Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI

Prediction of nodal disease in oral squamous cell carcinoma of the tongue: histopathological risk assessment with the focus on depth of invasion

OBJECTIVE

Cervical lymph node metastasis (CLNM) is one of the most relevant influencing factors for the oncological outcome of patients with oral squamous cell carcinoma (OSCC). Several studies showed that the tumors depth of invasion (DOI) influences the risk for CLNM, however varying across the oral subsites. The aim of this study is to investigate the role of DOI and other risk factors in OSCC of the tongue in relation to the occurrence of occult CLNM.

MATERIALS AND METHODS

In this retrospective study, n = 139 patients with primary OSCC of the tongue, treated by complete surgical resection (R0) with curative intention between 2013 and 2021, were included. For data analysis, epidemiologic data as well as preoperative tumor staging, surgical therapy including neck management, histopathological tumor data and follow-up were considered. Uni- and multivariate logistic regression were used to determine association between histopathological risk factors and the occurrence of occult CLNM.

RESULTS

The rate of occult cervical metastasis was 19.4%. T-staging, cervical nodal disease (pN+) and lymphatic invasion were significantly associated with reduced OS and RFS. While DOI had no relevant influence on the OS and RFS (p = 0.88 and p = 0.91 respectively), there was significant correlation between DOI and the occurrence of occult CLNM (OR: 1.17, 95%CI: 1.05-1.30; p < 0.01). The optimal cutoff in predicting occult CLNM was 6 mm (Sensitivity: 84.2%, Specificity: 73.5%, AUC: 0.75).

CONCLUSIONS

The DOI is a helpful risk parameter to predict the occurrence of occult nodal disease in OSCC of the tongue. Given the critical decision cutoff between 2 and 4 mm DOI for performing elective neck dissection in the current guidelines, our data suggests that in these cases, surgical de-escalation could be feasible with close follow-up.

CLINICAL RELEVANCE

This study highlights the relevance of DOI as a risk parameter in the prediction of CLNM with the aim to specify the individual patient risk and to deescalate surgical therapy in order to decrease comorbidities while improving the oncological prognosis.

Role of Computed Tomography in Prediction of Depth of Invasion and Cervical Lymph Node Metastasis in Oral Cancer

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.

Intraoral ultrasonography: an adjunct in oral onco-surgery

OBJECTIVE

To determine the precision and accuracy of intraoral sonography in assessing the depth of invasion in oral cancer.

MATERIAL AND METHODS

A prospective study was conducted in 30 cases of oral cancer. Subjects were subjected to computerised tomography and intraoral sonography before surgery. The depth of invasion assessed through clinical palpation and radiological tools was compared with surgical histopathology.

RESULTS

The depth of invasion assessed on clinical palpation and computerized tomography had statistically significant difference with histopathology whereas intraoral sonography didn't show any difference. The intraoral sonography and computerised tomography had comparable precision and accuracy, with a slight dominance of the computerised tomography in assessing the tumor's depth of invasion greater than 4 mm. However, intraoral sonography was more precise and accurate than computerised tomography in assessing the depth of invasion beyond 10 mm.

CONCLUSION

Intraoral sonography was found to be a reliable tool in the assessment of the depth of invasion in oral cancer. It can prove beneficial during surgery in achieving tumour-free surgical margins.

Accuracy of magnetic resonance imaging in the assessment of depth of invasion in tongue carcinoma: A systematic review and meta-analysis

Tongue carcinoma constitutes 10.4-46.9% of all oral squamous cell carcinomas (OSCCs) and is notoriously known for invading tissues deeper than the evident gross margins. The deeper the tumor invades, the higher are its chances of future morbidity and mortality due to extensive neck dissection and risk of recurrence. Magnetic resonance imaging (MRI) is a noninvasive diagnostic aid used for measuring a preoperative tumor's depth of invasion (DOI) as it can efficiently outline soft tissue tumors from adjacent normal tissue. To assess various MRI modalities used in measuring DOI in tongue carcinoma and their reliability compared with other DOI measuring modalities. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022330866), and the following Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) Diagnostic Test Accuracy guidelines were performed. PubMed electronic database was searched using a combination of keywords for relevant articles in the English language since 2016. Critical appraisal was carried out using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) risk-of-bias (RoB) assessment tool. A weighted mean difference (WMD) was calculated between MRI and histopathological DOI along with pooled correlation and subgroup analysis, where possible. A total of 795 records were retrieved of which 17 were included in the final review with 13 included for meta-analysis. A high RoB was found for most studies for all parameters except flow and timing. WMD showed a statistically significant MRI overestimation of 1.90 mm compared with histopathology. Subgroup analysis showed the 1.5 Tesla machine to be superior to the 3.0 Tesla machine, while imaging sequence subgroup analysis could not be performed. MRI is a viable preoperative DOI measurement modality that can help in efficient treatment planning to decrease surgical morbidity and mortality.

