1
|
Kottakota V, Sarkar DF, Tadepalli VNS, Yadaraju VA, Muralidhar KB, Kotne S, Bora M, Lagudu PBB. Role of Computed Tomography in Prediction of Depth of Invasion and Cervical Lymph Node Metastasis in Oral Cancer. J Maxillofac Oral Surg 2024; 23:856-863. [PMID: 39118909 PMCID: PMC11303614 DOI: 10.1007/s12663-024-02265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/08/2024] [Indexed: 08/10/2024] Open
Abstract
Objectives The primary aim is to determine the accuracy of contrast-enhanced computed tomography (CT) in evaluation of depth of invasion (DOI) and detection of cervical node metastasis. We also analysed the relation between radiographic DOI (rDOI) and cervical lymph node metastasis. Materials and Methods We have retrospectively reviewed 201 oral squamous cell carcinoma (SCC) patients. The rDOI was compared with histological DOI. Sensitivity, specificity, accuracy, and negative (NPV) and positive (PPV) predictive values were evaluated for CT scan in predicting nodal metastasis. The relation between rDOI and lymph node metastasis was analysed using ROC curve. Results rDOI correlated significantly with histologic DOI for oral tongue, buccal mucosa, gingiva, and mucosal lip SCC (P < 0.05) and for tumours with rDOI > 5 mm. The sensitivity, specificity, PPV, NPV and accuracy rate of CT scan were found to be 84.71%, 50.86%, 55.81%, 81.94% and 65.17%, respectively. Tumours with rDOI > 16 mm had significant (P < 0.001) chance of having neck node metastasis. Conclusion CT-derived DOI correlates significantly with pathological DOI although both are not similar. CT scan can predict nodal metastasis in fairly accurate manner using the four radiographic criteria used in this study. Radiographic depth of invasion can be used as predictor of cervical node metastasis.
Collapse
Affiliation(s)
- Viswanth Kottakota
- Department of Surgical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Dibya Falgoon Sarkar
- Department of Surgical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - V. N. Saratchandu Tadepalli
- Department of Surgical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Vijaya Aditya Yadaraju
- Department of Radiation Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Kalla B. Muralidhar
- Department of Surgical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Sanketh Kotne
- Department of Medical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Muralidhar Bora
- Department of Radiation Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| | - Perraju Bhaskar Bhuvan Lagudu
- Department of Medical Oncology, HCG Cancer Centre, APIIC Health City, Arilova, Visakhapatnam, Andhra Pradesh 530040 India
| |
Collapse
|
2
|
Russo A, Patanè V, Fusco L, Faggioni L, Boschetti CE, Santagata M, Neri E, Cappabianca S, Reginelli A. Reliability of Ultrasonographic Assessment of Depth of Invasion and Tumor Thickness in Intraoral Mucosa Lesions: A Preliminary Experience. J Clin Med 2024; 13:2595. [PMID: 38731124 PMCID: PMC11084595 DOI: 10.3390/jcm13092595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Despite the progress made in multidisciplinary care, there has been little improvement in the oncologic outcomes of oral cavity squamous cell carcinomas (OSCCs). In the latest edition of the TNM staging, "depth of invasion" (DOI) has recently been introduced as one of the criteria for determining the T stage, alongside other factors. DOI is widely recognized as an independent risk factor for nodal metastases and is a crucial consideration in the preoperative staging of OSCCs, along with measurements of tumor thickness (TT). While various diagnostic methods exist for assessing DOI, intraoral ultrasonography (IOUS) has gained popularity for its efficacy in evaluating OSCCs. Methods: This study sought to evaluate the diagnostic accuracy and reliability of ultrahigh-frequency ultrasound (UHFUS) in assessing oral cavity lesions compared to histopathological analysis. Results: The results revealed strong reliability in ultrasonographic measurements (ICC TT: 0.94; ICC DOI: 0.97) and distinct ultrasonographic features specific to different oral pathologies. This highlights the potential of UHFUS as a non-invasive imaging tool for precise diagnostic evaluations. Conclusions: Despite limitations such as a small sample size and focus on specific lesions, these promising results suggest that UHFUS could significantly enhance oral lesion diagnostics. Further research involving larger cohorts is necessary to validate and build upon these initial findings.
Collapse
Affiliation(s)
- Anna Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigia Fusco
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Ciro Emiliano Boschetti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Mario Santagata
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| |
Collapse
|
3
|
Spence RN, Au VH, Zhao Y, Feng AL, Juliano AF, Goss D, Varvares MA. Intraoperative Ultrasound for the Management of Oral Tongue Cancer: a Systematic Review and Meta-Analysis. OTO Open 2024; 8:e147. [PMID: 38846015 PMCID: PMC11154832 DOI: 10.1002/oto2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/17/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective To evaluate for correlation between intraoperative ultrasound (IOUS)-measured tumor thickness (TT) (uTT) and histopathological TT (hTT), and to compare IOUS-assisted resection with conventional resection in patients with oral tongue cancers. Data Sources Ovid MEDLINE (1946-2023), Embase.com (1947-2023), and Web of Science (All Databases 1900-2023). Review Methods Inclusion criteria were the use of IOUS for the management of oral tongue cancer. Studies that did not report quantitative data were excluded. Additionally, studies that were not contributory to meta-analysis, or a narrative analysis of pooled results were excluded. Selection was carried out by 2 reviewers. A total of 2417 studies were initially identified, with 12 ultimately being included in this review, and 7 included in the meta-analysis. Data were extracted by 2 investigators and were pooled using a random-effects model. Results Our meta-analysis reveals a pooled correlation coefficient of 0.92 (95% confidence interval: 0.80-0.96) for studies comparing uTT to hTT. Studies comparing IOUS-assisted resection to conventional resection found IOUS-assisted resection yielded wider nearest margins in all studies reporting this outcome. Conclusion IOUS reliably measures TT, similarly to that of histopathology measurement. IOUS-assisted resection, which allows the surgeon to view the deep extent of tumor invasion, may increase closest radial margin distance compared to conventional resection. IOUS-assisted resection may represent a more reliable approach to achieving clear margins than conventional resection.
Collapse
Affiliation(s)
- Ryland N. Spence
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Vivienne H. Au
- Department of Otolaryngology–Head and Neck SurgeryNew York‐Presbyterian Hospital, Columbia University and Weill Cornell Schools of MedicineNew YorkNew YorkUSA
| | - Yan Zhao
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - Allen L. Feng
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - Amy F. Juliano
- Department of RadiologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Deborah Goss
- Library Services, Massachusetts Eye and EarBostonMassachusettsUSA
| | - Mark A. Varvares
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| |
Collapse
|
4
|
Kaltoft M, Hahn CH, Wessman M, Hansen ML, Agander TK, Makouei F, Wessel I, Todsen T. Intraoral Ultrasound versus MRI for Depth of Invasion Measurement in Oral Tongue Squamous Cell Carcinoma: A Prospective Diagnostic Accuracy Study. Cancers (Basel) 2024; 16:637. [PMID: 38339388 PMCID: PMC10854529 DOI: 10.3390/cancers16030637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) of the tongue is the most common type of oral cavity cancer, and tumor depth of invasion (DOI) is an important prognostic factor. In this study, we investigated the accuracy of intraoral ultrasound and magnetic resonance imaging (MRI) for assessing DOI in patients with OSCC. Histopathological measurement of DOI was used as a reference standard. We conducted a prospective study including patients planned for surgical treatment of OSCC in the tongue. The DOI was measured in an outpatient setting by intraoral ultrasound and MRI, and was compared to the histopathological DOI measurements. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for ultrasound and MRI, and the Wilcoxon signed-rank test was used to test for significance. The correlation was evaluated using Pearson's correlation coefficient. We included 30 patients: 26 with T1 or T2 tumors, and 4 with T3 tumors. The mean difference from histopathology DOI was significantly lower for ultrasound compared to MRI (0.95 mm [95% LOA -4.15 mm to 6.06 mm] vs. 1.90 mm [95% LOA -9.02 mm and 12.81 mm], p = 0.023). Ultrasound also led to significantly more correct T-stage classifications in 86.7% (26) of patients compared to 56.7% (17) for MRI, p = 0.015. The Pearson correlation between MRI and histopathology was 0.57 (p < 0.001) and the correlation between ultrasound and histopathology was 0.86 (p < 0.001). This prospective study found that intraoral ultrasound is more accurate than MRI in assessing DOI and for the T-staging of oral tongue cancers. Clinical practice and guidelines should implement intraoral ultrasound accordingly.
Collapse
Affiliation(s)
- Mikkel Kaltoft
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Christoffer Holst Hahn
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Marcus Wessman
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Martin Lundsgaard Hansen
- Department of Radiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Tina Klitmøller Agander
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Fatemeh Makouei
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Irene Wessel
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Capital Region, 2100 Copenhagen, Denmark
| |
Collapse
|
5
|
Fu J, Alhaskawi A, Dong Y, Jin F, Chen J, Zou X, Zhou H, Liu Z, Abdalbary SA, Lu H. Improving oral squamous cell carcinoma diagnosis and treatment with fluorescence molecular imaging. Photodiagnosis Photodyn Ther 2023; 44:103760. [PMID: 37634605 DOI: 10.1016/j.pdpdt.2023.103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
Timely identification and complete removal of oral squamous cell carcinoma (OSCC) through surgery is crucial for effective treatment. However, current diagnostic methods that rely on physical abnormalities are not very informative and practical in clinical settings, leading to the late detection of oral cancer. Furthermore, no dependable intraoperative tools available for assessing surgical margins in real-time. Fluorescence imaging allows the visualization of biological processes occurring in the early stages of cancer, and as a result, small tumors can be detected at an early stage. Fluorescence imaging can effectively aid in assessing excised edges during surgery for OSCC as it possesses high sensitivity and spatial resolution. This review focuses on tongue cancer as a representation of OSCC and delves into various fluorescence techniques that can aid in early diagnosis and surgical guidance. The review also discusses the potential clinical applications of these techniques in the future.
