A multimodal diagnostic approach to intraosseous jaw lesions: clinical, radiographic, and histopathologic correlation

Abstract

Objective: Intraosseous jaw lesions present diagnostic challenges due to overlapping features and limited data on inter-modality concordance. Therefore, this study aimed to determine the diagnostic concordance between clinical, radiographic, and histopathologic assessments of intraosseous jaw lesions. Methods: A retrospective review was conducted on patients’ charts referred for cone-beam computed tomography (CBCT) of intraosseous jaw lesions at an oral surgery private practice (Dataset 1) between 2017 and 2024 and a university oral health clinic (Dataset 2) between 2019 and 2024. Descriptive characteristics were examined. Inter-rater agreement and the association between concordance and patient/lesion characteristics were analyzed. Results: A total of 196 cases were analyzed. In Dataset 1, absolute concordance between clinical, oral and maxillofacial radiologist (OMFR) reports, and histopathologic diagnosis was 30.1%. Substantial agreement was observed between clinical and histopathologic diagnoses ( κ = 0.617), with only fair agreement between clinical and OMFR reports ( κ = 0.336). In Dataset 2, moderate agreement was observed between clinical and OMFR diagnoses ( κ = 0.464). Radiolucent lesions and younger patients exhibited higher discordance, whereas radiopaque lesions and patients aged 41–60 yr showed higher concordance. Dentigerous cysts were the most frequently diagnosed lesion (47.9%); however, 76.3% of these cases were discordant on OMFR reports. Conclusion: This study revealed low absolute diagnostic agreement (30%) in private practice. On the contrary, a higher absolute agreement of 46% was found between clinical and radiographic diagnoses in academic settings. These findings highlight the need for a standardized, multidisciplinary diagnostic approach to enhance diagnostic accuracy, improve communication among professionals, and support better treatment planning.