Accuracy of Magnetic Resonance Imaging in Detecting Tumor Depth of Invasion in Squamous Cell Carcinoma of the Tongue: A Systematic Review

Objective

The objective of the study was to detect the accuracy of Magnetic Resonance Imaging (MRI) in assessing tumor depth of invasion (DOI) in squamous cell carcinoma (SCC) of the tongue.

Material and Methods

The electronic search of PubMed (including MEDLINE), COCHRANE CENTRAL and Google Scholar search engine for articles published from January 1, 2000, to September 31, 2021, was conducted and also searched the lists of references of relevant articles and reviews for studies involving patients with squamous cell carcinoma of the tongue.

Results

A total of 5362 articles were retrieved in the initial search. After the initial search process, 13 full-text articles were reviewed. Out of these 13 articles, seven met the inclusion criteria and were thus included in this systematic review.

Conclusion

The MRI-determined DOI based on T1-weighted sequences increases with increasing T stage. There is the highest correlation between the MRI-derived DOI and the histopathological DOI with increasing T stage. Therefore, MRI provides satisfactory diagnostic accuracy for measuring tumor DOI and, thus, may be considered a predictor of tumor stage.

Magnetic resonance imaging-based prediction models for tumor stage and cervical lymph node metastasis of tongue squamous cell carcinoma

Purpose

To evaluate the ability of preoperative MRI-based measurements to predict the pathological T (pT) stage and cervical lymph node metastasis (CLNM) via machine learning (ML)-driven models trained in oral tongue squamous cell carcinoma (OTSCC).

Materials and methods

108 patients with a new diagnosis of OTSCC were enrolled. The preoperative MRI study included post-contrast high-resolution T1-weighted images acquired in all patients. MRI-based depth of invasion (DOI) and tumor dimension-together with shape-based and intensity-based features-were extracted from the lesion volume segmentation. The entire dataset was randomly divided into a training set and a validation set, and the performances of different types of ML algorithms were evaluated and compared.

Results

MRI-based DOI and tumor dimension together with several shape-based and intensity-based signatures significantly discriminated the pT stage and LN status. The overall accuracy of the model for predicting the pT stage was 0.86 (95%CI, 0.78-0.92) and 0.81 (0.64-0.91) in the training and validation sets, respectively. There was no improvement in the model performance upon including shape-based and intensity-based features. The model for predicting CLNM based on DOI and tumor dimensions had a fair accuracy of 0.68 (0.57-0.78) and 0.69 (0.51-0.84) in the training and validation sets, respectively. The shape-based and intensity-based signatures have shown potential for improving the model sensitivity, with a comparable accuracy.

Conclusion

MRI-based models driven by ML algorithms could stratify patients with OTSCC according to the pT stages. They had a moderate ability to predict cervical lymph node metastasis.

Preoperative Determination of Depth of Invasion in Oral Cavity Squamous Cell Carcinoma by Standard Cross-Sectional Imaging With Computed Tomography and Positron Emission Tomography/Computed Tomography

Background Depth of invasion (DOI) is a known indicator of metastatic potential in oral cavity squamous cell carcinoma (SCC). Our purpose was to investigate the accuracy of preoperative determination of DOI in oral cavity SCC by computed tomography (CT) and positron emission tomography/computed tomography (PET/CT). Methodology A retrospective study was performed using consecutive patients with histologically proven oral cavity SCC presenting to our otorhinolaryngology department between January 2014 and July 2019 who underwent preoperative contrast-enhanced CT and/or PET/CT. Pathological assessment of DOI was determined by a review of pathology reports. The degree of DOI determined by radiographic studies was correlated to pathology results. Results A total of 79 patients were screened of whom appropriate radiographic studies were available for 63 patients. The mean DOI by pathological assessment was 12.3 ± 9.1 mm. CT and PET/CT determined depth both correlated with pathological DOI (r = 0.710; p < 0.001, r = 0.798; p < 0.001). No significant correlation was seen for CT-determined depth (r = 0.136; p = 0.709) or PET-determined depth (r = 0.234; p = 0.707) with pathologically confirmed superficial tumors (<5 mm). For patients with pathological tumor depth >10 mm, CT and PET determined depth both correlated with pathological depth (r = 0.577; p = 0.002, r = 0.668; p = 0.001). The sensitivity and specificity of CT and PET for the identification of deep invasion were 88.2% and 41.7% and 52.9% and 50%, respectively. Conclusions DOI measurement is feasible with routine preoperative CT and PET/CT images and is comparable to pathological measurement in patients with oral cavity SCC.

