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Gattani V, Pawar S, Gupta C, Bhola N, Sonpal P, Agrawal P. Bridging Tradition and Modernity: Embracing the Bipaddled Pectoralis Major Myocutaneous Flap for Challenging Oral Cavity Defects in the Free Flap Era. Cureus 2024; 16:e62341. [PMID: 39006683 PMCID: PMC11246768 DOI: 10.7759/cureus.62341] [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: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Oral squamous cell carcinoma is a serious global issue, with the prognosis decreasing as the disease severity increases. The implications of this condition are so disastrous that they cause a lot of suffering for the individual. Early diagnosis has proven to improve patients' overall survival and quality of life. Surgery remains the mainstay in treating oral carcinoma. It is aimed at the complete removal of the cancerous lesion along with the management of cervical nodal metastasis. Larger defects call for reconstruction with bulky flaps. In our case, we had a composite defect postresection of the cancerous lesion, which was reconstructed using a bipaddled pectoralis major myocutaneous flap.
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Affiliation(s)
- Vaishnavi Gattani
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Shreya Pawar
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Chetan Gupta
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Parmarth Sonpal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Palak Agrawal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
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Struckmeier AK, Buchbender M, Agaimy A, Kesting M. Diagnostic accuracy of contrast-enhanced computed tomography in assessing bone invasion in patients with oral squamous cell carcinoma. Clin Oral Investig 2024; 28:314. [PMID: 38748270 PMCID: PMC11096202 DOI: 10.1007/s00784-024-05705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) in detecting bone invasion in oral squamous cell carcinoma (OSCC) patients and to explore clinicopathological factors associated with its reliability. MATERIALS AND METHODS 417 patients underwent preoperative contrast-enhanced CT followed by radical surgery. The presence or absence of bone invasion served as the outcome variable, with histopathologic examination of the resection specimen considered the gold standard. Statistical analyses, comprising correlation analyses and the determination of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were conducted. RESULTS CT exhibited 76.85% sensitivity, 82.20% specificity, 47.14% PPV, and 89.67% NPV. False-positive and false-negative rates were 11.27% and 5.99%, respectively. Artifacts affected assessment in 44 patients, but not in those with bone invasion. Tumor size, depth of invasion (DOI), tumor localization at the upper jaw, lymphatic invasion, and perineural invasion correlated with incorrect identification of bone invasion (Chi-square, p < 0.05). CONCLUSIONS Despite utilizing thin-section CT, notable false-positive and false-negative results persisted. Patients with T3 tumors, DOI ≥ 10 mm, or upper jaw tumors are at higher risk for misidentification of bone invasion. Combining multiple methods may enhance diagnostic accuracy, and the integration of artificial intelligence or tracking electrolyte disturbances by tumor depth profiling shows promise for further assessment of bone invasion before histopathology. CLINICAL RELEVANCE Surgeons should consider these insights when planning tumor resection. Supplementary imaging may be warranted in cases with high risk factors for misidentification. Further methodological advancements are crucial for enhancing diagnostic precision.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany.
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
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Brown JS, Crowder LP, Willcocks EJ, Bajwa MS, Schache AG. Accuracy of preoperative clinical examination and imaging for mandibular resection in oral cancer: a systematic review of diagnostic test accuracy studies. Br J Oral Maxillofac Surg 2023; 61:28-38. [PMID: 36528411 DOI: 10.1016/j.bjoms.2022.10.005] [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: 07/05/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
The aim of this systematic review is not only to analyse the accuracy of clinical examination and radiological preoperative assessment of mandibular invasion reported in isolation, but to highlight those reports that have combined them. A total of 1636 titles and abstracts published between 1995 - 2000 were screened following a literature search in PubMed. Keywords were "mandible" and "squamous cell carcinoma". A total of 90 full manuscripts were reviewed with 24 meeting defined inclusion/exclusion criteria and yielding the data reported. The most sensitive test was single photon emission tomography with eight out of the 10 studies reporting sensitivity higher than 95%. Magnetic resonance imaging (MRI) demonstrated superior sensitivity but was less specific than computed tomography (CT). A single report attempted to report the combined CT and MRI scans with a separate expert reporting but did not result in more reliable detection. Periosteal stripping was not reported, and there was insufficient data to establish the value of new technologies. This review confirms that, to our knowledge, there are no reliable data on the results of combining imaging techniques with or without clinical examination. It emphasises the lack of data for the combination of preoperative techniques to enhance safe oncological resection of the mandible. Based on the evidence gathered in this review an algorithm of assessment of possible mandibular invasion is proposed. With new technologies available and 3-dimensional models to help plan the mandibular resection and reconstruction, the potential of combining preoperative investigations should be fully realised through prospective research.