Collapse
Affiliation(s)
- Jing Fu
- Department of Stomatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Feilu Jin
- Department of Oral and Maxillofacial Surgery, The 2nd Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Chen
- Department of Radiotherapy, Zhejiang cancer hospital, 310022, No.1 Banshan East Road
| | - Xiaodi Zou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China; Department of Zhejiang Chinese Medical University, The Second Affiliated School of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, 310003, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Zhenfeng Liu
- PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hang-zhou, Zhejiang Province, 310003, PR China
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Department of Stomatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China; Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, #866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, PR China.
| |
Collapse
|
6
|
Prasad K, Topf MC, Clookey S, Philips R, Curry J, Tassone P. Trends in Positive Surgical Margins in cT3-T4 Oral Cavity Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2023; 169:1200-1207. [PMID: 37232479 DOI: 10.1002/ohn.377] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Positive surgical margins in oral cavity squamous cell carcinoma are associated with cost escalation, treatment intensification, and greater risk of recurrence and mortality. The positive margin rate has been decreasing for cT1-T2 oral cavity cancer over the past 2 decades. We aim to evaluate positive margin rates in cT3-T4 oral cavity cancer over time, and determine factors associated with positive margins. STUDY DESIGN Retrospective analysis of a national database. SETTING National Cancer Database 2004 to 2018. METHODS All adult patients diagnosed between 2004 and 2018 who underwent primary curative intent surgery for previously untreated cT3-T4 oral cavity cancer with known margin status were included. Logistic univariable and multivariable regression analyses were performed to identify factors associated with positive margins. RESULTS Among 16,326 patients with cT3 or cT4 oral cavity cancer, positive margins were documented in 2932 patients (18.1%). Later year of treatment was not significantly associated with positive margins (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.96-1.00). The proportion of patients treated at academic centers increased over time (OR 1.02, 95% CI 1.01-1.03). On multivariable analysis, positive margins were significantly associated with hard palate primary, cT4 tumors, advancing N stage, lymphovascular invasion, poorly differentiated histology, and treatment at nonacademic or low-volume centers. CONCLUSION Despite increased treatment at academic centers for locally advanced oral cavity cancer, there has been no significant decrease in positive margin rates which remains high at 18.1%. Novel techniques for margin planning and assessment may be required to decrease positive margin rates in locally advanced oral cavity cancer.
Collapse
Affiliation(s)
- Kavita Prasad
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael C Topf
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick Tassone
- Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
7
|
Menditti D, Santagata M, Imola G, Staglianò S, Vitagliano R, Boschetti CE, Inchingolo AM. Personalized Medicine in Oral Oncology: Imaging Methods and Biological Markers to Support Diagnosis of Oral Squamous Cell Carcinoma (OSCC): A Narrative Literature Review. J Pers Med 2023; 13:1397. [PMID: 37763165 PMCID: PMC10532745 DOI: 10.3390/jpm13091397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
For decades, oral squamous cell carcinoma (OSCC) has been one of the most prevalent and mortal cancers worldwide. The gold standard for OSCC diagnosis is still histopathology but this narrative multidisciplinary review has the aim to explore the literature about conventional OSCC prognostic indicators related to the pTNM stage at the diagnosis such as the depth of invasion and the lymphovascular invasion associated with distant metastasis as indicators of poor life expectancy. Despite its multifactorial nature and recognizable precursors, its diagnosis at the early stages is still challenging. We wanted to highlight the importance of the screening as a primary weapon that a stomatologist should consider, intercepting all at-risk conditions and lesions associated with OSCC and its early stages. This narrative review also overviews the most promising imaging techniques, such as CT, MRI, and US-echography, and their application related to clinical and surgical practice, but also the most-investigated prognostic and diagnostic tissue and salivary biomarkers helpful in OSCC diagnosis and prognostic assessment. Our work highlighted remarkable potential biomarkers that could have a leading role in the future. However, we are still far from defining an appropriate and concrete protocol to apply in clinical practice. The hope is that the present and future research will overcome these limitations to benefit patients, clinicians, and welfare.
Collapse
Affiliation(s)
- Dardo Menditti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Mario Santagata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Gianmaria Imola
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Samuel Staglianò
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Rita Vitagliano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Ciro Emiliano Boschetti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | | |
Collapse
|
8
|
Caprioli S, Giordano GG, Pennacchi A, Campagnari V, Iandelli A, Parrinello G, Conforti C, Gili R, Giannini E, Marabotto E, Kayali S, Bianchi B, Peretti G, Cittadini G, Marchi F. Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience. Cancers (Basel) 2023; 15:4413. [PMID: 37686688 PMCID: PMC10486952 DOI: 10.3390/cancers15174413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins' appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.
Collapse
Affiliation(s)
- Simone Caprioli
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
| | - Giorgio-Gregory Giordano
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Alessia Pennacchi
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Valentina Campagnari
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Andrea Iandelli
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giampiero Parrinello
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Cristina Conforti
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Riccardo Gili
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Edoardo Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Giorgio Peretti
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giuseppe Cittadini
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Filippo Marchi
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| |
Collapse
|
9
|
Bekedam NM, Karssemakers LHE, van Alphen MJA, van Veen RLP, Smeele LE, Karakullukcu MB. Comparison of image quality of 3D ultrasound: motorized acquisition versus freehand navigated acquisition, a phantom study. Int J Comput Assist Radiol Surg 2023; 18:1649-1663. [PMID: 37243918 PMCID: PMC10491552 DOI: 10.1007/s11548-023-02934-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/21/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Intra-operative assessment of resection margins during oncological surgery is a field that needs improvement. Ultrasound (US) shows the potential to fulfill this need, but this imaging technique is highly operator-dependent. A 3D US image of the whole specimen may remedy the operator dependence. This study aims to compare and evaluate the image quality of 3D US between freehand acquisition (FA) and motorized acquisition (MA). METHODS Multiple 3D US volumes of a commercial phantom were acquired in motorized and freehand fashion. FA images were collected with electromagnetic navigation. An integrated algorithm reconstructed the FA images. MA images were stacked into a 3D volume. The image quality is evaluated following the metrics: contrast resolution, axial and elevation resolution, axial and elevation distance calibration, stability, inter-operator variability, and intra-operator variability. A linear mixed model determined statistical differences between FA and MA for these metrics. RESULTS The MA results in a statistically significant lower error of axial distance calibration (p < 0.0001) and higher stability (p < 0.0001) than FA. On the other hand, the FA has a better elevation resolution (p < 0.003) than the MA. CONCLUSION MA results in better image quality of 3D US than the FA method based on axial distance calibration, stability, and variability. This study suggests acquiring 3D US volumes for intra-operative ex vivo margin assessment in a motorized fashion.
Collapse
Affiliation(s)
- N M Bekedam
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Academic Centre of Dentistry Amsterdam, Vrije Universiteit, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| | - L H E Karssemakers
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - M J A van Alphen
- Department of Head and Neck Surgery and Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - R L P van Veen
- Department of Head and Neck Surgery and Oncology, Verwelius 3D Lab, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Nisi M, Gennai S, Graziani F, Izzetti R. The Reliability of Ultrasonographic Assessment of Depth of Invasion: A Systematic Review with Meta-Analysis. Diagnostics (Basel) 2023; 13:2833. [PMID: 37685371 PMCID: PMC10486678 DOI: 10.3390/diagnostics13172833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Depth of invasion (DOI) has been recognized to be a strong prognosticator for oral squamous cell carcinoma (OSCC). Several diagnostic techniques can be employed for DOI assessment, however intraoral ultrasonography has been increasingly applied for the intraoral evaluation of OSCCs. The aim of the present study is to review the evidence on the application of intraoral ultrasonography to the assessment of DOI in patients affected by OSCC. A systematic electronic and manual literature search was performed, and data from eligible studies were reviewed, selected, and extracted. The studies had to report the correlation between DOI estimated with ultrasonography versus histopathology. A meta-analysis was conducted on the quantitative data available. Sixteen articles were included in the review following the screening of the initial 228 studies retrieved from the literature. The meta-analysis showed a significant correlation between ultrasonographic and histopathologic measurements (p < 0.01). The studies were all at low/moderate risk of bias. Ultrasonography appears a valuable tool for DOI assessment.
Collapse
Affiliation(s)
| | | | | | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56123 Pisa, Italy
| |
Collapse
|
11
|
Makouei F, Agander TK, Ewertsen C, Søndergaard Svendsen MB, Norling R, Kaltoft M, Hansen AE, Rasmussen JH, Wessel I, Todsen T. 3D Ultrasound and MRI in Assessing Resection Margins during Tongue Cancer Surgery: A Research Protocol for a Clinical Diagnostic Accuracy Study. J Imaging 2023; 9:174. [PMID: 37754938 PMCID: PMC10532641 DOI: 10.3390/jimaging9090174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/28/2023] Open
Abstract
Surgery is the primary treatment for tongue cancer. The goal is a complete resection of the tumor with an adequate margin of healthy tissue around the tumor.Inadequate margins lead to a high risk of local cancer recurrence and the need for adjuvant therapies. Ex vivo imaging of the resected surgical specimen has been suggested for margin assessment and improved surgical results. Therefore, we have developed a novel three-dimensional (3D) ultrasound imaging technique to improve the assessment of resection margins during surgery. In this research protocol, we describe a study comparing the accuracy of 3D ultrasound, magnetic resonance imaging (MRI), and clinical examination of the surgical specimen to assess the resection margins during cancer surgery. Tumor segmentation and margin measurement will be performed using 3D ultrasound and MRI of the ex vivo specimen. We will determine the accuracy of each method by comparing the margin measurements and the proportion of correctly classified margins (positive, close, and free) obtained by each technique with respect to the gold standard histopathology.
