Immunohistochemical assessment of murine double minute 2 in solid vs unicystic ameloblastoma: A systematic review and meta-analysis

Abstract

Objective This project aimed to evaluate the immunoexpression pattern of murine double minute 2 (MDM2) in solid ameloblastomas compared to unicystic ameloblastomas.

Methods The review followed PRISMA guidelines and was registered in the PROSPERO database. PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar were comprehensively searched. Original cross-sectional studies were included. The meta-analysis was performed using STATA V15 and RevMan. Positivity rates were pooled using a random-effects model (REM), the labeling index was analyzed using mean difference under a REM, and expression intensity (moderate–strong) was assessed as categorical data using a REM with Hartung-Knapp adjustment. Heterogeneity was evaluated with the Chi² test and I² statistic. The methodological quality and certainty of the evidence were assessed using the Joanna Briggs Institute items and the GRADE system.

Results Nine studies (n = 438 specimens) were analyzed, of which 325/438 (74.2 %) were ameloblastoma biopsies. MDM2 positivity was detected in 403/438 cases (92 %). A statistically significant association in favor of solid ameloblastoma was observed (RR = 2.08; 95 %CI [1.66–2.60]; p = 0.005), indicating a twofold probability of finding high MDM2 expression in solid compared to unicystic ameloblastomas. Four of the nine studies (44.4 %) were considered to be of low quality, and the certainty of evidence was low to very low.

Conclusions MDM2 expression was prevalent in both types of ameloblastomas, with a higher intensity of expression observed in solid cases. However, due to study heterogeneity, further investigations with more robust methodological designs are recommended to assess the diagnostic potential of MDM2 in ameloblastomas.