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Affiliation(s)
- James S Brown
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK; Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, 200 London Road, Liverpool L3 9TA, UK.
| | - Lauren P Crowder
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK
| | - Edward J Willcocks
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK
| | - Mandeep S Bajwa
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK; Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, 200 London Road, Liverpool L3 9TA, UK
| | - Andrew G Schache
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, UK; Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, 200 London Road, Liverpool L3 9TA, UK
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Lo Casto A, Cannella R, Taravella R, Cordova A, Matta D, Campisi G, Attanasio M, Rinaldi G, Rodolico V. Diagnostic and prognostic value of magnetic resonance imaging in the detection of tumor depth of invasion and bone invasion in patients with oral cavity cancer. LA RADIOLOGIA MEDICA 2022; 127:1364-1372. [PMID: 36255660 DOI: 10.1007/s11547-022-01565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To evaluate the accuracy of preoperative contrast-enhanced magnetic resonance imaging (MRI) in the assessment of radiological depth of invasion (rDOI) and bone invasion in patients with oral cavity cancer, and the prognostic value of preoperative rDOI. MATERIALS AND METHODS This retrospective study included patients with surgically resected oral cavity cancer and preoperative MRI acquired within four weeks before surgery. Two readers evaluated the MRI to assess the superficial and deep bone invasion, preoperative T stage, and measured the rDOI. The rDOI was compared to the histopathological DOI (pDOI), used as reference standard. Prognostic value of preoperative features for the disease-specific survival was evaluated using the Kaplan-Meier curve and multivariable Cox proportional hazards analysis. RESULTS The final population included 80 patients (50 males, mean age 67.7 ± 13.6 years). There was a strong statistically significant correlation between the rDOI (median 10 mm) and the pDOI (median 9 mm) (ρ: 0.978, p < 0.001). The agreement between MRI and histopathological T stage was excellent (k = 0.93, 95% CI 0.86, 0.99). The sensitivity and specificity of preoperative MRI were 93.3% and 98.8% for deep bone invasion, while they were 75.0% and 95.8% for superficial bone invasion, respectively. The rDOI > 10 mm was associated with poorer disease-specific survival (log-rank p = 0.016). The rDOI remained the only independent preoperative predictor associated with poorer disease-specific survival at multivariable analysis (hazard ratio 5.5; 95% CI 1.14, 26.58; p = 0.033). CONCLUSION Preoperative MRI is accurate for the assessment of DOI and bone invasion. The rDOI is an independent preoperative predictor of disease-specific survival in patients with oral cavity cancer.
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Affiliation(s)
- Antonio Lo Casto
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (Bi.N.D.), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Roberto Cannella
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (Bi.N.D.), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy.
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università degli Studi di Palermo, Palermo, Italy.
| | | | - Adriana Cordova
- Divisione di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), Università degli Studi di Palermo, Palermo, Italy
| | - Daniele Matta
- Divisione di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), Università degli Studi di Palermo, Palermo, Italy
| | - Giuseppina Campisi
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), Università degli Studi di Palermo, Palermo, Italy
| | - Massimo Attanasio
- Departmentimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Sezione di Oncologia, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), Università degli Studi di Palermo, Palermo, Italy
| | - Vito Rodolico
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, Università degli Studi di Palermo, Palermo, Italy
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Mahajan A, Agarwal U, Patil V, Patil V, Vaish R, Noronha V, D' Cruz A, Pankaj Chaturvedi S, Laskar S, Sable N, Janu A, Patil A, Rane S, Mittal N, Joshi A, Menon N, Prabhash K. Proposed sub-compartmentalization of high infratemporal fossa involvement in gingivobuccal cancers and its impact on clinical outcome and staging: A narrative review. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_293_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Archana P, Shenoy P, Chatra L, Veena KM, Prabhu R, Shetty P. Evaluation of patterns of mandibular bone invasion in CBCT of patients with oral squamous cell carcinoma: A descriptive study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Diagnostic efficacy of PET-CT, CT, and MRI in preoperative assessment of mandibular invasion caused by head and neck cancer: A systematic review and meta-analysis. Oral Oncol 2021; 116:105264. [PMID: 33756286 DOI: 10.1016/j.oraloncology.2021.105264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/24/2021] [Accepted: 03/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aims to conduct a systematic review and meta-analysis of the performance of PET-CT, CT, and MRI in diagnosing mandible invasion induced by head and neck cancer (HNC). MATERIALS AND METHODS The MEDLINE, Embase, Science Direct, CNKI and CQVIP databases were searched from inception until August 1, 2020. Then, a meta-analysis was conducted to calculate the combined diagnostic values with the corresponding 95% CIs. Two independent researchers completed the full text screening, data abstraction, and risk assessment. RESULTS This meta-analysis included 53 studies (N = 2 946 participants). For the pooled sensitivity (SEN), MRI (SEN: 0.88, 95% CI: 0.81-0.93) was found to have a significantly higher SEN (P = 0.0045), when compared to CT (SEN: 0.77, 95% CI: 0.71-0.82), while compared with PET-CT (SEN: 0.88, 95% CI: 0.64-0.97), the SEN was approximately equal (P > 0.05). The analysis revealed that the combined specificity (SPE) of MRI (SPE: 0.83, 95% CI: 0.74-0.89) and PET-CT (SPE: 0.81, 95% CI: 0.57-0.93) was lower than that of CT (SPE: 0.87, 95% CI: 0.83-0.90), but there was no statistical significance among these (P > 0.05). The comparison of the area under curve (AUC) reflected that PET-CT, CT and MRI have approximately equal summary diagnostic power in detecting mandibular invasion (P > 0.05). CONCLUSION The findings suggest that compared with CT, MRI is significantly superior for higher SEN in diagnosing mandibular invasion. The SEN of MRI and PET-CT were approximately equal. For the summary of diagnostic power, more prospective clinical trials that directly compare these three methods are needed in the future.