Ultra-High-Resolution CT of the Head and Neck with Deep Learning Reconstruction-Assessment of Image Quality and Radiation Exposure and Intraindividual Comparison with Normal-Resolution CT

OBJECTIVES

To assess the benefits of ultra-high-resolution CT (UHR-CT) with deep learning-based image reconstruction engine (AiCE) regarding image quality and radiation dose and intraindividually compare it to normal-resolution CT (NR-CT).

METHODS

Forty consecutive patients with head and neck UHR-CT with AiCE for diagnosed head and neck malignancies and available prior NR-CT of a different scanner were retrospectively evaluated. Two readers evaluated subjective image quality using a 5-point Likert scale regarding image noise, image sharpness, artifacts, diagnostic acceptability, and assessability of various anatomic regions. For reproducibility, inter-reader agreement was analyzed. Furthermore, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and slope of the gray-value transition between different tissues were calculated. Radiation dose was evaluated by comparing CTDIvol, DLP, and mean effective dose values.

RESULTS

UHR-CT with AiCE reconstruction led to significant improvement in subjective (image noise and diagnostic acceptability: p < 0.000; ICC ≥ 0.91) and objective image quality (SNR: p < 0.000; CNR: p < 0.025) at significantly lower radiation doses (NR-CT 2.03 ± 0.14 mSv; UHR-CT 1.45 ± 0.11 mSv; p < 0.0001) compared to NR-CT.

CONCLUSIONS

Compared to NR-CT, UHR-CT combined with AiCE provides superior image quality at a markedly lower radiation dose. With improved soft tissue assessment and potentially improved tumor detection, UHR-CT may add further value to the role of CT in the assessment of head and neck pathologies.

Advanced imaging of head and neck infections

When head and neck infection is suspected, appropriate imaging contributes to treatment decisions and prognosis. While contrast-enhanced CT is the standard imaging modality for evaluating head and neck infections, MRI can better characterize the skull base, intracranial involvement, and osteomyelitis, implying that these are complementary techniques for a comprehensive assessment. Both CT and MRI are useful in the evaluation of abscesses and thrombophlebitis, while MRI is especially useful in the evaluation of intracranial inflammatory spread/abscess formation, differentiation of abscess from other conditions, evaluation of the presence and activity of inflammation and osteomyelitis, evaluation of mastoid extension in middle ear cholesteatoma, and evaluation of facial neuritis and labyrinthitis. Apparent diffusion coefficient derived from diffusion-weighted imaging is useful for differential diagnosis and treatment response of head and neck infections in various anatomical sites. Dynamic contrast-enhanced MRI perfusion may be useful in assessing the activity of skull base osteomyelitis. MR bone imaging may be of additional value in evaluating bony structures of the skull base and jaw. Dual-energy CT is helpful in reducing metal artifacts, evaluating deep neck abscess, and detecting salivary stones. Subtraction CT techniques are used to detect progressive bone-destructive changes and to reduce dental amalgam artifacts. This article provides a region-based approach to the imaging evaluation of head and neck infections, using both conventional and advanced imaging techniques.

Correlation between radiologic depth of invasion and pathologic depth of invasion in oral cavity squamous cell carcinoma: A systematic review and meta-analysis

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.

Preoperative evaluation of depth of invasion in oral tongue squamous cell carcinoma: A systematic review and meta-analysis

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 (CI_95% = [0.82-0.88]) and 0.80 (CI_95% = [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 (CI_95%= [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.

