Diagnóstico diferencial imaginológico entre ameloblastoma e queratocisto odontogênico: uma revisão de escopo

Abstract

Ameloblastoma (AM) and odontogenic keratocyst (OKC) are odontogenic lesions with distinct biological behavior; however, they share important clinical and imaging similarities, which makes differential diagnosis challenging. The identification of more accurate imaging parameters becomes essential to assist in therapeutic planning, prognosis, and clinical decision-making. The aim of this study was to evaluate and compare the imaging features of AM and OKC, seeking to establish criteria that may assist in the differential diagnosis between these lesions. For this purpose, a scoping review was conducted according to the methodological recommendations of the Joanna Briggs Institute and reported following the PRISMA-ScR checklist. Observational studies, case series, and case reports published without language or time restrictions, addressing imaging characteristics of AM and OKC, were included. Searches were performed in the PubMed, Scopus, Web of Science, and Embase databases, in addition to gray literature through Google Scholar. Study selection was carried out by independent reviewers using the Rayyan software. Clinical, imaging, and therapeutic data from the lesions were extracted, and qualitative and quantitative descriptive analyses of the findings were performed. The results included 38 studies published between 1990 and 2024, totaling 763 cases of AM and 1,114 cases of OKC. A predominance in males and greater mandibular involvement were observed in both lesions. AM predominantly presented a multilocular pattern (70.12%), greater bone expansion (87.9%), and a higher frequency of root resorption (68%). In contrast, OKC predominantly exhibited a unilocular pattern (61.53%), less bone expansion (39.9%), and a greater association with impacted/included teeth (63.12%). Both lesions presented well-defined margins, although this feature was more consistently observed in AM. The results also demonstrated agreement with studies highlighting computed tomography as an essential examination for three-dimensional lesion characterization and improved diagnostic differentiation. Divergences were observed regarding tooth displacement, which was more frequent in AM in this review. It is possible to conclude that AM and OKC present relevant imaging differences, especially related to locularity, bone expansion, association with impacted teeth, and root resorption, although no isolated criterion is definitive. The standardization of imaging reports and histopathological correlation remain indispensable for greater diagnostic accuracy and appropriate treatment definition.