Collapse
Affiliation(s)
- Fatemeh Makouei
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Tina Klitmøller Agander
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Caroline Ewertsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, DK-2100 Copenhagen, Denmark
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Rikke Norling
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Mikkel Kaltoft
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Adam Espe Hansen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Jacob Høygaard Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, DK-2100 Copenhagen, Denmark
| |
Collapse
|
12
|
Carnicelli G, Disconzi L, Cerasuolo M, Casiraghi E, Costa G, De Virgilio A, Esposito AA, Ferreli F, Fici F, Lo Casto A, Marra S, Malvezzi L, Mercante G, Spriano G, Torzilli G, Francone M, Balzarini L, Giannitto C. Image-Guided Intraoperative Assessment of Surgical Margins in Oral Cavity Squamous Cell Cancer: A Diagnostic Test Accuracy Review. Diagnostics (Basel) 2023; 13:1846. [PMID: 37296701 PMCID: PMC10252470 DOI: 10.3390/diagnostics13111846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The assessment of resection margins during surgery of oral cavity squamous cell cancer (OCSCC) dramatically impacts the prognosis of the patient as well as the need for adjuvant treatment in the future. Currently there is an unmet need to improve OCSCC surgical margins which appear to be involved in around 45% cases. Intraoperative imaging techniques, magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS), have emerged as promising tools in guiding surgical resection, although the number of studies available on this subject is still low. The aim of this diagnostic test accuracy (DTA) review is to investigate the accuracy of intraoperative imaging in the assessment of OCSCC margins. (2) Methods: By using the Cochrane-supported platform Review Manager version 5.4, a systematic search was performed on the online databases MEDLINE-EMBASE-CENTRAL using the keywords "oral cavity cancer, squamous cell carcinoma, tongue cancer, surgical margins, magnetic resonance imaging, intraoperative, intra-oral ultrasound". (3) Results: Ten papers were identified for full-text analysis. The negative predictive value (cutoff < 5 mm) for ioUS ranged from 0.55 to 0.91, that of MRI ranged from 0.5 to 0.91; accuracy analysis performed on four selected studies showed a sensitivity ranging from 0.07 to 0.75 and specificity ranging from 0.81 to 1. Image guidance allowed for a mean improvement in free margin resection of 35%. (4) Conclusions: IoUS shows comparable accuracy to that of ex vivo MRI for the assessment of close and involved surgical margins, and should be preferred as the more affordable and reproducible technique. Both techniques showed higher diagnostic yield if applied to early OCSCC (T1-T2 stages), and when histology is favorable.
Collapse
Affiliation(s)
- Giorgia Carnicelli
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Luca Disconzi
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
| | - Michele Cerasuolo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Elena Casiraghi
- AnacletoLab, Department of Computer Science “Giovanni degli Antoni”, Università degli Studi di Milano, Via Celoria 18, 20133 Milan, Italy;
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, 717 Potter Street, Berkeley, CA 94710, USA
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | | | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Federica Fici
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, 90127 Palermo, Italy;
| | - Silvia Marra
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Marco Francone
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Luca Balzarini
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| | - Caterina Giannitto
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (G.C.); (L.D.); (F.F.); (M.F.); (L.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy; (A.D.V.); (F.F.); (S.M.); (L.M.); (G.M.); (G.S.)
| |
Collapse
|
13
|
Zhang L, Judd RT, Zhao S, Rygalski C, Li M, Briody A, Swendseid B, Blakaj DM, Agrawal A, Ozer E, Carrau RL, Teknos TN, VanKoevering K, Rocco JW, Old MO, Seim NB, Puram SV, Haring CT, Kang SY. Immediate resection of positive margins improves local control in oral tongue cancer. Oral Oncol 2023; 141:106402. [PMID: 37094500 DOI: 10.1016/j.oraloncology.2023.106402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/08/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES This study investigates the impact of immediate resection of positive margins on local control of oral tongue cancer. MATERIALS AND METHODS We analyzed 273 consecutive oral tongue cancers resected from 2013 to 2018. Additional resection was performed in cases during the initial operation based on surgeon inspection of the specimen and/or frozen margins. Positive margins were defined as invasive carcinoma/high-grade dysplasia < 1 mm from the inked edge. Patients were grouped as follows: negative margin (Group 1); positive margin with immediate additional tissue resection (Group 2); and positive margin without additional tissue resection (Group 3). RESULTS Overall, the rate of local recurrence was 7.7 % (21/273), and the rate of positive main specimen margin was 17.9 %. Of these patients, 38.8 % (19/49) underwent immediate additional resection of the presumed positive margin. Group 3 had higher local recurrence rates than Group 1 after adjustment for T-stage (aHR 2.8 [95 % CI 1.0-7.7], p = 0.04). Group 2 had similar rates of local recurrence (aHR 0.45 [95 % CI 0.06-3.6], p = 0.45). Three year local recurrence free survival for Groups 1, 2, and 3 were 91 %, 92 % and 73 %, respectively. Compared to the main specimen margin, sensitivity of intraoperative frozen tumor bed margins was 17.4 %, and specificity was 95 %. CONCLUSION In patients with positive main specimen margins, anticipation and detection in real-time with immediate additional tissue resection reduced local recurrence to rates similar to those with negative main specimen margins. These findings support the use of technology to provide real-time intraoperative margin data and guide additional resection for improved local control.
Collapse
Affiliation(s)
- Lisa Zhang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ryan T Judd
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Songzhu Zhao
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Chandler Rygalski
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Michael Li
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | | | - Brian Swendseid
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Dukagjin M Blakaj
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Amit Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Theodoros N Teknos
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Kyle VanKoevering
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Sidharth V Puram
- Department of Otolaryngology, Division of Head and Neck Surgery, Washington University School of Medicine, USA
| | - Catherine T Haring
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA.
| |
Collapse
|
14
|
Intraoperative Imaging Techniques to Improve Surgical Resection Margins of Oropharyngeal Squamous Cell Cancer: A Comprehensive Review of Current Literature. Cancers (Basel) 2023; 15:cancers15030896. [PMID: 36765858 PMCID: PMC9913756 DOI: 10.3390/cancers15030896] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Inadequate resection margins in head and neck squamous cell carcinoma surgery necessitate adjuvant therapies such as re-resection and radiotherapy with or without chemotherapy and imply increasing morbidity and worse prognosis. On the other hand, taking larger margins by extending the resection also leads to avoidable increased morbidity. Oropharyngeal squamous cell carcinomas (OPSCCs) are often difficult to access; resections are limited by anatomy and functionality and thus carry an increased risk for close or positive margins. Therefore, there is a need to improve intraoperative assessment of resection margins. Several intraoperative techniques are available, but these often lead to prolonged operative time and are only suitable for a subgroup of patients. In recent years, new diagnostic tools have been the subject of investigation. This study reviews the available literature on intraoperative techniques to improve resection margins for OPSCCs. A literature search was performed in Embase, PubMed, and Cochrane. Narrow band imaging (NBI), high-resolution microendoscopic imaging, confocal laser endomicroscopy, frozen section analysis (FSA), ultrasound (US), computed tomography scan (CT), (auto) fluorescence imaging (FI), and augmented reality (AR) have all been used for OPSCC. NBI, FSA, and US are most commonly used and increase the rate of negative margins. Other techniques will become available in the future, of which fluorescence imaging has high potential for use with OPSCC.
Collapse
|
15
|
Au VH, Yoon BC, Juliano A, Sadow PM, Faquin WC, Varvares MA. Correlation of Intraoperative Ultrasonographic Oral Tongue Shape and Border and Risk of Close Margins. Otolaryngol Head Neck Surg 2023; 168:1576-1579. [PMID: 36880451 DOI: 10.1002/ohn.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
Intraoperative ultrasound (IOUS) is a potentially useful adjunct to the resection of oral tongue cancers (OTC). IOUS images of the tumor-normal tissue interface show different patterns of invasion. In this retrospective series of 29 patients treated for OTC, we evaluated if there was a correlation between IOUS findings of patterns of invasion and final histology and assessed if there was any associated risk of increased incidence of positive or close margins with different patterns of invasion as seen on ultrasound. Although we found no significant correlation between ultrasound patterns of invasion and histological evaluation, we did find that an infiltrative pattern of invasion on IOUS did result in a significant risk of a close margin. Further exploration of these findings in a larger prospective study could provide definitive information on the efficacy of this modality in OTC resections.
Collapse
Affiliation(s)
- Vivienne H Au
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Byung C Yoon
- Department of Radiology, Stanford Health Care/VA Palo Alto Heath Care, Stanford Medical School, Stanford, California, USA
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Correlation between radiologic depth of invasion and pathologic depth of invasion in oral cavity squamous cell carcinoma: A systematic review and meta-analysis. Oral Oncol 2023; 136:106249. [PMID: 36417807 DOI: 10.1016/j.oraloncology.2022.106249] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To comprehensively assess the correlation between radiologic depth of invasion (rDOI) and pathologic depth of invasion (pDOI) in oral cavity squamous cell carcinoma (OSCC) by meta-analysis. MATERIALS AND METHODS PubMed and Embase databases were searched to find pertinent articles reporting rDOI of OSCC. Studies evaluating the correlations and mean differences (MDs) between rDOI and pDOI were included. The rDOI was measured based on ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). The correlation coefficients and MDs between rDOI and pDOI were meta-analytically pooled. Between-study heterogeneity was assessed using Higgins' inconsistency index (I2). Subgroup analysis was performed based on imaging modality. RESULTS Twenty-three studies with 1787 patients were included. The pooled correlation coefficient and MD were 0.86 (95 % confidence interval [CI], 0.82-0.90; I2 = 66.9 %) and 1.84 mm (95 % CI, 1.02-2.65 mm; I2 = 88.2 %), respectively. In subgroup analysis, MRI showed the largest MD (n = 12, 2.61 mm), followed by US (n = 2, -0.41 mm) and CT (n = 2, 0.12 mm). US showed the highest correlation coefficient (n = 3, 0.91), followed by MRI (n = 12, 0.85) and CT (n = 3, 0.82). CONCLUSION rDOI measured by US, CT, and MRI demonstrated excellent correlations with pDOI.
Collapse
|
17
|
Preoperative evaluation of depth of invasion in oral tongue squamous cell carcinoma: A systematic review and meta-analysis. Oral Oncol 2023; 136:106273. [PMID: 36521381 DOI: 10.1016/j.oraloncology.2022.106273] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
The inclusion of depth of invasion (DOI) in the American Joint Committee on Cancer's staging system for oral cavity squamous cell carcinoma (SCC) has major clinical impacts. Recent studies have evaluated the reliability of imaging modalities and biopsy techniques to measure DOI preoperatively. The objective of this systematic review and meta-analysis was to comprehensively include all previously described methods to measure preoperative DOI in oral tongue SCC (OTSCC) and to compare their reliability. A systematic review was conducted on PubMed, Embase and Cochrane according to the PRISMA guidelines. Studies that evaluated the reliability of DOI measured on biopsy or imaging (rDOI) by comparing it to DOI on histopathology (pDOI) were included for extraction. A meta-analysis was conducted to obtain pooled correlation coefficients for each imaging modality. The pooled correlation coefficients between rDOI and pDOI were 0.86 (CI95% = [0.82-0.88]) and 0.80 (CI95% = [0.70-0.87]) for magnetic resonance imaging (MRI) studies and computed tomography (CT) studies, respectively. For ultrasound (US), the correlation coefficient could only be measured by including studies which measured not only DOI but also tumor thickness. It was 0.89 (CI95%= [0.82-0.94]). Overall, MRI is the better studied modality. It has a good reliability to measure preoperative rDOI in OTSCC. CT is less studied but appears to be less reliable. US cannot be compared to these imaging modality as it has been used more often to measure TT than DOI.