Prediction of nodal metastasis based on intraoral sonographic findings of the primary lesion in early-stage tongue cancer

The aim of this study was to clarify the correlation between imaging findings obtained using intraoral ultrasonography (US) and pathological findings of tongue cancers, and to examine the predictive value of intraoral US findings with respect to occult nodal metastasis. This was a retrospective study based on the medical records of 123 patients with T1-2N0 tongue cancer. The depth of invasion (DOI) on intraoral US was positively correlated with the pathological invasion depth (PID) (ρ = 0.7080, P < 0.0001). Receiver operating characteristic analyses revealed an optimal DOI cut-off value of 4.1 mm and optimal PID cut-off value of 3.9 mm to detect nodal metastasis. Regarding the margin shape of the primary tumour on intraoral US, the incidence of nodal metastasis was significantly higher for the permeated type than for the pressure type (P < 0.001) and wedge-shaped type (P = 0.002). Furthermore, tumours with peritumoural vascularity assessed by power Doppler US had a significantly higher incidence of nodal metastasis than tumours without (P = 0.003). The sensitivity, specificity, and accuracy of the permeated type to predict nodal metastasis was 53.6%, 95.8%, and 86.2%, respectively. These results suggest that intraoral US findings closely reflect pathological findings and could be useful to predict occult nodal metastasis in patients with early-stage tongue cancer.

Ultrasound accurately assesses depth of invasion in T1‐T2 oral tongue cancer

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.

Application of Dynamic Contrast-Enhanced MRI in the Diagnosis of Rheumatoid Arthritis

In order to solve the application problem of dynamic contrast-enhanced MRI in the diagnosis of rheumatoid arthritis, this paper proposes application research based on dynamic contrast-enhanced MRI in the staging diagnosis of rheumatoid arthritis. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has a high value in evaluating the activity of patients with early rheumatoid arthritis (RA). This paper discusses the correlation between hemodynamic parameters and omeractramris score, clinical laboratory indexes, and activity score (DAS28), analyzes its feasibility in evaluating the prognosis of RA, and provides a reliable basis for the rational formulation of an early RA treatment plan. After reviewing the previous cases, 33 patients with subclinical synovitis of RA were selected for wrist joint contrast-enhanced ultrasonography. The data were analyzed by contrast-enhanced software, and the quantitative parameters of contrast-enhanced were obtained: start development time (AT), peak time (TTP), peak intensity (PI), grad gradient, and area under the curve (AUC). The synovial blood supply was classified by CEUS, and the CEUS blood supply classification and power Doppler (PDUS) blood supply classification were compared. The results of regression analysis showed that AUC (or = 1.026, 95% CI: 1.001–1.052) and PI (or = 1.561, 95% CI: 1.019–2.393) were independent risk factors for predicting the aggravation of the disease. The diagnostic efficacy of AUC and PI in predicting the aggravation of the disease was analyzed. The areas under the ROC curve of AUC and PI were 0.935 and 0.927, respectively, and the difference between them was not statistically significant.

Prediction of the degree of pathological differentiation in tongue squamous cell carcinoma based on radiomics analysis of magnetic resonance images

Background

Tongue squamous cell carcinoma (TSCC) is one of the most difficult malignancies to control. It displays particular and aggressive behaviour even at an early stage. The purpose of this paper is to explore the value of radiomics based on magnetic resonance fat-suppressed T2-weighted images in predicting the degree of pathological differentiation of TSCC.

Methods

Retrospective analysis of 127 patients with TSCC who were randomly divided into a primary cohort and a test cohort, including well-differentiated, moderately differentiated and poorly differentiated. The tumour regions were manually labelled in fat-suppressed T2-weighted imaging (FS-T2WI), and PyRadiomics was used to extract radiomics features. The radiomics features were then selected by the least absolute shrinkage and selection operator (LASSO) method. The model was established by the logistic regression classifier using a 5-fold cross-validation method, applied to all data and evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity.

Results

In total, 1132 features were extracted, and seven features were selected for modelling. The AUC in the logistic regression model for well-differentiated TSCC was 0.90 with specificity and precision values of 0.92 and 0.78, respectively, and the sensitivity for poorly differentiated TSCC was 0.74.

Conclusions

The MRI-based radiomics signature could discriminate between well-differentiated, moderately differentiated and poorly differentiated TSCC and might be used as a biomarker for preoperative grading.

