High-resolution cone-beam computed tomography for assessment of bone invasion in oral cancer: Comparison with conventional computed tomography

Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): a prospective study

BACKGROUND

Oral squamous carcinoma (OSCC) is often diagnosed at late stages and bone erosion or invasion of the jawbone is frequently present. Computed tomography (CT) and magnetic resonance imaging (MRI) are known to have high diagnostic sensitivities, specificities, and accuracies in detecting these bone affections in patients suffering from OSCC. To date, the existing data regarding the impact of cone-beam computed tomography (CBCT) have been weak. Therefore, this study aimed to investigate whether CBCT is a suitable tool to detect bone erosion or invasion in patients with OSCC.

METHODS

We investigated in a prospective trial the impact of CBCT in the diagnosis of bone erosion or invasion in patients with OSCC who underwent surgery. Every participant received a CBCT, CT, and MRI scan during staging. Imaging modalities were evaluated by two specialists in oral and maxillofacial surgery (CBCT) and two specialists in radiology (CT and MRI) in a blinded way, to determine whether a bone affection was present or not. Reporting used the following 3-point system: no bony destruction ("0"), cortical bone erosion ("1"), or medullary bone invasion ("2"). Histological examination or a follow-up served to calculate the sensitivities, specificities, and accuracies of the imaging modalities.

RESULTS

Our results revealed high diagnostic sensitivities (95.6%, 84.4%, and 88.9%), specificities (87.0%, 91.7%, and 91.7%), and accuracies (89.5%, 89.5%, and 90.8%) for CBCT, CT, and MRI. A pairwise comparison found no statistical difference between CBCT, CT, and MRI.

CONCLUSION

Our data support the routine use of CBCT in the diagnosis of bone erosion and invasion in patients with OSCC as diagnostic accuracy is equal to CT and MRI, the procedure is cost-effective, and it can be performed during initial contact with the patient.

Accuracy of cone-beam computed tomography for the evaluation of mandible invasion by oral squamous cell carcinoma

BACKGROUND

For patients with oral squamous cell carcinoma (OSCC), accurate evaluation of mandible invasion and resection with appropriate boundaries are important for preserving the structure and function of the mandible and preventing local recurrence. Although cone-beam computed tomography (CBCT), which has high spatial resolution, is now widely used in the diagnosis of oral and maxillofacial bone lesions, no studies have systematically evaluated the accuracy of CBCT for evaluating the presence of bone invasion, the boundaries of bone invasion and the presence of nerve invasion. Therefore, this study aimed to systemically explore the accuracy of CBCT in the preoperative assessment of mandibular invasion by OSCC.

METHODS

Thirty mandibular specimens from OSCC patients were collected in this study. The samples were marked and subjected to CBCT examination. Hematoxylin-eosin staining was used for histopathological assessment sed as the gold standard. The evaluation included the presence of bone invasion, the boundaries of bone invasion and the presence of nerve invasion. The CBCT and histopathological boundaries of bone invasion were delineated and merged to compare and calculate the deviation of CBCT in boundary evaluation.

RESULTS

The accuracy of CBCT in evaluating the presence of mandible invasion was 100%, and the accuracy of CBCT in evaluating the presence of nerve invasion was 69.2%. A mean deviation of 2.97 mm was found for assessment of the boundary of bone invasion using CBCT compared with the histopathological standard. The interexaminer agreement and intraexaminer agreement were perfect for the detection of bone invasion and nerve invasion (κ > 0.8). The intraclass correlation coefficient was 0.923 for the consistency test of boundary delineation on CBCT images.

CONCLUSION

CBCT is quite reliable in determining the presence or absence of mandible invasion but not as reliable for nerve invasion. The deviation in bone invasion boundary estimation should be considered in osteotomy for OSCC.