Collapse
|
18
|
Wang S, Yu RX, Fan W, Li CX, Fei WM, Li S, Zhou J, Hu R, Liu M, Xu F, Xu J, Cui Y. Detection of skin thickness and density in healthy Chinese people by using high-frequency ultrasound. Skin Res Technol 2023; 29:e13219. [PMID: 36331142 PMCID: PMC9838783 DOI: 10.1111/srt.13219] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Due to a recent development of high-frequency ultrasound (HFUS) systems, it is easier to realize high-resolution in vivo imaging of the biological tissues. The object of this study was to map the thickness and echo density of skin layers in healthy Chinese people and assess the influence of gender, age, and region on it. METHODS A total of 189 volunteers (85 male, 104 female) with age range of 22-75-year old (mean age of 41.2-year old) were enrolled. The thickness and density of the epidermis and dermis layer were detected by high-frequency (22 or 75 MHz) ultrasonography at 13 different anatomical sites, including the forehead, cheeks, flexor and extensor forearms, flexor and extensor upper arms, inner and outer legs, inner and outer thighs, back, and abdomen. RESULTS The thickness and density of epidermis/dermis between different anatomical sites were statistically significant (p < 0.05). The epidermis thickness of the face and trunk were less than that of the limbs, whereas the thicknesses of the dermis were on the contrary. The density of the epidermis/dermis of the face and trunk were less than that of the limbs. The thickness of dermis in most of the sites were higher in male than in female, and the density of epidermis and dermis in most of the sites were less in men than in women. The thicknesses/densities of dermis were lower in older age group in almost all sites, whereas only several sites reached statistical. The difference between the north and south regions showed the environment also influenced the thickness and density of the skin. CONCLUSION HFUS provides a simple noninvasive method for evaluating the skin thickness and echo-density, which, reflecting intradermal structure, exhibit systematic regional variation. With the establishment of Chinese phenotypic database of skin thickness and density, it will be helpful for the skin disease assessment, skin surgery, and cosmetology technology.
Collapse
Affiliation(s)
- Shangshang Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui-Xing Yu
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Wen Fan
- Department of Dermatology, The Second People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Cheng-Xu Li
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School, Beijing, China
| | - Wen-Min Fei
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School, Beijing, China
| | - Shanshan Li
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Junfeng Zhou
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ruiming Hu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengguo Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Graduate School, Beijing, China
| |
Collapse
|
19
|
Surgical Extent for Oral Cancer: Emphasis on a Cut-Off Value for the Resection Margin Status: A Narrative Literature Review. Cancers (Basel) 2022; 14:cancers14225702. [PMID: 36428794 PMCID: PMC9688090 DOI: 10.3390/cancers14225702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
The optimal cut-off point of the resection margin was recently debated in oral cancer. To evaluate the current evidence of the dynamic criteria of the resection margin, a review of the available literature was performed. Studies were sourced from PubMed and EMBASE by searching for the keywords "mouth neoplasm", "oral cancer", "oral cavity cancer", "oral squamous cell carcinoma", "tongue cancer", "margins of excision", "surgical margin" and "resection margin". We found approximately 998 articles on PubMed and 2227 articles on EMBASE. A total of 3225 articles was identified, and 2763 of those were left after removing the duplicates. By applying advanced filters about the relevance of the subjects, these were narrowed down to 111 articles. After the final exclusion, 42 full-text articles were reviewed. The universal cut-off criteria of 5 mm used for determining the resection margin status has been debated due to recent studies evaluating the impact of different margin criteria on patient prognosis. Of note, the degree of the microscopic extension from the gross tumor border correlates with tumor dimensions. Therefore, a relatively narrow safety margin can be justified in early-stage oral cancer without the additional risk of recurrence, while a wide safety margin might be required for advanced-stage oral cancer. This review suggests a surgical strategy to adjust the criteria for risk grouping and adjuvant treatments, according to individual tumor dimensions or characteristics. In the future, it might be possible to establish individual tumor-specific surgical margins and risk stratification during or after surgery. However, the results should be interpreted with caution because there is no strong evidence (e.g., prospective randomized controlled studies) yet to support the conclusions. Our study is meaningful in suggesting future research directions and discussions.
Collapse
|
20
|
Lo WC, Chang CM, Cheng PC, Wen MH, Wang CT, Cheng PW, Liao LJ. The Applications and Potential Developments of Ultrasound in Oral Cancer Management. Technol Cancer Res Treat 2022; 21:15330338221133216. [PMID: 36254559 PMCID: PMC9580086 DOI: 10.1177/15330338221133216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oral cancer is endemic and causes a great burden in Southern Asia. It is preferably treated by surgery with/without adjuvant radiotherapy (RT) or chemoradiation therapy, depending on the stage of the disease. Close or positive resection margin and cervical lymph node (LN) metastasis are important prognostic factors that have been presented to be related to undesirable locoregional recurrence and poor survival. Ultrasound (US) is a simple, noninvasive, time-saving, and inexpensive diagnostic modality. It can depict soft tissues very clearly without the risk of radiation exposure. Additionally, it is real-time and continuous image is demonstrated during the exam. Furthermore, the clinician can perform US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at the same time. US with/without US-guided FNA/CNB is reported to be of value in determining tumor thickness (TT), depth of invasion (DOI), and cervical LN metastasis, and in aiding the staging of oral cancer. DOI has a relevant prognostic value as reported in the eighth edition of the American Joint Committee on Cancer staging of oral cancer. In the present review, we describe the clinical applications of US in oral cancer management in different phases and potential applications in the future. In the pretreatment and surgical phase, US can be used to evaluate TT/DOI and surgical margins of oral cancer in vivo and ex vivo. The prediction of a malignant cervical LN (nodal metastasis) by the US-based prediction model can guide the necessity of FNA/CNB and elective neck dissection in clinical early-stage oral cancer. In the posttreatment surveillance phase, US with/without US-guided FNA or CNB is helpful in the detection of nodal persistence or LN recurrence, and can assess the possibility and extent of carotid artery stenosis after irradiation therapy. Both US elastography and US swallowing assessment are potentially helpful to the management of oral cancer.
Collapse
Affiliation(s)
- Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Graduate Institute of Medicine, Yuan Ze University, Taoyuan,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Biomedical Engineering, National Yang-Ming University, Taipei
| | - Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Biomedical Engineering, National Yang-Ming University, Taipei,Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City
| | - Ming-Hsun Wen
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Electrical Engineering, Yuan Ze University, Taoyuan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Electrical Engineering, Yuan Ze University, Taoyuan,Li-Jen Liao, MD, PhD, Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Banqiao, New Taipei 22061.
,
| |
Collapse
|
21
|
Nilsson O, Knutsson J, Landström FJ, Magnuson A, von Beckerath M. Ultrasound accurately assesses depth of invasion in T1-T2 oral tongue cancer. Laryngoscope Investig Otolaryngol 2022; 7:1448-1455. [PMID: 36258857 PMCID: PMC9575113 DOI: 10.1002/lio2.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depth of invasion (DOI) is important for the T-classification of squamous cell carcinoma of the oral tongue (SCCOT) and incorporated in the TNM 8 classification of oral cavity cancer. To determine DOI clinical palpation is performed, but the preferred radiological modality remains controversial. The aim of this study was to investigate the assessment of DOI using ultrasound (US-DOI). Methods The DOI was assessed in 40 patients with T1-T3 SCCOT by ultrasound, palpation, computed tomography and magnetic resonance imaging (MRI). Histopathological DOI (H-DOI) was gold standard. Bland-Altman analysis was used to compare mean difference and 95% limits of agreement (LOA). Results The mean difference of US-DOI was -0.5 mm (95% LOA -4.9-4.0) compared to H-DOI and the mean difference for MRI was 3.9 mm (95% LOA -2.3-10.2). In the subgroup analysis of cT1-T2 the US-DOI mean difference was 0.1 mm and the 95% LOA limits -2.5-2.7. Conclusions Ultrasound seems to be the most accurate method to assess DOI in T1-T2 SCCOT. MRI overestimates DOI and cannot assess a substantial proportion of the tumors. Level of Evidence 2c.
Collapse
Affiliation(s)
- Olof Nilsson
- Department of OtolaryngologyÖrebro University HospitalÖrebroSweden
- School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Johan Knutsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of OtolaryngologyVastmanland County HospitalVästeråsSweden
| | - Fredrik J. Landström
- Department of OtolaryngologyÖrebro University HospitalÖrebroSweden
- School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Mathias von Beckerath
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Oto‐Rhino‐Laryngology, Head and Neck SurgeryKarolinska University HospitalStockholmSweden
| |
Collapse
|
22
|
Nilsson O, Knutsson J, Landström FJ, Magnuson A, von Beckerath M. Ultrasound-assisted resection of oral tongue cancer. Acta Otolaryngol 2022; 142:743-748. [PMID: 36537851 DOI: 10.1080/00016489.2022.2153916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In surgical resection of squamous cell carcinoma of the oral tongue (SCCOT), achieving clear margins is important for prognosis. Insufficient histopathological margins are common, particularly deep margins. AIMS/OBJECTIVES The aim of the present study was to determine whether ultrasound (US)-assisted resection could decrease the proportion of insufficient histopathological deep margins in SCCOT. MATERIAL AND METHODS 34 patients with SCCOT undergoing US-assisted resection (study group) were compared to 76 whose resections were performed without US (conventional group). Outcome measures were insufficient deep histopathological resection margins and mean difference in deep margins. RESULTS Insufficient deep resection margins (<5.0 mm) were seen in 8 of 34 (23.5%) in the study group, compared to 31 of 76 (40.8%) in the conventional group, unadjusted RR 0.58 [95% CI 0.30-1.12; p = .11], adjusted RR 0.82 [95% CI 0.35-1.92; p = .64]. Unadjusted mean difference was 1.4 mm (95% CI 0.1-2.7, p = .04), adjusted mean difference 1.1 mm (95% CI -2.7 to 0.5, p = .19). CONCLUSIONS Intraoperative US can visualize the deep resection margins in T1/T2 SCCOT. US-assisted resection seems to decrease the number of insufficient histopathological deep margins, though the results are not statistically significant. Comparatively good results in the conventional group is one explanation for the lack of significance. CLINICALTRIALS.GOV ID NCT04059861.