MRI before biopsy correlates with depth of invasion corrected for shrinkage rate of the histopathological specimen in tongue carcinoma

The purpose of this study was to evaluate which radiological depth of invasion (r-DOI) measurement is the most concordant to clinical DOI (c-DOI) derived from correction for the shrinkage rate of the histopathological specimens. We retrospectively reviewed 128 patients with tongue carcinoma who had undergone glossectomy between 2006 and 2019. At first, the width shrinkage rate during formalin fixation and preparation process of histopathological specimens was evaluated. From the shrinking rates, a formula to calculate c-DOI from pathological DOI (p-DOI) was developed. The correlation between c-DOI and r-DOI was evaluated. The specimen shrinkage rate during the histopathological specimen preparation process was 10.3%. Based on that, we yielded the correct formula for c-DOI based on p-DOI and preparation shrinkage rate: c-DOI = p-DOI × 100/89.7. The regression equations for the association of c-DOI with r-DOI measured by ultrasound (n = 128), MRI before biopsy (n = 18), and MRI after biopsy (n = 110) were y = 1.12 * x + 0.21, y = 0.89 * x − 0.26, and y = 0.52 * x + 2.63, respectively, while the coefficients of determination were 0.664, 0.891, and 0.422, respectively. In conclusion, r-DOI using MRI before biopsy most strongly correlated with c-DOI.

Subtraction iodine imaging with area detector CT to improve tumor delineation and measurability of tumor size and depth of invasion in tongue squamous cell carcinoma

Purpose

Tumor size and depth of invasion (DOI) are mandatory assessments for tumor classification in tongue cancer but are often non-assessable on CT due to dental artifacts. This study investigated whether subtraction iodine imaging (SII) would improve tumor delineation and measurability.

Materials and methods

Fifty-seven consecutive patients with tongue cancer, who underwent scanning with a 320-row area detector CT with contrast administration and were treated with surgical resection, were retrospectively evaluated. CT was reconstructed with single-energy projection-based metallic artifact reduction (sCT). SII was generated by subtracting the pre-contrast volume scans from the post-contrast volume scans using a high-resolution deformable registration algorithm. MRI scans were also evaluated for comparing the ability of measurements. Two radiologists visually graded the tumor delineation using a 5-point scale. Tumor size and DOI were measured wherever possible. The tumor delineation score was compared using the Wilcoxon signed-rank method. Spearman’s correlations between imaging and pathological measurements were calculated. Intraclass correlation coefficients of measurements between readers were estimated.

Results

The tumor delineation score was greater on sCT-plus-SII than on sCT alone (medians: 3 and 1, respectively; p < 0.001), with higher number of detectable cases observed with sCT-plus-SII (36/57 [63.2%]) than sCT alone (21/57 [36.8%]). Tumor size and DOI measurability were higher with sCT-plus-SII (29/57 [50.9%]) than with sCT alone (17/57 [29.8%]). MRI had the highest detectability (52/57 [91.2%]) and measurability (46/57 [80.7%]). Correlation coefficients between radiological and pathological tumor size and DOI were similar for sCT (0.83–0.88), sCT-plus-SII (0.78–0.84), and MRI (0.78–0.90). Intraclass correlation coefficients were higher than 0.95 for each modality.

Conclusions

SII improves detectability and measurability of tumor size and DOI in patients with oral tongue squamous cell carcinoma, thus increasing the diagnostic potential. SII may also be beneficial for cases unevaluable on MRI due to artifacts or for patients with contraindications to MRI.

Assessment of squamous cell carcinoma of the floor of the mouth with magnetic resonance imaging

PURPOSE

We aimed to use magnetic resonance imaging (MRI) to determine the relationship between the pathological depth of invasion (DOI), undetectability, and tumor thickness of squamous cell carcinoma of the floor of the mouth.

MATERIALS AND METHODS

We retrospectively evaluated the relationship between pathological DOI and MRI detectability, as well as the relationship between pathological DOI and tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging or coronal T2-weighted imaging.

RESULTS

We analyzed 30 patients with squamous cell carcinoma of the floor of the mouth; MRI revealed that the pathological DOI of the 11 undetectable lesions (median 2 mm) was smaller than that of the 19 detectable lesions (median 14 mm) (p < 0.001), and the cut-off value was 3 mm (sensitivity, 0.84; specificity, 0.91; area under the curve, 0.89). Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was assessed in all 19 detectable lesions; however, tumor thickness on coronal T2-weighted imaging could not be assessed in eight cases. Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was found to be significantly associated with the pathological DOI.

CONCLUSIONS

Undetectability on MRI indicates superficial lesions with a pathological DOI value that is less than 3 mm. In detectable lesions, tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging is associated with pathological DOI.

Radiologic Evaluation of the Head and Neck Cancer Patient

CT, PET, ultrasound, and MRI examinations all have roles in the staging and surveillance of cancers in the head and neck. Contrast-enhanced CT is generally the primary examination because of availability, cost, reproducibility, and good overall quality regardless of where performed. PET, ultrasound, and MRI have more specific and nuanced applications. Good interdisciplinary interactions with radiologist consultation can streamline the examination process and reduce the examination burden on patients by limiting the number and maximizing the quality of the examinations and image-guided interventions performed.

