeff ct the soft jaw lesions. er Th efore, in the current study, we investigated tissues, while others affect the osseous tissues and others the agreement rate between radiographic interpretation and aeff ct both tissues. eTh clinical and radiographic findings play histopathologic diagnosis of jaw lesions. asignicfi antroleindiagnosisbuthistopathologyisusuallythe major determinant of the diagnosis. Biopsy is the gold standard for the diagnosis of many jaw 2. Materials and Methods pathologies . eTh diagnosis assigned by a pathologist at In this retrospective review, the records of all patients the end of a biopsy report is often the basis on which many referred to a university-based oral and maxillofacial pathol- crucial decisions are based in regard to patient management ogy service over a three-year period were reviewed. Inclusion and prognosis. Yet, the accuracy of a pathologists’ ability to criteria included the availability of diagnostically adequate reach the correct diagnoses is an inadequately studied area. histopathologic samples and diagnostically adequate imag- In the literature, the highest misdiagnosis rate was related to non-odontogenic tumors of the oral cavity, accounting ing with reports of jaw lesions based on the 2017 World for approximately 11.5%, followed by malignant tumors, Health Organization (WHO) classicfi ation of odontogenic accounting for approximately 9% . and maxillofacial lesions . This descriptive study took place 2 Radiology Research and Practice Table 1: Descriptive statistics for the cases included in the study (N=104). Study Variable Descriptive Statistics Mean + SD (range) Age (years) 30.7+ 16.2 (4-76) % (N) Gender (female) 53.8% (56) Location (mandible) 53.8% (56) Disease category: (i) Odontogenic cysts of inflammatory origin 52.9% (55) (ii) Odontogenic developmental cysts and non-odontogenic cysts 28.8% (30) (iii) Tumors (benign and malignant) 15.4% (16) (iv) Fibro-osseous lesions 2.9% (3) Advanced imaging 18.3% (19) SD: standard deviation; advanced imaging: any three-dimensional imaging such as computed tomography, cone beam computed tomography, or magnetic resonance imaging. at the Faculty of Dentistry of King Abdulaziz University, Jed- Furthermore, eighty-one percent of cases of the 128 cases had dah, Saudi Arabia. Data collection commenced aer ft ethical diagnostically adequate images. One hundred and four cases approval from the research ethics board (Number 009-15) were included in this study. was obtained. The guidelines of the Helsinki Declaration were Table 1 exhibits the descriptive statistics for the cases followed diligently. Each patient was assigned a unique num- included in the study sample. eTh mean age was 31 years ber that linked the clinical, radiographic, and histopathologic with awiderange of agefrom4yearsto76years.There information. However, this information was available only to was almost equal representation in terms of gender and the principal investigator so that no connection can be made location of the pathology (maxilla versus mandible). In to the patient. terms of the disease categories, the most prevalent category Two board-certified oral and maxillofacial pathologists was odontogenic cysts of inflammatory origin (55%), while (OMFP) reviewed the histopathology samples and their fibroosseous lesions (FOL) were the least prevalent (2.9%). diagnosis was based on the 2017 World Health Organization Only18%ofcases hadsomeformofadvancedimaging (WHO) classicfi ation of odontogenic and maxillofacial bone defined as any three-dimensional imaging such as computed lesions . Two board-certified oral radiologists (OMFR) tomography, cone beam computed tomography, or magnetic reviewed and interpreted the radiographic images. Brief resonance imaging. clinical information was available to both disciplines as age, In sixteen percent of cases, OMFP required OMFR gender, location, and pertinent medical history, if any. eTh consultation to reach a diagnosis. Agreement between OMFP histopathology requisition form did not consistently include andOMFRwas demonstratedinalmosthalfofthecases reference to the availability of imaging for each case. (49%), whereas no agreement was reached in 35% of cases All available images were reviewed including periapical (Figure 1). and bitewing radiographs, panoramic radiographs, cone eTh need for communication between OMFP and OMFR beam computed tomography (CT), multidetector CT, and varied according to the disease category. Communication was not