IMAGING MODALITIES FOR THE EVALUATION OF MAXILLOFACIAL METASTATIC BONE LESIONS: A SYSTEMATIC REVIEW AND AN EVIDENCE MAP

Resumo

Objectives: To conduct a systematic review and develop an evidence map of the main radiographic features and the usefulness of imaging modalities for the evaluation of maxillofacial metastatic bone lesions. Methods: The PECO strategy was used to define eligibility and to answer the question: Do cancer patients (P) undergoing imaging exams (E) present radiographic/imaging signs of metastases in the head region (O)? Searches were performed in PubMed, Embase, Scopus, and Google Scholar in accordance with the PRISMA statement. Only case reports/case series with histopathological confirmation were included. Risk of bias was assessed with Joanna Briggs Institute tools. Results: From 8,475 initial records and 20 manually retrieved studies, 29 articles met the inclusion criteria. The studies included 63 patients with metastases in maxilla (4.8%) or mandible (95.3%). Panoramic radiography is the primary imaging modality for the evaluation of metastatic lesions of the jaws (64.8%), followed by scintigraphy (25.39%), HCT (20.6%), lateral oblique radiograph (18.3%), periapical radiograph (14.1%), MRI (6.9%), SPECT (6.3%), PET/CT (3.17%), occlusal radiograph (2.8%), posteroanterior mandibular radiograph (2.8%), ultrasonography (1.58%), and mentonasal radiograph (1.4%). The predominant radiographic appearance of panoramic radiograph was an ill-defined osteolytic lesion (76.2%), although mixed or sclerotic patterns were noted in cases of breast and prostate cancer. Conclusions: Panoramic radiography supported initial screening. HCT and MRI defined lesion extent and soft tissue involvement. Scintigraphy showed increased tracer uptake near the affected jaw, while PET/CT demonstrated homogeneous uptake. Dental surgeons should remain vigilant during clinical and imaging evaluations, particularly in patients with a history of cancer.

Keywords: Jaw Neoplasms. Metastasis. Panoramic Radiograph. Computed Tomography. Magnetic Resonance Imaging. Dentistry.