Keratocyster: Overensstemmelse mellem tentativ klinisk/radiologisk diagnose og histopatologisk
Baggrund – Den odontogene keratocyste (OKC) udgør omkring 10 % af alle cyster diagnosticeret i kæberne. Diagnosen er baseret på histopatologisk undersøgelse, og selvom kliniske og radiologiske fund ofte giver mistanke om keratocyste, er det ikke sjældent at den kliniske diagnose ikke er i overensstemmelse med det histopatologiske billede. Formål – At undersøge overensstemmelsen mellem den kliniske tentative diagnose og den histopatologiske diagnose blandt konsekutive tilfælde af keratocyster. Materiale og metoder – 78 konsekutive tilfælde af keratocyster er analyseret for demografiske og kliniske optegnelser samt kliniske tentative diagnoser. Materialet stammede fra odontologiske specialistafdelinger på danske hospitaler samt fra de to tandlægeskoler i Danmark. Resultater – 67 % af patienterne var mænd, og aldersspredningen var 7-84 år. To tredjedele af OKC forekom i mandiblen. Den kliniske diagnose ”keratocyste” fremgik i 37 % af tilfældene, mens 34 % af tilfældene diagnosticeredes klinisk som en anden kæbecyste. I andre 17 % blev der stillet en uspecifik cystediagnose. I 6 % af tilfældene var den kliniske diagnose en odontogen tumor. I 63 % af tilfældene kunne klinikeren således ikke stille den korrekte diagnose ud fra kliniske og radiologiske fund. Konklusion – Selv erfarne klinikere kan have problemer med at differentiere mellem keratocyster og andre kæbecyster. Undersøgelsen understøtter vigtigheden af, at alt væv fjernet ved et kirurgisk indgreb, hvor andre undersøgelsesformer ikke kan afgøre diagnosen definitivt, skal undersøges histologisk for at sikre korrekt diagnostik, adækvat behandling og opfølgning.
Klinisk relevans:
Concordance between tentative clinical/radiological diagnosis and histopathological diagnosis: Introduction – About 10% of all cysts in the jaws are odontogenic keratocysts (OKC) (keratocystic odontogenic tumours). The diagnosis is based on histopathologic examination although clinical and radiologic features often give suspicion of keratocyst. Objectives – The aim of the present study was to examine the concordance between the tentative clinical diagnosis and the final histopathological diagnosis among consecutive cases of keratocysts. Materials and methods – 78 consecutive cases of histopathologically confirmed keratocysts were analysed for demographic and clinical records, and tentative clinical diagnoses. The material originated from departments of oral and maxillofacial surgery in Danish hospitals and the oral surgery departments in the two dental schools in Denmark. Results – 67% of patients were men, and the age distribution was 7-84 years. Two thirds of the keratocysts were located in the mandible. The clinical diagnosis ”keratocyst” was made in 37% of the cases, while 34 % of the cases were diagnosed clinically as another specific jaw cyst. In 17% a non-specific diagnosis of ”cyst” was made. In 6 % of the cases the clinical diagnosis was an odontogenic tumour. Thus, in 63 % of the cases the clinician could not make the correct diagnosis based on clinical and radiologic features. Conclusion – Even experienced clinicians can fail in differentiating between keratocysts and other jaw cysts. The results of this study emphasize the importance of histopathological examination if other examinations cannot secure a definite diagnosis, in order to ensure adequate treatment and follow-up.
