15h00 Beyond the Biopsy – The Role of Imaging in Diagnosing Maxillofacial Fibro-osseous Lesions

Fibro-osseous lesions are a large, heterogeneous group of neoplastic, dysplastic, inflammatory, and reactive lesions with overlapping histological and radiographic features. In any particular patient, many differential diagnoses can be considered ranging from dysplastic (fibrous dysplasia, cemento-osseous dysplasia) to inflammatory (condensing osteitis, chronic sclerosing osteomyelitis) and neoplastic lesions (ossifying  fibromas). Unfortunately, histological examination of a biopsy specimen can rarely differentiate between these different lesions with confidence. Correlation of biopsy findings with the clinical and radiographic appearance of the lesion is therefore critical in rendering a correct diagnosis. Here, we will argue the cardinal role of radiographic imaging in the diagnosis of maxillofacial fibro-osseous lesions and the limited role of histological examination. 

Three major pitfalls will be discussed through illustrative cases: (1) the importance of describing all parts of the lesion, (2) the problem of shallow biopsies through shaving and contouring, and (3) not placing the lesion into a broader context. Ultimately, in diagnosing these challenging lesions the clinician should consider all possible categories of fibro-osseous lesions, and most importantly be guided by the imaging features rather than aspecific biopsy results.