Utility of intraoral ultrasound in managing oral tongue squamous cell carcinoma: Systematic review

OBJECTIVES/HYPOTHESIS

Adequate surgical resection of early stage oral tongue cancer provides the best chance at preventing locoregional disease recurrence. Determination of tumor dimensions and margin location is challenging and can lead to inadequate resections with close/positive margins. Ultrasonography has proven its utility in determining the thickness and extent of tongue tumors. Preoperative tumor dimension measurements carry increased significance with the addition of depth of invasion (DOI) to the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. We report the results of a systematic review of the literature pertaining to the use of ultrasound in the diagnosis and management of oral tongue carcinoma.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement checklist was used to inform the design of this systematic review. All studies that utilized ultrasound in the diagnosis/management of primary carcinoma of the oral tongue were included. PubMed, Embase, and Cochrane were reviewed to identify eligible studies.

RESULTS

Nineteen articles were included in our analysis. Six hundred seventy-eight patients were studied in the articles included. Ultrasound tumor thickness measurements correlate well with those on histopathology and show promise as a predictor of cervical lymph node metastasis. Ultrasound can be safely used intraoperatively for deep margin assessment.

CONCLUSIONS

Ultrasound is useful in the evaluation of oral tongue malignancies. More experience is needed to determine if it is reliable in determining preoperative DOI in light of the role this tumor parameter plays in the eighth edition of the AJCC staging manual. Laryngoscope, 129:662-670, 2019.

Visual Interpretation Compared with Caliper and Computerized Measurements in Experimental Vessel Stenosis

To explain visual interpretation errors on angiograms, visual interpretation, caliper measurement, and computerized measurement of cine film were compared using each of 10 graphic models and 10 acrylic models with “stenotic vessels”. Stenosis > 40% was overestimated and stenosis < 40% underestimated by visual interpretation. In caliper measurement, stenosis > 40% at exposure of 90 kV was greatly overestimated by a degree similar to the estimation by visual interpretation, and stenosis > 40% at exposures of 74 kV and 58 kV was slightly overestimated. In computerized measurement, the estimation was consistent with the actual degree of stenosis. Therefore, visual interpretation was not reliable for estimation, and computerized measurement was indispensable for estimation of vessel stenosis. Moreover, we consider the most common cause of error in visual interpretation to be optical illusions.

Transbuccal sonographic evaluation of the local extent of tumors of the tongue with pathological correlation

PURPOSE

The object of this study was to evaluate the usefulness of preoperative transbuccal ultrasound (US) for the evaluation of tongue tumors. Thus, we evaluated the correlation between preoperative US measurements and postoperative pathologic measurements of tongue tumor size.

METHODS

From January 2003 to March 2011, 29 patients with tongue tumors were evaluated. All patients underwent preoperative transbuccal US at 1 day before surgery. Preoperative US was compared with pathology findings, including specimen size. The maximum anterior-posterior (AP) diameter of the long axis of the tumor, the maximum width (WD), and the maximum thickness (TH) of the tumor were measured with US along with a pathologic evaluation of the specimens.

RESULTS

The mean AP was 22 ± 1 mm; WD was 13 ± 6 mm, and TH was 10 ± 5 mm using US. The pathologic mean AP was 21 ± 12 mm; WD was 12 ± 6 mm, and TH was 9 ± 4 mm. The Spearman's correlation coefficients of the AP, WD, and TH were 0.905 (p < 0.001), 0.918 (p < 0.001), and 0.971 (p < 0.001), respectively.

CONCLUSIONS

Transbuccal US is a useful tool for predicting tongue tumor extent.

Intraoral Sonography–Assisted Resection of T1–2 tongue Cancer for Adequate deep Resection

Objective

To investigate the clinical usefulness of intraoral sonography-assisted resection for securing adequate deep resection margins in T1–2 tongue cancers.

Study Design

Prospective clinical trial.

Materials and Methods

Twenty consecutive patients with clinical T1–2 tongue cancers were enrolled and their lesions were removed by intraoral sonography-assisted resection. We then retrospectively collected data from 20 T stage-matched patients without intraoral sonography-assisted resection as the control group. All resections were performed with a goal of 15 mm margin. The mucosal and deep safety margins were compared between the two groups.

Results

Intraoral sonography could predict the paraffin-embedded tumor thickness with an error of 3.16 ± 2.24 mm. The deep safety margins were more adequate for intraoral sonography–assisted resection (9.8 ± 5.2 mm) than for conventional resection (4.0 ± 2.03 mm) ( P < 0.001), while the mucosal safety margins were not different

Conclusion

Intraoral sonography-assisted resection provides a more adequate deep resection margin for early T-stage tongue cancers.

