1<0.4</sub> ）。CBCT診斷根尖周囊腫的正確性與發(fā)病部位（ P=0.033 ）、上皮剩余（ P=0.036 ）和泡沫細(xì)胞（ P= 0.027）有相關(guān)性，而與膽固醇裂隙、出血、鈣化、急慢性炎癥以及炎癥程度無相關(guān)性（ (P>0.05) 。根尖周囊腫和牙源性角化囊腫中上皮標(biāo)志物的表達(dá)：大部分病例CK14和CK19陽性表達(dá)，CD57陰性表達(dá)。細(xì)胞增殖活性標(biāo)志物的表達(dá)：根尖周囊腫的Ki-67陽性細(xì)胞率為 1%～3% ，嚴(yán)重感染會(huì)增加至 15% ；牙源性角化囊腫Ki-67陽性細(xì)胞率為 1%～3% 或 10%～80% 。結(jié)論CBCT診斷根尖周囊腫和根尖周肉芽腫的敏感性較好，而特異性較差。CBCT診斷根尖周囊腫的正確性與發(fā)病部位、上皮剩余以及泡沫細(xì)胞相關(guān)，而與膽固醇裂隙、出血、鈣化、急慢性炎癥以及炎癥程度無關(guān)。牙源性角化囊腫患者Ki-67表達(dá)陽性細(xì)胞數(shù)高于根尖周囊腫，且主要定位于副基底細(xì)胞層。-龍?jiān)雌诳W(wǎng)" />

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錐形束CT及免疫組織化學(xué)染色在根尖周囊腫診斷與鑒別診斷中的應(yīng)用

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[中圖分類號]R781.34 [文獻(xiàn)標(biāo)志碼]A [doi] 10.7518/gjkq.2025075

[Abstract]ObjectiveThis studyaimed to investigate the diagnosticanddiferential diagnosticutilityofcone beam computed tomography（CBCT）and immunohistochemical staining in distinguishing among periapicalcysts，periapical granulomas，andodontogenic keratocysts.MethodsTheclinicopathologicalandimagingdataof143 patients with periapical cystsand45 patientswithperiapical granulomas werecolectedand analyzed.Atotal of 29cases of parafinembeddedperiapical cystsand24casesofodontogenic keratocysts were selected. Immunohistochemical stainingfor CK14，CK19，CD57，andKi-67wasperformed， andtherelevant literaturewasreviewed.ResultsThe accuracy of CBCT in the diagnosis of periapical cyst was 68.5% ，and the accuracy of CBCT in the diagnosisof periapical granuloma was 44.4% .However， CBCT diagnoses are inconsistent with the pathological results for periapical cysts and granulomas （Kappa <0.4 ）.Theaccuracy of CBCT in the diagnosis of periapical cyst was related to thelocation of the lesion （P=0.033 ），residual epithelium（ P=0.036 ），andfoamcells （P=0.027 ）but not to cholesterol cleft， hemorrhage，calcification，acute and chronic inflammation，and the degree of inflammation （P>0.05） .Expression of epithelial markers in periapical cysts and odontogenic keratocysts： CK14 and CK19 were positively expresed in most cases，and CD57was negatively expressed.Expressionof markersofcellproliferative activity：Ki-67positivity inperiapical cysts ranged from 1% to 3% ，severe infection increased Ki-67 positivity to 15% ，and Ki-67 positivity in odontogenic keratocysts ranged from 1% to 3% or 10% to 80% .ConclusionThe sensitivity of CBCT in the diagnosis of periapical cysts and periapicalgranulomas is good，butthespecificityispoor.TheaccuracyofCBCTinthediagnosis of periapical cysts is relatedtothelocationofthelesion，residualepithelium，andfoamcelsbutnottocholesterolcleft，hemorrage，calcification，acuteandchonicinflammation，andthedegreeofinflammation.ThenumberofKi-67-positivecelsinpatients withodontogenic keratocysts was higher thanthat inperiapicalcysts，andthepositivecells were mainlylocated inthe accessory basal cell layer.

[Key words]periapicalcyst；pathologicaldiagnosis；conebeamcomputedtomography；immunohistochemical staining

精確評估根尖周病損對臨床醫(yī)生進(jìn)行準(zhǔn)確診斷并制定恰當(dāng)?shù)闹委熡?jì)劃至關(guān)重要。（剩余14311字）

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