18/10/2023
Benign vs malignant - how do you tell the difference?
While a biopsy is only the guaranteed way to distinguish between benign and malignant lesions, there are often radiographic features that can help us with our diagnosis:
Borders -
Benign lesions tend to have smooth, well-defined borders. This means the borders are easily traceable with a distinct beginning and end to the lesion.
On the other hand, malignant lesions are generally poorly demarcated, reflecting their infiltrating and destructive nature. The borders of malignancies will often appear 'fuzzy' or 'jagged.'
Cortex -
When benign lesions involve the adjacent cortices of the mandible or maxilla, the cortex will be thinned and expanded. In these cases, the cortex will still be continuous, even if just barely visible.
With malignant lesions, often the cortex will be destroyed or perforated. Sometimes a 'periosteal reaction' will also develop (a formation of a new, thin layer of bone along the outside of the cortex).
Teeth -
Benign lesions can displace or resorb adjacent teeth; however, root resorption also occurs in malignant lesions!
'Floating' teeth can appear in the presence of malignant lesions. This is where the supporting bone and associated structures around the teeth have been destroyed, leaving a tooth that appears to be 'floating' in space. Malignant lesions also may invade into the PDL space, resulting in irregular and nonconcentric widening of the PDL space.
These are the main difference in radiographic appearance that we see between benign and malignant lesions. However, just be aware that certain benign lesions and malignancies can overlap in their radiographic features, making a definitive diagnosis only possibly through biopsy and histology.
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