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Wang T, Yang H, Liang D. Effect of Tracer Staining Technology Based on Nano-Carbon Suspension on Patients with Oral Squamous Cell Carcinoma. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:995-1000. [PMID: 33183435 DOI: 10.1166/jnn.2021.18702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Oral squamous cell carcinoma has the characteristics of high malignancy, strong invasiveness and special anatomical location. The prognosis of patients is generally poor. Invasion and metastasis of oral squamous cell carcinoma is a complex process involving multiple levels and factors. In order to explore the value of sentinel lymph node biopsy tracked by nano-carbon suspension in the treatment of early oral squamous cell carcinoma, 58 patients with early oral squamous cell carcinoma were selected in this paper. The pathological results of sentinel lymph nodes were analyzed after operation. In this study, the detection rate, sensitivity, accuracy, and false negative rate of the sentinel lymph nodes with the nano-carbon suspension were 95.6%, 86.4%, 92.2%, and 11.4%, respectively. The results show that sentinel lymph node biopsy traced by nano-carbon suspension has certain application value in guiding the treatment of early oral squamous cell carcinoma.
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Affiliation(s)
- Tongwu Wang
- Department of Stomatology, First People's Hospital of Lianyungang, No. 182 Tongguan North Road, Lianyungang, Jiangsu Province, 222000, China
| | - Hongyu Yang
- Department of Stomatology, First People's Hospital of Lianyungang, No. 182 Tongguan North Road, Lianyungang, Jiangsu Province, 222000, China
| | - Dong Liang
- Department of Stomatology, Lianyungang Municipal Oriental Hospital, No. 57 Zhonghua West Road, Lianyungang, Jiangsu Province, 222000, China
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Yue LE, Sharif KF, Sims JR, Sandler ML, Baik FM, Sobotka S, Everest S, Brandwein-Weber M, Khorsandi AS, Likhterov I, Urken ML. Oral squamous carcinoma: Aggressive tumor pattern of invasion predicts direct mandible invasion. Head Neck 2020; 42:3171-3178. [PMID: 32710523 DOI: 10.1002/hed.26360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/12/2020] [Accepted: 06/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Aggressive histologic worst pattern of invasion (WPOI) in surrounding soft tissue has been shown to be predictive of higher local recurrence and poorer survival in oral cavity squamous cell carcinoma (OCSCC) patients. This study investigates whether aggressive WPOI can predict the mandibular invasion phenotype. METHODS Patients consecutively diagnosed with OCSCC undergoing a mandibulectomy (marginal or segmental) between 2013 and 2018 were reviewed. Senior physicians re-reviewed radiologic scans and pathologic slides of 44 cases. RESULTS Aggressive WPOI (WPOI-4, 5) is significantly associated with infiltrative bone invasion. Non-aggressive WPOI (WPOI-1, 2, 3) is significantly associated with the absence of bone invasion. CONCLUSIONS WPOI has become a useful tool that further characterizes the biologic behavior of OCSCC. Potentially, planned surgery may escalate from a marginal to segmental mandibulectomy based on aggressive WPOI for patients with radiographically uncertain cortical status. Further studies are needed to validate the relationship between OCSCC WPOI and mandible status.
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Affiliation(s)
- Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York City, New York, USA
| | - Kayvon F Sharif
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York City, New York, USA
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York City, New York, USA
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Stanislaw Sobotka
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sedef Everest
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York City, New York, USA
| | - Ilya Likhterov
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York City, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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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.
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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
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