Collapse
Affiliation(s)
- Olof Nilsson
- Deparment of Otolaryngology, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Knutsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Deparment of Otolaryngology, Västerås Central Hospital, Västerås, Sweden
| | | | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mathias von Beckerath
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Deparment of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
23
|
de Koning KJ, van Es RJJ, Klijn RJ, Breimer GE, Willem Dankbaar J, Braunius WW, van Cann EM, Dieleman FJ, Rijken JA, Tijink BM, de Bree R, Noorlag R. Application and accuracy of ultrasound-guided resections of tongue cancer. Oral Oncol 2022; 133:106023. [PMID: 35901543 DOI: 10.1016/j.oraloncology.2022.106023] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Surgical removal of squamous cell carcinoma of the tongue (SCCT) with tumour-free margin status (≥5 mm) is essential for loco-regional control. Inadequate margins (<5 mm) often indicate adjuvant treatment, which results in increased morbidity. Ultrasound (US)-guided SCCT resection may be a useful technique to achieve more adequate resection margins compared to conventional surgery. This study evaluates the application and accuracy of this technique. METHODS Forty patients with SCCT were included in a consecutive US cohort. During surgery, the surgeon aimed for a 10-mm echographic resection margin, while the tumour border and resection plane were captured in one image. Ex-vivo US measurements of the resection specimen determined whether there was a need for an immediate re-resection. The margin status and the administration of adjuvant treatment were compared those of with a consecutive cohort of 96 tongue cancer patients who had undergone conventional surgery. A receiver operating characteristic analysis was done to assess the optimal margin of ex-vivo US measurements to detect histopathologically inadequate margins. RESULTS In the US cohort, the frequency of free margin status was higher than in the conventional cohort (55% vs. 16%, p < 0.001), and the frequency of positive margins status (<1 mm) was lower (5% vs. 15%, respectively, p < 0.001). Adjuvant radiotherapy was halved (10% vs. 21%), and the need for re-resection was comparable (10% vs. 9%). A cut-off value of 8 mm for ex-vivo measurements prevented histopathologically inadequate margins in 76%. CONCLUSION US-guided SCCT resections improve margin status and reduce the frequency of adjuvant radiotherapy.
Collapse
Affiliation(s)
- Klijs J de Koning
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reinoud J Klijn
- Department of Oral and Maxillofacial Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerben E Breimer
- Department. of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Weibel W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen M van Cann
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - François J Dieleman
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Noorlag
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
24
|
Quantitative Ultrasound Analysis of Oral Mucosa: An Observational Cross-Sectional Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: Ultrasonography is gaining popularity as a diagnostic tool in the study of the oral mucosa. The precision of ultrasound has made it possible to identify the various layers, based on their echogenicity. The aim of this study was to perform a quantitative analysis of healthy oral mucosa based on the analysis of greyscale, echo levels (dB), and attenuation values (dB/cm). (2) Methods: Thirty-three patients (17 females and 16 males; 58.42 ± 13.29 y.o) were recruited for this study. The images were acquired with the GE Logiq-e R7 with a linear probe at 18 MHz frequency (harmonic). For each tissue (epithelium, rete ridges, connective tissue, muscle, and bone), regions of interest were traced for the analysis of echo levels, grey levels, and attenuation values. One-way ANOVA and pairwise comparison were performed. (3) Results: Three-hundred and thirty images were analyzed. Analysis of echo levels and grey levels showed a significant difference between epithelium and rete ridges (p = 0.001), and between rete ridges and connective tissue (p = 0.001), but not between epithelium and connective tissue (p = 0.831) or connective and muscle layers (p = 0.383). The attenuation values appeared to be specific for each tissue layer (p = 0.001). (4) Conclusions: Quantitative analysis applied to ultrasound imaging of the oral mucosa allows the definition of specific tissue areas.
Collapse
|
25
|
De Berardinis R, Tagliabue M, Belloni P, Gandini S, Scaglione D, Maffini F, Margherini S, Riccio S, Giugliano G, Bruschini R, Chu F, Ansarin M. Tongue cancer treatment and oncological outcomes: The role of glossectomy classification. Surg Oncol 2022; 42:101751. [DOI: 10.1016/j.suronc.2022.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
|
26
|
High-Definition Ultrasound Characterization of Squamous Carcinoma of the Tongue: A Descriptive Observational Study. Cancers (Basel) 2022; 14:cancers14030564. [PMID: 35158831 PMCID: PMC8833637 DOI: 10.3390/cancers14030564] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The application of high-frequency ultrasound in the oral cavity for malignant lesions is a growing trend. As with other parts of the body, this method could become routine in the future. With this in mind, this work aimed to characterize squamous tumors of the tongue ultrasonographically and added additional descriptive elements to the current literature. Abstract High-definition ultrasonography is a diagnostic tool that uses sound echoes to produce images of tissues and organs. In the head and neck region, ultrasounds have been used to diagnose different types of lesions. The intraoral approach was shown to be a real-time, non-invasive way to characterize oral lesions. The tongue is the most often examined region because of its accessibility. This observational study aimed to describe the qualitative characteristics of tongue squamous cell carcinoma images obtained with high-definition intraoral ultrasound by comparing them with the corresponding histopathological sample. Twenty patients were enrolled in this study. The scans of the lesions were carried out with an 18 MHz linear ultrasound probe following the long axis of the lesion. For each lesion, five frames were selected, on which descriptive analysis was performed. A histological sample was taken and then compared to the ultrasonographic acquisition. The sonographic appearance of the tissue layers has a good correlation between ultrasound and histological morphology, and it was easy to distinguish the tumor from the homogenous composition of the tongue tissues. Furthermore, a correlation between the structure by section and pattern of tumor margin features by ultrasound was obtained. Intraoral ultrasonography appears to be a promising technique in the non-invasive characterization of tongue squamous cell carcinoma. Further studies will be needed to improve the technique in terms of ergonomics and repeatability.
Collapse
|
27
|
van Schaik JE, Halmos GB, Witjes MJH, Plaat BEC. An overview of the current clinical status of optical imaging in head and neck cancer with a focus on Narrow Band imaging and fluorescence optical imaging. Oral Oncol 2021; 121:105504. [PMID: 34454339 DOI: 10.1016/j.oraloncology.2021.105504] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Early and accurate identification of head and neck squamous cell carcinoma (HNSCC) is important to improve treatment outcomes and prognosis. New optical imaging techniques may assist in both the diagnostic process as well as in the operative setting by real-time visualization and delineation of tumor. Narrow Band Imaging (NBI) is an endoscopic technique that uses blue and green light to enhance mucosal and submucosal blood vessels, leading to better detection of (pre)malignant lesions showing aberrant blood vessel patterns. Fluorescence optical imaging makes use of near-infrared fluorescent agents to visualize and delineate HNSCC, resulting in fewer positive surgical margins. Targeted fluorescent agents, such as fluorophores conjugated to antibodies, show the most promising results. The aim of this review is: (1) to provide the clinical head and neck surgeon an overview of the current clinical status of various optical imaging techniques in head and neck cancer; (2) to provide an in-depth review of NBI and fluorescence optical imaging, as these techniques have the highest potential for clinical implementation; and (3) to describe future improvements and developments within the field of these two techniques.
Collapse
Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
28
|
Evaluation of Depth of Invasion in Oral Squamous Cell Carcinoma with Ultra-High Frequency Ultrasound: A Preliminary Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intraoral ultrasonography has been widely employed for the preoperative assessment of tumor margins due to its capability to evaluate depth of invasion (DOI) and tumor thickness (TT). Recently, a novel ultrasonographic technique, ultra-high frequency ultrasound (UHFUS) has been increasingly applied to the study of oral lesions. This study evaluates the potential application of intraoral UHFUS to assess DOI and TT parameters of oral squamous cell carcinoma (OSCC) lesions. Patients clinically suspected of OSCC lesions were enrolled and underwent an intraoral UHFUS examination preoperatively. The parameters of TT, DOI, echogenicity, and vascularization were assessed. The parameters of TT and DOI as evaluated by means of UHFUS were compared to histology, which was set as the benchmark. Ten patients in total were enrolled. UHFUS-based DOI and TT measurements were found to positively correlate with histology (p < 0.05), although UHFUS provided a slight overestimation of DOI. No differences were found in terms of echogenicity or vascularization depending on the site of the lesion. According to these preliminary results, UHFUS could support the preoperative assessment of TT and DOI, potentially enhancing the clinical evaluation of OSCC.
Collapse
|
29
|
Bruschini R, Maffini F, Chiesa F, Lepanto D, De Berardinis R, Chu F, Tagliabue M, Giugliano G, Ansarin M. Oral cancer: changing the aim of the biopsy in the age of precision medicine. A review. ACTA ACUST UNITED AC 2021; 41:108-119. [PMID: 34028455 PMCID: PMC8142729 DOI: 10.14639/0392-100x-n1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/03/2021] [Indexed: 01/15/2023]
Abstract
Oral cancer is a heterogeneous disease that develops through a complex, multi-step process. Precision medicine should help to better understand its molecular basis, integrate traditional classifications and have a positive impact on cancer management. To apply this information in clinical practice, we need to define its histology and identify biomarkers expressed by the tumour that provide useful information for planning tailored treatment. The most reliable information currently derives from evaluation of biomarkers on post-operative samples. To plan personalised treatment, oncologists need to assess these markers on biopsy samples. We reviewed the recent literature and identified 6 of 184 publications that compared markers measured on biopsy and post-operative samples or assessed their predictivity for the development of lymph node metastases. Data from these studies suggest that markers measured on biopsy samples can provide useful indications for tailoring treatments. However, due to their heterogeneity and low level of evidence, these results need to be confirmed by clinical studies on a large population to standardise and validate biomarkers in biopsies and to assess their reliability in other diagnostic mini-invasive procedures such as radiomics and liquid biopsy.
