Radiographic and Histological Correlation of Large Periapical Lesions: A Retrospective Analysis

Objectives: To evaluate the correlation between radiographic appearance and histological diagnosis of large periapical lesions in an Indian population, assessing the reliability of CBCT in distinguishing lesion types. Methods: A retrospective study was conducted on 94 patients with periapical radiolucencies who underwent both CBCT imaging and histopathological evaluation. Lesion type, location, and distribution were documented. Histological findings were compared with CBCT-based diagnoses, and statistical analysis was performed to assess correlation. Results: While CBCT classified all 94 lesions as cystic, histopathology confirmed only 39 (41.5%) as radicular cysts, whereas 49 (52.1%) were periapical granulomas and 6 (6.4%) belonged to other histological categories. Most lesions were located in the maxilla (84%) and anterior region (95.7%). A notable discrepancy was observed between radiographic and histological diagnoses (p < 0.05). Conclusions: CBCT, though valuable for lesion visualization, lacks definitive diagnostic capability in differentiating cysts from granulomas. Histopathology remains the gold standard. A combined diagnostic approach is recommended to avoid misdiagnosis and guide appropriate treatment.