Diagnostic efficacy of PET-CT, CT, and MRI in preoperative assessment of mandibular invasion caused by head and neck cancer: A systematic review and meta-analysis

OBJECTIVE

This study aims to conduct a systematic review and meta-analysis of the performance of PET-CT, CT, and MRI in diagnosing mandible invasion induced by head and neck cancer (HNC).

MATERIALS AND METHODS

The MEDLINE, Embase, Science Direct, CNKI and CQVIP databases were searched from inception until August 1, 2020. Then, a meta-analysis was conducted to calculate the combined diagnostic values with the corresponding 95% CIs. Two independent researchers completed the full text screening, data abstraction, and risk assessment.

RESULTS

This meta-analysis included 53 studies (N = 2 946 participants). For the pooled sensitivity (SEN), MRI (SEN: 0.88, 95% CI: 0.81-0.93) was found to have a significantly higher SEN (P = 0.0045), when compared to CT (SEN: 0.77, 95% CI: 0.71-0.82), while compared with PET-CT (SEN: 0.88, 95% CI: 0.64-0.97), the SEN was approximately equal (P > 0.05). The analysis revealed that the combined specificity (SPE) of MRI (SPE: 0.83, 95% CI: 0.74-0.89) and PET-CT (SPE: 0.81, 95% CI: 0.57-0.93) was lower than that of CT (SPE: 0.87, 95% CI: 0.83-0.90), but there was no statistical significance among these (P > 0.05). The comparison of the area under curve (AUC) reflected that PET-CT, CT and MRI have approximately equal summary diagnostic power in detecting mandibular invasion (P > 0.05).

CONCLUSION

The findings suggest that compared with CT, MRI is significantly superior for higher SEN in diagnosing mandibular invasion. The SEN of MRI and PET-CT were approximately equal. For the summary of diagnostic power, more prospective clinical trials that directly compare these three methods are needed in the future.

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study

BACKGROUND

Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS.

METHODS

It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019.

RESULTS

The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001).

CONCLUSION

Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.

An Unusual Case of Mandibular Squamous Cell Carcinoma in Intimacy with an Impacted Wisdom Tooth

Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting with symptoms mimicking odontogenic infections should receive vigilant attention by clinicians with regard to the disease history, clinical signs, radiographic evidence, and decision for histopathological analysis. This is especially true in the context of impacted dentition, where malignancy must be considered when formulating a differential diagnosis.

Investigation of dental cone-beam CT pixel data and a modified method for conversion to Hounsfield unit (HU)

OBJECTIVES

To investigate the relationship in dental cone-beam CT (CBCT) between the manufacturer-reported image pixel data and a modified conversion to CT number densities in Hounsfield unit (HU).

METHODS

A standardized CT phantom was imaged using typical clinical parameters on CBCT from three manufacturers (Carestream 9300^®, Carestream Health, Rochester, NY; J Morita 3D Accutomo^®, J. Morita Mfg. Corp., Kyoto, Japan; and Planmeca Promax 3D^®, Planmeca Helsinki, OY, Finland). Reconstructed axial slices were evaluated using regions of interest to ascertain the mean pixel value in five materials in the phantom. The Digital Imaging and Communications in Medicine data were also evaluated to determine if raw pixel data had been adjusted during the image reconstruction. A modified version of the existing manual HU conversion technique was applied, and the resultant slope and y-intercept were used to scale the pixel values ultimately to HU for all images.

RESULTS

The DICOM header data show that a modified rescale y-intercept was applied to both the Carestream and Planmeca image data yielding manufacturer-produced results in HU. The Morita pixel data were unmodified and report in shades of grey or grey values (GV). The Carestream manufacturer-derived HU measurements showed good correlation in air (-1000 HU), but all other materials ranged from 2.6 to 13.5 σ from the specified phantom value. Results in the modified conversion technique images fell within 1.0-2.4 σ from the specified phantom values.

CONCLUSIONS

While more studies are needed to test for regularity, this study suggests that our modified technique could be a means of getting more accurate quantitative data from dental CBCTs.