Ki-67 expression as a diagnostic biomarker in odontogenic cysts and tumors: A systematic review and meta-analysis.

Mahnaz Jabbarzadeh,Maryam Kouhsoltani,Michael R Hamblin,Maedeh Vakili Saatloo,Nafiseh Vahed,Fatemeh Pournaghi-Azar

doi:10.34172/joddd.2021.012

Abstract

Ki-67 is a marker of cell proliferation, used as an important diagnostic marker in the pathologic differentiation of various lesions. It is also relevant for developing targeted molecular therapies. We carried out a systematic review to assess the Ki-67 labeling index (LI) in odontogenic cysts and tumors. Databases were searched, including PubMed (MEDLINE), Scopus, CINHAL, PsycoInfo, the Cochrane Library, and Proquest. The meta-analysis was carried out based on the data of 608 lesions. When a 5% cut-off point was set, ki-67 LI of all benign odontogenic tumors dropped below this point. All the malignant tumors demonstrated an LI of over 15.3%; a significantly higher Ki-67 LI in malignant odontogenic lesions (17.59±2.80) was observed. Among benign tumors, the largest and the smallest Ki-67 LIs were seen in ameloblastoma (4.39±0.47) and adenomatoid odontogenic tumor (0.91±1.71). The mean values of Ki-67 LI in tumors and cysts were 4.23 (0.38) and 1.04 (0.07), respectively. Among odontogenic cysts, the highest Ki-67 LI was found in odontogenic keratocyst (OKC) (3.58±0.51), and the lowest in the radicular cyst (1.29±0.62%). Ki-67 LIs in all odontogenic cysts were <3%, except for OKC. This controversial lesion seems to have a profile more similar to a tumor, and a treatment plan similar to tumors might be suggested. We found that odontogenic lesions have diverse proliferative activities that help differentiate between various lesions and suggest therapeutic plans.

Highlights

Odontogenic lesions are one of the most common pathologic entities in the jaw region
In 2005, odontogenic keratocyst (OKC) was classified as a benign odontogenic tumor in the WHO classification; it is still debated whether OKC is a benign tumor or an odontogenic cyst.[4]
The studies were retrieved by searching for the following keywords: “odontogenesis”, “odontogenic cyst”, “keratocyst”, “odontogenic keratocyst”, “radicular cyst”, “ki67”, “malignant ameloblastoma”, “ameloblastic sarcoma”, “ameloblastic fibrosarcoma”, “odontogenic carcinoma”, “odontogenic malignancy”, “CEOT”, “KCOT”, “MIB-1 antigen”, “MIB-1 protein”, “antigen MIB 1”, “protein MIB 1”, “Ki67 antigen”, “dentigerous cyst”, “radicular cyst”, “follicular cyst”, “periapical cyst”, “calcifying odontogenic cyst”, “residual cyst”, “glandular odontogenic cyst”, “dental tissue neoplasm”, “odontogenic tumor”, “odontogenic

Summary

Introduction

Odontogenic lesions are one of the most common pathologic entities in the jaw region. Odontogenic cysts arise from different types of odontogenic epithelial cell types. The most common odontogenic cyst is the dentigerous cyst, which accounts for 20% of all the mandibular epithelial cysts.[1] An odontogenic keratocyst (OKC) is classified as a dental lamina cyst with a tendency to relapse after surgery, and it exhibits relatively aggressive clinical behavior. OKCs have a different origin, progression course, and biological behavior from other odontogenic cysts, e.g., dentigerous or radicular cysts.[2] Relatively high mitotic activity and increased epithelial cell turnover rates have been proposed to account for the growth of OKCs.[3] In 2005, OKC was classified as a benign odontogenic tumor in the WHO classification; it is still debated whether OKC is a benign tumor or an odontogenic cyst.[4]

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