[Intraoperative endosonographic guided resection of tongue carcinoma]

BACKGROUND

Exact estimation of a tumor's size and the definition of adequate resection margins in carcinomas of the tongue are often difficult because of the tumor's extension and deep infiltration.

METHODS

We have developed a method that allows intraoperative visualisation and marking of tumor margins. Intra-operative endosonography was performed on nine patients with carcinomas of the tongue using a 8-12 MHz linear array transducer. The oral cavity was flooded with normal saline solution and the transducer was immersed therein. This allowed scanning in a non-contact mode. The tumor margins were marked with a surgical suture under endosonographic monitoring.

RESULTS

In the nine patients studied, the histological margins corresponded to the sonographic margins. The sonographic marking proved to be useful during the resection of the tumor and histological safety margins were respected in each case.

CONCLUSIONS

This non-invasive procedure provides a quick and reliable orientation during the resection of tongue carcinoma, and a more precise and individual definition of resection margins is possible. Intraoperative non-contact use of endosonography is a promising method.

Measurement of Tongue Movement During Vowels Production with Computer-Assisted B-Mode and M-Mode Ultrasonography

OBJECTIVES: We sought to apply B- + M-mode ultrasonography in combination with the cushion-scanning technique (CST) in quantitative analysis of tongue movement during vowel articulation.

STUDY DESIGN AND SETTING: Twenty normal persons (10 women and 10 men) were enrolled in this study. Each individual was asked to enunciate 5 vowels:/e/, /i/, /al/, /o/, and /ju/. A noninvasive diagnostic technique, computer-assisted B-mode plus M-mode ultrasonography, was used in combination with the CST to assess their tongue movement. The sonographic signals were recorded on a video recorder and then transferred to a personal computer via a frame grabber for digital assessment.

RESULTS: M-mode images show an amplitude-time diagram, whereas B-mode images reveal midsagittal tongue configuration. The ranges of tongue movement in midsagittal plane in male speakers during production of the vowels /e/, /i/, /al/, /o/, and /ju/ were 8.29 ± 1.76,4.00 ± 0.78, 13.82 ± 2.86, 14.05 ± 1.63, and 6.72 ± 1.66 mm, respectively; for female speakers, the averages were 7.19 ± 0.92, 3.36 ± 1.31, 12.74 ± 2.16, 12.86 ± 2.18, and 7.11 ± 2.09 mm, respectively.

CONCLUSIONS: The computer-assisted B-mode plus M-mode ultrasonography in combination with the CST provides a standardized and quantifiable ultrasonographic examination for the clinical investigation of tongue movement during vowel articulation. In our study group, there was no difference in the thickness of tongue or the range of tongue movement in midsagittal plane during articulation of the selected vowels between males and females. Further exploration can be extended in the field of speech research by this valuable tool.

Intraoperative B-mode endosonography of tongue carcinoma

BACKGROUND

Exact estimation of a tumor's size and definition of adequate resection margins in carcinomas of the tongue are often difficult because of the tumor's extension and deep infiltration.

METHODS

We developed a method that allows intraoperative visualization and marking of tumor margins: intraoperative endosonography was performed in five patients with carcinomas of the tongue with an 8- to 12-MHz linear array transducer. The oral cavity was flooded with normal saline solution, and the transducer was immersed therein. This allowed scanning in a noncontact mode. The tumor margins were marked with a surgical suture under endosonographic monitoring.

RESULTS

In the five patients studied, histologic margins corresponded to sonographic margins. The sonographic marking proved to be useful during the resection of the tumor, and histologic safety margins were respected in each case.

CONCLUSIONS

This noninvasive procedure provides a quick and reliable orientation during resection of tongue carcinoma, and a more precise and individual definition of resection margins is possible. Intraoperative noncontact use of endosonography is a promising method, and further studies may confirm this.

Ultrasound versus physical examination in staging carcinoma of the mobile tongue

Surgical therapy for early lesions of the tongue should have the potential to be both oncologically sound and easy to rehabilitate. Obviously, the amount of tongue left behind after surgery is proportional to the post-operative function. Hence accurate mapping of the diseased tongue is of paramount importance in order to limit or extend the resection margins. We have evaluated the use of ultrasound in carcinoma of the tongue, and also compared its relative accuracy with physical examination for determining the extent of growth, keeping the histopathological size as a gold standard. We found that ultrasound is more accurate in detecting T2 and T3 tumours than T1 lesions. Intraoral sonographic mapping may be the answer for such small lesions. In addition, ultrasonography is beneficial in showing spread to contiguous areas of the tongue. However, post-radiation fibrosis and frank residual disease were not differentiated accurately by ultrasound. Thus ultrasonography can be an effective investigative tool and together with physical examination it can increase diagnostic accuracy leading to precise surgery for carcinoma of the tongue.