Why was the concordance rate of imaging and clinical diagnosis in cemento-osseous dysplasia low? A retrospective study of 55 cases.
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OBJECTIVE: The World Health Organization (WHO) recommends that cemento-osseous dysplasia (COD) be diagnosed based on imaging findings, avoiding biopsy when possible. This study aimed to evaluate the concordance between imaging and clinical diagnoses in 55 COD patients, and to identify key clinical and radiographic features that may help prevent unnecessary biopsy or inappropriate treatment. METHODS: Between September 1, 2017, and August 31, 2018, 55 patients diagnosed with COD were randomly selected from the imaging database of West China Hospital of Stomatology. Two radiologists reviewed all cases to assess correlations between COD variants and clinical symptoms, identify common misdiagnoses, and examine subsequent treatment decisions. RESULTS: The cohort showed a strong female predominance (female: male = 48:7). The concordance rate between imaging and clinical diagnoses was only 1.8% (1/55); the remaining 98.2% were either misdiagnosed or overlooked clinically. Most lesions were incidentally discovered on radiographs (65%), while others were associated with tooth pain (18%), facial swelling (9%), tooth mobility (5%), or abscess (2%). A statistically significant difference was found between symptomatic and asymptomatic groups across COD variants (Fisher's Exact Test, P < 0.05; Cramer's V = 0.45, 95% CI: 0.28-0.67). Among 27 clinically overlooked cases, only one was correctly diagnosed. Misdiagnoses included tooth-related diseases (n = 10), tumors or cysts (n = 6), osteomyelitis (n = 3), bone islands (n = 1), and mixed diagnoses (n = 7). No significant differences were observed in COD variants, treatment duration, or the number of clinical visits and departments among the misdiagnosed cases. The only correctly diagnosed patient received surgical curettage. Twenty-two patients received no treatment. Others underwent root canal therapy, extraction, curettage, or combinations thereof. Some patients also received dental implants or orthodontic treatment. CONCLUSION: Cemento-osseous dysplasia (COD), a type of non-neoplastic fibro-osseous lesion of the jaw, is frequently misdiagnosed in clinical practice. These diagnostic errors often lead to unnecessary interventions and complications. Enhanced clinician training in radiographic interpretation-particularly the use of cone-beam computed tomography (CBCT)-is essential for enhancing diagnostic accuracy and guiding appropriate management.