Collapse
Affiliation(s)
- Roberto Bruschini
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Chiesa
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Lepanto
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Chu
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
30
|
Sun LF, Wang CX, Cao ZY, Han W, Guo SS, Wang YZ, Meng Y, Hou CX, Zhu QH, Tang YT, Li HQ, Zhang T, Ye JH. Evaluation of autofluorescence visualization system in the delineation of oral squamous cell carcinoma surgical margins. Photodiagnosis Photodyn Ther 2021; 36:102487. [PMID: 34411738 DOI: 10.1016/j.pdpdt.2021.102487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Delineating the margins of Oral squamous cell carcinoma (OSCC) is a critical step for optimaltumor resection. The aim of this study was to evaluate the accuracy of lesion surgical margin identification using autofluorescence visualization. MATERIALS AND METHODS Thirty patients with OSCC were included in this study. For each lesion, the fluorescence loss boundary was determined using VELscope before ablative surgical resection (with a 1.5-2cm safety margin) was performed. A total of 126 samples were obtained from 30 surgical specimens, each containing the tissue from the fluorescence loss boundary to surgical margin. The status of each sample was determined by oral pathologists and the staining intensities of Ki-67, E-cadherin, and Vimentin at the fluorescence loss boundary and surgical margin were evaluated by immunohistochemistry. RESULTS Fluorescence loss regions were identified in all patients. Of the 126 samples collected, HE staining identified 77 normal epithelia (61.1%), 26 mild dysplasia (20.6%), 17 severe dysplasia (13.4%) and 6 carcinomas in situ (4.9%). A significant correlation was found between the differentiation grade of tumor cells and the pathological status of the surgical marginal specimens (P<0.05). Forty-two of the 126 samples were randomly selected for further immunohistochemical staining. No significant differences were seen in Ki-67, E-cadherin, or Vimentin expression at the fluorescence loss boundary or surgical margin, however, the proteins' expression level was positively correlated with the degree of dysplasia (P<0.01). CONCLUSION Autofluorescence visualization has potential as a simple surgical margin setting device for OSCC and may help delineate the superficial area of OSCC with acceptable accuracy. However, when considering the inherent limitations of this system, we suggest that the approach should only be applied under certain conditions, such as when dealing with superficial, well-differentiated lesions.
Collapse
Affiliation(s)
- Li-Fan Sun
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, Huaxia Stomatological Hospital Affiliated to Suzhou Health College, Suzhou 215000, China
| | - Chen-Xing Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zheng-Yao Cao
- Depatment of Stomatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
| | - Wei Han
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Song-Song Guo
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi-Zhou Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ying Meng
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chen-Xing Hou
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qing-Hai Zhu
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu-Ting Tang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huai-Qi Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Tianzhu Zhang
- National Key Bioelectronics Stomatology Laboratory, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
| | - Jin-Hai Ye
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China.
| |
Collapse
|
31
|
Yamaguchi K, Nakagawa K, Yoshimi K, Ariya C, Nakane A, Furuya J, Tohara H. Age-related changes in swallowing muscle intramuscular adipose tissue deposition and related factors. Exp Gerontol 2021; 153:111505. [PMID: 34343633 DOI: 10.1016/j.exger.2021.111505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate age-related changes in the intramuscular adipose tissue (IAT) of the tongue and geniohyoid muscle (GHM) and associated factors. DESIGN Exploratory cross-sectional study. SETTING AND PARTICIPANTS This study included 89 participants recruited from a health survey, which included 38 younger adults (age range, 20-63 years) and 51 older adults (age range, 65-87 years). MEASUREMENTS Age, body mass index, body fat, lean body mass, skeletal muscle mass index, trunk muscle mass index, tongue pressure, jaw opening force, and oral diadochokinesis were assessed. The cross-sectional area (CSA) and echo intensity (EI) of the tongue and GHM were measured using ultrasonography. IAT was assessed according to EI values. The factors related to the IAT of each muscle were examined using multiple regression analysis. We also investigated the correlation of IAT with factors related to oral function and systemic and morphological factors. RESULTS Neither the EI of the tongue nor that of the GHM had a significant correlation with factors related to oral function and systemic factors. In the multiple regression analysis, significant explanatory variables for EI of the tongue and GHM were age (β = 0.14, P = 0.019; tongue and β = 0.13, P = 0.017; GHM) and the CSA of each muscle (β = -0.01, P = 0.042; tongue and β = -0.04, P = 0.003; GHM). EI was positively associated with age and negatively associated with muscle CSA. CONCLUSION Age-related changes in the IAT show the same trend for both the tongue and GHM, unlike age-related changes in muscle mass. The IATs of the tongue and GHM were not significantly correlated with oral function and systemic factors. Therefore, EI may not be a useful index for the functional evaluation of the tongue and GHM.
Collapse
Affiliation(s)
- Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Chantaramanee Ariya
- Department of Preventive Dentistry, Naresuan University, 99 Moo 9, Phitsanulok-Nakhon Sawan Road, Tha Pho, Mueang Phitsanulok 65000, Thailand
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Junichi Furuya
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Geriatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| |
Collapse
|
32
|
Salzano G, Dell'Aversana Orabona G, Abbate V, Vaira LA, Committeri U, Bonavolontà P, Piombino P, Maglitto F, Russo C, Russo D, Varricchio S, Attanasi F, Turri-Zanoni M, de Riu G, Califano L. The prognostic role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in early-stage squamous cell carcinomas of the oral tongue. Oral Maxillofac Surg 2021; 26:21-32. [PMID: 34106358 DOI: 10.1007/s10006-021-00969-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 01/03/2023]
Abstract
The appropriate surgical management of early-stage oral tongue squamous cell carcinoma (OTSCC) remains a debated topic. The aim of this study is to investigate the role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in predicting the presence of occult neck metastases in early-stage OTSCC. A retrospective analysis of patients affected by early-stage (cT1-T2 cN0) OTSCC who were submitted to elective neck dissection (END) was performed. Tumors were classified retrospectively according to the 8th TNM classification, the DOI was assessed on the pre-operative magnetic resonance imaging, and the pre-treatment NLR was calculated for each patient. A logistic regression model to estimate the probability π (x) of cervical metastases by studying the NLR and DOI was carried out. Next, the correlation between the two variables, the NLR and DOI, was preliminarily studied. A cohort of 110 patients was analyzed (mean age, 62 years old; male to female ratio 1.2:1). The patients were staged as cT1 in 53 cases and cT2 in 57 cases. A DOI greater than 5.4 mm and a NLR greater than 2.93 are associated with an increased risk of presenting occult cervical metastases. Furthermore, the variables NLR and DOI are linearly associated with a positive correlation, proved by Spearman's rank correlation coefficient rho of 0.64, with a unitary increase in the DOI of 1 mm directly associated with an increase of 0.47 in the NLR. The DOI and NLR can be effectively used to predict the occurrence of occult neck metastasis and therefore to plan an END in early-stage OTSCC.
Collapse
Affiliation(s)
- Giovanni Salzano
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy.
| | - Giovanni Dell'Aversana Orabona
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Vincenzo Abbate
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Luigi Angelo Vaira
- Operative Unit of Maxillofacial Surgery, University Hospital of Sassari, Viale San Pietro 43/b, Sassari, Italy
| | - Umberto Committeri
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Paola Bonavolontà
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Pasquale Piombino
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Fabio Maglitto
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, University "Federico II", Surgical Pathology Section, 80131, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, University "Federico II", Surgical Pathology Section, 80131, Naples, Italy
| | - Federica Attanasi
- Department of Statistical Sciences, University La Sapienza, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giacomo de Riu
- Operative Unit of Maxillofacial Surgery, University Hospital of Sassari, Viale San Pietro 43/b, Sassari, Italy
| | - Luigi Califano
- Department Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Via Sergio Pansini 5, Naples, Italy
| |
Collapse
|
33
|
Romano A, Di Stasio D, Petruzzi M, Fiori F, Lajolo C, Santarelli A, Lucchese A, Serpico R, Contaldo M. Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process. Cancers (Basel) 2021; 13:cancers13122864. [PMID: 34201237 PMCID: PMC8228647 DOI: 10.3390/cancers13122864] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance. Abstract Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.
Collapse
Affiliation(s)
- Antonio Romano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Fausto Fiori
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli–IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Andrea Santarelli
- Department of Clinical Specialist and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy;
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
- Correspondence: ; Tel.: +39-3204876058
| |
Collapse
|
34
|
A comparative study between CT, MRI, and intraoral US for the evaluation of the depth of invasion in early stage (T1/T2) tongue squamous cell carcinoma. Oral Radiol 2021; 38:114-125. [PMID: 33970389 PMCID: PMC8741672 DOI: 10.1007/s11282-021-00533-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
Objectives This study aimed to clarify the accuracy of intraoral ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in preoperative image depth of invasion (DOI) measurement of T1/T2 tongue cancer through comparison with histopathological measurements. Methods Imaging of the primary lesions was performed at our hospital; the lesions were classified into T1 and T2 based on the 8th edition of the AJCC/UICC, and surgery performed. There was histopathological confirmation of lesions as squamous cell carcinoma in 48 patients with tongue cancer. T3 and T4 cases, cases in which preoperative chemotherapy and radiation therapy were performed, and cases where biopsy was performed before imaging were excluded. The radiological DOI in US, CT, and MRI and the histopathological DOI as base were comparatively investigated and statistical analyses were performed by Bland–Altman analysis and Spearman's rank correlation coefficient. Results Bland–Altman analysis showed that the US radiological DOI was overestimated by an average of 0.2 mm compared to the histopathological DOI, while CT and MRI radiological DOI were overestimated by an average of 2–3 mm. The comparison of CT and MRI revealed that the difference between the MRI and histopathological DOI, as well as the 95% limit of agreement, were smaller than those of the CT radiological DOI. Conclusions US is the most accurate preoperative diagnostic tool for T1 and T2 squamous cell carcinoma; CT and MRI tend to have an overestimation of about 2–3 mm and so caution is required.
