Are All Odontogenic Keratocysts Keratocystic Odontogenic Tumors? Correlation between Imaging Features and Epithelial Cell Proliferation

This study was to correlate and analyze the imaging features and epithelial cell proliferation pattern in different cases of keratocystic odontogenic tumors (KCOT) and study the role of inflammation using proliferative markers and different radiographic patterns of KCOT to determine its biological behavior. One hundred and eighty-six cases of KCOT were taken together and grouped based on radiographic patterns. Forty cases were randomly selected and stained using a proliferating cellular nuclear antigen marker. The correlation between imaging and epithelial proliferation with and without inflammation was determined. Unilocular variety is the most common type of KCOT, showing least epithelial proliferation of all the patterns. More than 50% of the multilocular KCOTs were associated with inflammation, showing an enhanced rate of epithelial proliferation. Results were subjected to statistical analysis. Different rates of epithelial proliferation of the different patterns suggested that all odontogenic keratocysts do not behave like tumors and that aggressive treatment should be reserved for selective cases only depending on radiographic and other histopathological parameters such as inflammation.