needed for 93.8% of cases under the tumors cat- magnetic resonance imaging (MRI) examinations. Disagree- ments among the disciplines were resolved by consensus. egory and 89.1% of cases under the odontogenic cysts of inflammatory origin category (Figure 2). eTh odds of needing Cases were allocated into disease categories consistent communication between OMFP and OMFR were about 2.5 with the 2017 World Health Organization (WHO) classica fi - times higher for odontogenic cysts of developmental origin tion of odontogenic and maxillofacial lesions . eTh n, the and non-odontogenic cysts compared to odontogenic cysts of histopathologic diagnosis was compared to the radiographic inflammatory origin but did not reach statistical significance interpretation and each case was given one of three codes (oddsratio (OR):2.5,95%CIofOR:0.7-8.2). Whilethe based on the agreement between the two disciplines: (0) odds of needing communication were half for tumor cases no agreement, (1) agreement, and (2) if communication was compared to cases with odontogenic cysts of inflammatory needed between the two disciplines to reach a diagnosis. origin (OR: 0.5, 95% CI of OR: 0.06- 4.9). The need of Statistics were done using the Statistical Package for Social communication between OMFP and OMFR was three times Sciences (SPSS 22, Windows, SPSS Inc., Chicago, USA). more with cases having advanced imaging compared to cases Percent agreement was calculated. withconventional imagingonly(OR:3.2,95%CIofOR:1- 10.4). 3. Results The percent agreement between OMFP and OMFR in this sample varied according to the disease category and was The initial sample included 311 cases. Of these, only 128 cases (41%) had a diagnostically adequate histopathologic sample. highest for the tumors category (62.5%). This was followed Radiology Research and Practice 3 Communication 62.5 needed 49.1 46.7 16% Agreement without communication No agreement 49% 35% Odontogenic cysts of Odontogenic cysts of Tumors (benign and malignant) inflammatory origin developmental origin and non- odontogenic cysts Disease Categories Figure 3: Percent agreement between histopathologic diagnosis and radiographic interpretation based on disease categories. Agreement without communication No agreement Communication needed and proceeds through several stages that requires input from numerous outlets including clinical findings, imaging nd- fi Figure 1: Agreement and need of communication to reach a ings, and histopathology findings. Therefore, it is essential diagnosis between oral and maxillofacial pathologist (OMFP) and oral and maxillofacial radiologist (OMFR). that these data be collected in a thorough manner to ensure completeness.Itisalsocrucial that thesedatabecorrelatedto ensure comprehensiveness. 100% 90% Cohen’skappa isthemostcommonlyusedmeasure to 80% assess inter-rater reliability ; however Kappa was incal- 70% 60% culable in this study because the histopathologic diagnosis 50% is the gold standard and therefore was constant. This is 40% 30% a recognized limitation of Kappa . Percent agreement 20% was calculated instead and was found to be 49% between 10% 0% radiographic interpretation and histopathologic diagnosis, Odontogenic cysts Odontogenic cysts Tumors (benign and Fibro-osseous which is lower than other published studies. A study by of inflammatory of developmental malignant) lesions origin origin and non- Sarabadani et al. in 2013 found the concordance between odontogenic cysts radiology and histopathology for central jaw lesions to be Disease Categories 71.4% , whereas the concordance between clinical impres- No communication needed sion and histopathology diagnosis was 80.4% . Several Communication needed studies have investigated the concordance between clinical and histopathology without any regard for imaging data. Figure 2: Comparison of percentage of cases that did and did not This may be due to the few number of cases with available require communication between oral and maxillofacial pathologist (OMFP) and oral and maxillofacial radiologist (OMFR) in relation imaging. to disease categories. The most commonly encountered disease category was odontogenic cysts of inflammatory origin. This disease cat- egory accounted for 53% of cases included in this review; however, the agreement rate for this entity was only 49%. This by odontogenic cysts of inflammatory origin (49.1%) and is due to the fact that dieff rentiating periapical granulomas odontogenic cysts of developmental origin