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

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.

Correlation between the magnetic resonance imaging features of squamous cell carcinoma of the buccal mucosa and pathologic depth of invasion

OBJECTIVE

The objective of this study was to determine correlations between magnetic resonance imaging (MRI) features including radiologic depth of invasion (r-DOI) and pathologic DOI (p-DOI) of squamous cell carcinoma of the buccal mucosa.

STUDY DESIGN

In total, 31 lesions were retrospectively evaluated. MRI findings included detectability, buccinator muscle invasion (positive: BMI+, negative: BMI-), buccal fat pad invasion (positive: BFPI+, negative: BFPI-), and r-DOI measured on T2-weighted images (T2-DOI) and contrast-enhanced T1-weighted images (CET1-DOI). These findings were compared to the p-DOI of the tumors.

RESULTS

The p-DOI values of undetectable lesions were smaller than those of detectable lesions (P < .001), and the cutoff value was 1 mm. BMI+ and BFPI+ lesions had significantly larger p-DOI values than the corresponding BMI- and BFPI- lesions (P < .001), with cutoff values of 5 and 6 mm, respectively. The correlation coefficient between CET1-DOI and p-DOI was 0.68 (P < .001). CET1-DOI values were larger than p-DOI (P < .001) and the average difference between them was 3.4 mm. T2-DOI was inconclusive in 50% of cases. Interobserver agreements of MRI evaluation were good to very good.

CONCLUSION

MRI-derived parameters were useful in estimating p-DOI and may be helpful in predicting the depth of invasion of tumors and the risk of lymph node metastasis.

Primary tumour characteristics poorly correlate with extracapsular spread and cervical sublevel IIb metastasis in patients with oral squamous cell carcinoma and clinically N0 neck: A retrospective study

Introduction:

Nodal metastasis reduces the survival by 50% in head-and-neck squamous cell carcinomas. The presence of nodal extension/extracapsular spread (ECS) further reduces survival. Current literature favors a selective level IIb sparing neck dissection in clinically N0 neck. Studies have evaluated the role of primary tumour size, number of lymph nodes, and depth of invasion (DOI) with the occurrence of extranodal extension (ENE).

Patients and Methods:

Patients were retrospectively reviewed who presented with oral cavity carcinomas and clinically N0 neck. Relationship was sought between tumour site, size, histological grading, DOI, and the occurrence of level IIb metastasis and ECS. A P < 0.05 was considered statistically significant.

Results:

The relationship showed insignificant correlation with P values (0.6643, 0.6704, 0.6779, and 0.6779) between site, size, grading, DOI, and level IIb and ENE.

Discussion:

Previous studies have shown DOI >5 mm and lymph node size 15 mm and multiple lymph nodes predict ECS. DOI and primary site with more than 20% for occult metastasis predicts elective neck treatment. However, in our study, no correlation was found between primary tumour characteristics and ECS or level IIb metastasis. Elective neck dissection is the standard surgical protocol from both diagnostic and therapeutic viewpoints. The only criterion for level IIb dissection is concomitant presence of level IIa involvement intraoperatively. Since ENE can occur early in the disease process, elective neck dissection remains the standard of care.

Radiological approach for the newly incorporated T staging factor, depth of invasion (DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection

The 8^th edition of American Joint Committee on Cancer's (AJCC) Cancer Staging Manual was modified by incorporating depth of invasion (DOI) in the T categorization of oral cavity cancer. This is because DOI is strongly associated with cervical lymph node metastasis, which is the most important negative prognostic factor of oral cavity cancer. This major change in the AJCC Cancer Staging Manual caused re-staging of T category in several cases. Although, the DOI on MRI and CT (radiological DOI; r-DOI) strongly correlated with pathological DOI (p-DOI), it is often 2-3 mm larger than p-DOI. Due to this variance, estimation of p-DOI based on r-DOI may not be accurate. However, when a lesion is undetectable on MRI, p-DOI was often smaller than 4 mm. On the other hand, when MRI depicts lesions with styloglossus and hyoglossus muscle invasion, p-DOI was always larger than 4 mm. These correlations between MRI findings and p-DOI are important when assessing the need for elective neck dissection, as the National Comprehensive Cancer Network (NCCN) recommends elective neck dissection in cases with DOI greater than 4 mm.