Collapse
|
35
|
Brouwer de Koning SG, Schaeffers AWMA, Schats W, van den Brekel MWM, Ruers TJM, Karakullukcu MB. Assessment of the deep resection margin during oral cancer surgery: A systematic review. Eur J Surg Oncol 2021; 47:2220-2232. [PMID: 33895027 DOI: 10.1016/j.ejso.2021.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
The main challenge for radical resection in oral cancer surgery is to obtain adequate resection margins. Especially the deep margin, which can only be estimated based on palpation during surgery, is often reported inadequate. To increase the percentage of radical resections, there is a need for a quick, easy, minimal invasive method, which assesses the deep resection margin without interrupting or prolonging surgery. This systematic review provides an overview of technologies that are currently being studied with the aim of fulfilling this demand. A literature search was conducted through the databases Medline, Embase and the Cochrane Library. A total of 62 studies were included. The results were categorized according to the type of technique: 'Frozen Section Analysis', 'Fluorescence', 'Optical Imaging', 'Conventional imaging techniques', and 'Cytological assessment'. This systematic review gives for each technique an overview of the reported performance (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, or a different outcome measure), acquisition time, and sampling depth. At the moment, the most prevailing technique remains frozen section analysis. In the search for other assessment methods to evaluate the deep resection margin, some technologies are very promising for future use when effectiveness has been shown in larger trials, e.g., fluorescence (real-time, sampling depth up to 6 mm) or optical techniques such as hyperspectral imaging (real-time, sampling depth few mm) for microscopic margin assessment and ultrasound (less than 10 min, sampling depth several cm) for assessment on a macroscopic scale.
Collapse
Affiliation(s)
- S G Brouwer de Koning
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - A W M A Schaeffers
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W Schats
- Scientific Information Service, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands; Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
36
|
Intraoral Ultrasonographic Features of Tongue Cancer and the Incidence of Cervical Lymph Node Metastasis. J Oral Maxillofac Surg 2021; 79:932-939. [DOI: 10.1016/j.joms.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
|
37
|
Subramaniam N, Poptani H, Schache A, Bhat V, Iyer S, Sunil HV, Chandrasekhar N, Pillai V, Chaturvedi P, Krishna S, Krishnamurthy A, Kekatpure V, Kuriakose M, Iyer NG, Thakkar A, Kantharia R, Sonkar A, Shetty V, Rangappa V, Kolur T, Vidhyadharan S, Murthy S, Kudpaje A, Srinivasalu V, Mahajan A. Imaging advances in oral cavity cancer and perspectives from a population in need: Consensus from the UK-India oral cancer imaging group. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2021. [DOI: 10.4103/jhnps.jhnps_10_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
38
|
Abbott S, Zelesco M, Gibson D. Tongue sonography: An introduction. SONOGRAPHY 2020. [DOI: 10.1002/sono.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Steven Abbott
- Medical Imaging Department Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Marilyn Zelesco
- Medical Imaging Department Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Daren Gibson
- Medical Imaging Department Fiona Stanley Hospital Murdoch Western Australia Australia
| |
Collapse
|
39
|
Bulbul MG, Zenga J, Tarabichi O, Parikh AS, Sethi RK, Robbins KT, Puram SV, Varvares MA. Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members. Laryngoscope 2020; 131:782-787. [PMID: 32827312 DOI: 10.1002/lary.28976] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/20/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. STUDY DESIGN Cross-sectional survey. METHODS We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. RESULTS A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. CONCLUSIONS To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination. LEVEL OF EVIDENCE 4 Laryngoscope, 131:782-787, 2021.
Collapse
Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Osama Tarabichi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Rosh K Sethi
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, U.S.A
| |
Collapse
|
40
|
McIlduff CE, Martucci MG, Shin C, Qi K, Pacheck AK, Gutierrez H, Mortreux M, Rutkove SB. Quantitative ultrasound of the tongue: Echo intensity is a potential biomarker of bulbar dysfunction in amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2423-2428. [PMID: 32828046 DOI: 10.1016/j.clinph.2020.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To learn if quantitative ultrasound (QUS) distinguishes the tongues of healthy participants and amyotrophic lateral sclerosis (ALS) patients by echo intensity (EI) and to evaluate if EI correlates with measures of bulbar function. METHODS Ultrasound was performed along the midline of the anterior tongue surface in 16 ALS patients and 16 age-matched controls using a linear hockey stick 16-7 MHz transducer. A region of interest was manually drawn and then EI was determined for the upper 1/3 of the muscle. For patients, the ALS functional rating scale - revised (ALSFRS-R) was used to calculate bulbar sub-scores and the Iowa Oral Performance Instrument (IOPI) was used to measure tongue strength. RESULTS EI was significantly higher in ALS patients than in healthy participants (49.8 versus 37.8 arbitrary units, p < 0.01). In the patient group, EI was negatively correlated with ALSFRS-R bulbar sub-score (RS = -0.65, p < 0.01). An inverse correlation between EI and tongue strength did not reach significance (RS = -0.34, p = 0.28). CONCLUSIONS This study suggests that EI can differentiate healthy from diseased tongue muscle, and correlates with a standard functional measure in ALS patients. SIGNIFICANCE Tongue EI may represent a novel biomarker for bulbar dysfunction in ALS.
Collapse
Affiliation(s)
- C E McIlduff
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA.
| | - M G Martucci
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - C Shin
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - K Qi
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - A K Pacheck
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - H Gutierrez
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - M Mortreux
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - S B Rutkove
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| |
Collapse
|
41
|
Rocchetti F, Tenore G, Montori A, Cassoni A, Cantisani V, Di Segni M, Di Gioia CRT, Carletti R, Valentini V, Polimeni A, Romeo U. Preoperative evaluation of tumor depth of invasion in oral squamous cell carcinoma with intraoral ultrasonography: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:130-138. [PMID: 32792295 DOI: 10.1016/j.oooo.2020.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of preoperative intraoral ultrasonography (US) in the assessment of tumor depth of invasion (DOI) in oral squamous cell carcinoma (OSCC). STUDY DESIGN Records of 32 patients with biopsy-proven OSCC who underwent preoperative intraoral US were retrospectively reviewed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy as indicated by receiver operating characteristic (ROC) analysis were measured for US in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa. The correlations between US and histologic DOI, and between US DOI and US diameter of the lesion, were assessed. RESULTS US sensitivity, specificity, PPV, and NPV in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa were 93.1%, 100%, 100%, and 60%, respectively. The area under the ROC curve was 0.96. A significant correlation was found between the measurements of US DOI and histological DOI (r = 0.907). A moderate correlation was found between US DOI and US diameter (r = 0.591). CONCLUSIONS Intraoral US has potential in preoperatively determining tumor DOI and may provide additional guidance for optimal planning of therapy for OSCC patients .
Collapse
Affiliation(s)
- Federica Rocchetti
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Gianluca Tenore
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessandra Montori
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - Andrea Cassoni
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Mattia Di Segni
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Raffaella Carletti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentino Valentini
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Umberto Romeo
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
42
|
Assessment of tumour depth in early tongue cancer: Accuracy of MRI and intraoral ultrasound. Oral Oncol 2020; 110:104895. [PMID: 32653839 DOI: 10.1016/j.oraloncology.2020.104895] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/14/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Complete resection of tongue cancer is necessary to achieve local control. Unfortunately, deep resection margins are frequently inadequate. To improve deep margin control, accurate knowledge of tumour thickness is pivotal. Magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS) are frequently applied for tumour staging. This study explores the accuracy of these techniques to estimate depth of invasion. MATERIALS AND METHODS The data of patients with a T1-2 tongue cancer that had been treated surgically between 2014 and 2018 were retrospectively analysed. Measurements that had been taken by either MRI or ioUS were compared with those taken during histopathology. RESULTS A total of 83 patients with tongue cancer had undergone a pre-operative MRI and 107 had been studied through an ioUS. Tumour thickness measured by MRI (r = 0.72) and ioUS (r = 0.78) correlated significantly (p < 0.001) with histopathological depth of invasion (DOI). In tumours with a DOI of 0-10 mm, MRI has a mean absolute difference with histopathology of 3.1 mm (SD 3.2 mm) and ioUS of 1.6 mm (SD 1.3 mm). In tumours with a DOI greater than 10 mm, MRI has a mean absolute difference of 3.5 mm (SD 3.0 mm) and ioUS of 4.7 mm (SD 3.5 mm). CONCLUSION Estimation of histopathological DOI in tongue cancers with DOI till 10 mm is very accurate through use of ioUS. ioUS tends to underestimate DOI in tumors exceeding 10 mm DOI. MRI tends to overestimate DOI in both thin and thick tumours. Since ultrasound measurements can be performed during surgery, ioUS could potentially guide the surgeon in the achievement of adequate resection margins.
Collapse
|
43
|
Vassiliou LV, Acero J, Gulati A, Hölzle F, Hutchison IL, Prabhu S, Testelin S, Wolff KD, Kalavrezos N. Management of the clinically N 0 neck in early-stage oral squamous cell carcinoma (OSCC). An EACMFS position paper. J Craniomaxillofac Surg 2020; 48:711-718. [PMID: 32718880 DOI: 10.1016/j.jcms.2020.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/20/2020] [Indexed: 12/12/2022] Open
Abstract
Metastasis of oral squamous cell carcinoma (OSCC) to the cervical lymph nodes has a significant impact on prognosis. Accurate staging of the neck is important in order to deliver appropriate treatment for locoregional control of the disease and for prognosis. The management of the neck in early, low volume disease (clinically T1/T2 oral cavity tumours) has long been debated. The risk of occult nodal involvement in cT1/T2 OSCC is estimated around 20-30%. We describe the natural evolutionary history of OSCC and its patterns of spread and metastasis to the local lymphatic basins. We discuss most published literature and studies on management of the clinically negative neck (cN0). Particular focus is given to prospective randomized trials comparing the outcomes of upfront elective neck dissection against the observational stance, and we summarize the results of the sentinel node biopsy studies. The paper discusses the significance of the primary tumour histological characteristics and specifically the tumour's depth of invasion (DOI) and its impact on predicting nodal metastasis. The DOI has been incorporated in the TNM staging highlighting its significance in aiding the treatment decision making and this is reflected in world-wide oncological guidelines. The critical analysis of all available literature amalgamates the existing evidence in early OSCC and provides recommendations in the management of the clinically N0 neck.