as well as non- from cysts is challenging from an imaging perspective. odontogenic cysts (46.7%). For the FOLs disease category, From a practical perspective, this differentiation may not be there was no agreement at all between OMFR and OMFR. necessary since both conditions are usually treated similarly. eTh seresultsare demonstratedinFigure3.Theoddsof Agreement rates were highest for tumors perhaps because the agreement between OMFP and OMFR were about twice features of these lesions are undebatable or perhaps because times higher for tumors compared to odontogenic cysts of the reviewers were not required to assign a specific disease inflammatory origin but did not reach statistical significance label. This measure was taken because from an imaging (OR= 1.7, 95% CI of OR: 0.6- 5.4). While the odds of agree- perspective it is usually easy to recognize malignant features ment were almost comparable for cysts of developmental but it is dicffi ult to pinpoint the exact type of malignancy. origin compared to odontogenic cysts of inflammatory origin The radiographic images that were examined in the cases (OR= 0.9, 95% CI of OR: 0.4-2.2). currentstudy were notlimitedtoaspecicfi type ornumber andincludedany images thatwereavailablefor each case. 4. Discussion These included conventional images as well as advanced Reaching an accurate diagnosis is a fundamental step in the imaging, such as cone beam computed tomography (CBCT), process of patient management and treatment planning. eTh conventional computed tomography (CT), and magnetic process of reaching a correct diagnosis is not an easy one resonance imaging (MRI). eTh accuracy of each type of Percentage of Cases Percent Agreement 4 Radiology Research and Practice imaging varies, which ultimately influences the accuracy of 5. Conclusion the interpretation. We predict that the agreement between Agreement rates between OMFP and OMFR were higher radiographic interpretation and histopathology diagnosis for tumors when compared to cysts. Also, agreement rates may have been higher, had all the available images been between OMFP and OMFR improved with ecffi ient consulta- of theadvancedtype. Advanced imagingisthestandard tion between the two disciplines. Future studies should aim to of care in most cases with pathology because the three- investigate the agreement among clinical, radiographic, and dimensional imaging provides significantly more informa- histopathologic ndin fi gs. tion regarding the features, behavior, and extent of the lesion, which improves the interpretation process. Future studies should examine the eeff ct of imaging type on the agreement Data Availability rate with histopathologic diagnosis. eTh data used to supportthe nfi dingsofthisstudy are Approximately 16% of the osseous lesions reviewed in this study required communication between OMFP and OMFR included within the supplementary information files. before a na fi l histopathologic diagnosis was assigned. This was especially true for FOL as 67% required communication Disclosure with the radiologist. FOL lesions such as b fi rous dysplasia for example are known to be challenging in terms of histopatho- The research did not receive any specific grant from funding logic diagnosis, their features can be confused with those of agencies in the public, commercial, or not-for-protfi sectors. other forms of b fi ro-osseous lesions and with osteomyelitis and even well differentiated osteogenic sarcoma [9–11]. Three Conflicts of Interest vastly different conditions with extremely different manage- ment approaches. For these cases, imaging plays a significant The authors declare no conflicts of interest. role and communication between the OMFP and OMFR becomes of paramount importance. Supplementary Materials Gephardt at al. reported that missing information such as theanatomiclocationofthelesion canresultinrevision The supplemental material is the data on which the ndings fi or even changing of a histopathologic diagnostic decision of the study are based. I submitted it as supplemental material . Furthermore, other studies have demonstrated that as per the author instruction. (Supplementary Materials) amended histopathology reports aer ft consultation with the clinician or radiologist lead to major changes in manage- References ment in 3.8% of cases and minor changes in 2.9% of cases . er Th efore, it is essential for OMFP to communicate  R. J. Melrose, J. P. Handlers, S. 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