Collapse
Affiliation(s)
- Leandros V Vassiliou
- Department of Oral and Maxillofacial Surgery, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK
| | - Julio Acero
- Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Alcala University, Madrid, Spain
| | - Aakshay Gulati
- Maxillofacial Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, UK
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, Aachen University Hospital, Aachen, Germany
| | - Iain L Hutchison
- Department of Oral & Maxillofacial Surgery, Barts Health NHS Trust, Saving Faces-The Facial Surgery Research Foundation, London, UK
| | - Satheesh Prabhu
- Division of Oral & Maxillofacial Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sylvie Testelin
- Department of Maxillo-Facial Surgery, University Hospital of Amiens, Amiens, France
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, University Hospital Rechts der Isar, Munich, Germany
| | - Nicholas Kalavrezos
- Department of Head & Neck Surgery, University College London Hospital, London, UK.
| |
Collapse
|
44
|
Wunschel M, Neumeier M, Utpatel K, Reichert TE, Ettl T, Spanier G. Staging more important than grading? Evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma. Clin Oral Investig 2020; 25:1169-1182. [PMID: 32601998 PMCID: PMC7878266 DOI: 10.1007/s00784-020-03421-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
Objectives The present study evaluated the predictive value of staging and grading parameters concerning the presence of lymph-node metastases, overall survival (OS), and relapse-free survival (RFS) of patients with oral squamous cell carcinoma (OSCC). Materials and methods HE-stains of 135 surgically treated (R0) primary OSCCs were analyzed using a both microscopic and software-based approach. Depth of invasion (DOI) and resection margins (RM) were measured, and each case was graded according to the malignancy grading system as described by Anneroth et al. and Bryne et al. on two different sites of the tumor (surface and invasion front; TS and IF). Results Parameters that could be identified as significant predictors of OS and RFS were UICC cancer stage (p = 0.009 and p = 0.012); pT-stage as defined in the 7th edition (p = 0.029 and 0.015) and, after restaging using DOI, 8th edition (p = 0.023 and p = 0.005) of the TNM classification of malignant tumors; the presence of lymphonodular metastases (LM) (p = 0.004 and p = 0.011); degree of keratinization (p = 0.029 and p = 0.042); and pattern of growth (p = 0.029 and p = 0.024) at the TS after applying a binary scale for both parameters. Also, when directly comparing the most extreme subgroups (scores 1 and 4) of lymphoplasmacytic infiltration at the IF, there was a significant difference in OS (p = 0.046) and RFS (p = 0.005). Invasion of blood vessels (p = 0.013) and perineural invasion (p = 0.023) were significantly associated with a lower OS. Age lower than 60 years (univariate p = 0.029, multivariate p = 0.031), infiltration of lymphatic vessels (p = 0.003), infiltration of nerves (p = 0.010), pT-stage (8th edition) (p = 0.014), degree of keratinization at the IF (p = 0.033), and nuclear polymorphism at the IF (p = 0.043) after conversion to a binary scale were found to be significant prognostic parameters regarding the presence of LM. DOI evolved as a significant predictor for OS (p = 0.006), RFS (p = 0.003), and LM (p = 0.032) in metric and grouped analysis. Conclusions The current evaluation revealed depth of invasion as strongest histologic predictor of metastatic tumor growth, overall survival, and relapse-free survival in OSCC, confirming the current adaption of the T-classification. Other distinct histologic grading parameters investigated during this study can give valuable indications of a tumor’s potential aggressiveness, but the exact site, mode, and procedure need further exploration. Clinical relevance Integrating measurement of DOI also into the pretherapeutic staging process could aid in treatment planning.
Collapse
Affiliation(s)
- Michael Wunschel
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Miriam Neumeier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Gerrit Spanier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
45
|
Almangush A, Mäkitie AA, Triantafyllou A, de Bree R, Strojan P, Rinaldo A, Hernandez-Prera JC, Suárez C, Kowalski LP, Ferlito A, Leivo I. Staging and grading of oral squamous cell carcinoma: An update. Oral Oncol 2020; 107:104799. [PMID: 32446214 DOI: 10.1016/j.oraloncology.2020.104799] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.
Collapse
Affiliation(s)
- Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Institute of Biomedicine, Pathology, University of Turku, Turku, Finland; Faculty of Dentistry, University of Misurata, Misurata, Libya.
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, UK.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | | | | | - Carlos Suárez
- Instituto de Investigacion Sanitaria del Principado de Asturias and (CIBERONC), ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil; Head and Neck Surgery, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.
| |
Collapse
|
46
|
Calabrese L, Pietrobon G, Fazio E, Accorona R. Reply to "From compartmental to anatomically-based circumferential resection-Is the trend reversal of justified?". Head Neck 2020; 42:2766-2767. [PMID: 32420633 DOI: 10.1002/hed.26254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/24/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Luca Calabrese
- Division of Otorhinolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico Fazio
- Division of Otorhinolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
47
|
Locatello LG, Bruno C, Pietragalla M, Taverna C, Novelli L, Nardi C, Bonasera L, Cannavicci A, Maggiore G, Gallo O. A critical evaluation of computed tomography-derived depth of invasion in the preoperative assessment of oral cancer staging. Oral Oncol 2020; 107:104749. [PMID: 32388410 DOI: 10.1016/j.oraloncology.2020.104749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depth of invasion (DOI) has been introduced into the latest TNM classification of oral squamous cell carcinoma (OSCC). Despite its primarily pathological definition (pDOI), a preoperative evaluation of a radiological DOI (rDOI) would be useful but a standard and practical definition is lacking. The primary aim of this study is to measure the rDOI by computed tomography (CT) and compare it to the pDOI in a cohort of OSCC patients. Then, we analyze the utility and reliability of rDOI in the preoperative setting. METHODS 58 cases of OSCC operated at our Institution from 2016 to 2019 were included. After accounting for plane-specific shrinkage factors and for different oral subsites, we have compared pDOI and rDOI for each spatial plane by paired difference test and correlation coefficient. Radiological accuracy and survival analysis were also determined to identify rDOI's clinical value. RESULTS For lateral tongue, pDOI was more strongly related with axial rDOI (P < 0.01); for hard palate, the best plane was the sagittal one (P < 0.01); in floor of mouth (FOM) lesions, the strongest correlation was with coronal rDOI (P < 0.01), as well as for cheek buccal mucosa; sagittal scans seem to be the best to evaluate dorsum of the tongue and retromolar trigone; gingiva (P < 0.01) was most correctly evaluated in the coronal plane. Overall accuracy of rDOI restaging was 75.41%. Disease-free survival seems to be worse as rDOI increases. CONCLUSIONS We suggest that with a standardized imaging protocol patients could be better classified according to CT-derived DOI.
Collapse
Affiliation(s)
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Cecilia Taverna
- Department of Pathology, Careggi University Hospital, Florence, Italy
| | - Luca Novelli
- Department of Pathology, Careggi University Hospital, Florence, Italy
| | - Cosimo Nardi
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Luigi Bonasera
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Angelo Cannavicci
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| |
Collapse
|
48
|
Ultrasound aids in intraoperative assessment of deep resection margins of squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg 2020; 58:285-290. [DOI: 10.1016/j.bjoms.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/15/2019] [Indexed: 11/22/2022]
|
49
|
Mahajan A, Ahuja A, Sable N, Stambuk HE. Imaging in oral cancers: A comprehensive review. Oral Oncol 2020; 104:104658. [PMID: 32208340 DOI: 10.1016/j.oraloncology.2020.104658] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Abstract
This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management of oral cavity squamous cell carcinoma (OSCC). Early OSCC can be treated with either surgery alone while advanced cancers are treated with a combination of surgery, radiotherapy and/or chemotherapy. Considering the complex anatomy of the oral cavity and its surrounding structures, imaging plays an indispensable role not only in locoregional staging but also in the distant metastatic work-up and post treatment follow-up. Knowledge of the anatomy with understanding of common routes of spread of cancer, allows the radiologist to accurately determine disease extent and augment clinical findings to plan appropriate therapy. This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management.
Collapse
Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India.
| | - Ankita Ahuja
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Nilesh Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Hilda E Stambuk
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| |
Collapse
|
50
|
Heidari AE, Pham TT, Ifegwu I, Burwell R, Armstrong WB, Tjoson T, Whyte S, Giorgioni C, Wang B, Wong BJ, Chen Z. The use of optical coherence tomography and convolutional neural networks to distinguish normal and abnormal oral mucosa. JOURNAL OF BIOPHOTONICS 2020; 13:e201900221. [PMID: 31710775 PMCID: PMC7250484 DOI: 10.1002/jbio.201900221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
Incomplete surgical resection of head and neck squamous cell carcinoma (HNSCC) is the most common cause of local HNSCC recurrence. Currently, surgeons rely on preoperative imaging, direct visualization, palpation and frozen section to determine the extent of tissue resection. It has been demonstrated that optical coherence tomography (OCT), a minimally invasive, nonionizing near infrared mesoscopic imaging modality can resolve subsurface differences between normal and abnormal head and neck mucosa. Previous work has utilized two-dimensional OCT imaging which is limited to the evaluation of small regions of interest generated frame by frame. OCT technology is capable of performing rapid volumetric imaging, but the capacity and expertise to analyze this massive amount of image data is lacking. In this study, we evaluate the ability of a retrained convolutional neural network to classify three-dimensional OCT images of head and neck mucosa to differentiate normal and abnormal tissues with sensitivity and specificity of 100% and 70%, respectively. This method has the potential to serve as a real-time analytic tool in the assessment of surgical margins.
Collapse
Affiliation(s)
- Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- University of California - Irvine, School of Medicine, Irvine, CA 92617, USA
| | - Ibe Ifegwu
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Ross Burwell
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - William B. Armstrong
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Tjoa Tjoson
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Stephanie Whyte
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Carmen Giorgioni
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Beverly Wang
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Brian J.F. Wong
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| |
Collapse
|