Subscribe to RSS
Preoperative ultrasonography for tumor thickness evaluation in guiding management in patients with early oral tongue squamous cell carcinoma
Subject Editor: Financial support and sponsorship Nil.
Objectives: (1) To assess the statistical correlation between the tumor thickness (TT) by ultrasonography (USG) and microscopic measurement in cases of early oral tongue squamous cell carcinoma (OTSCC). (2) To assess the predictive capacity of TT by ultrasound in detecting nodal metastasis. Materials and Methods: Prospective analysis was performed in 24 patients for a period of 2 years from 2012 to 2013. Nodal status and TT measurement was done preoperatively by neck and intraoral USG respectively in cases of early (pT1 & T2, clinically N0) OTSCC. As per the institution protocol after histopathological confirmation of malignancy, all patients underwent resection of primary lesion and ipsilateral elective neck dissection (Level - I to IV). Measurement of TT was obtained intraoperatively from fresh glossectomy specimen and postoperatively from histopathological paraffin section examination. The statistical correlation between TT measured by USG and histopathology was assessed by Pearson’s correlation coefficient. Chi-square test was used to find the association of pathological T stage, TT with pathological nodal status. Results: Significant statistical correlation was seen between TT by USG and microscopic measures. Between the two, TT measurements were within 1 mm in 37.5% (9/24) of cases, within 2 mm in 29.16% (7/24), and was greater than 2 mm in 8 cases. The Pearson’s correlation r is 0.678 (P < 0.001) and ICC (interclass correlation coefficient) is 0.808. The average difference between microscopic and US thickness (Bias) is -0.14637 and the limits of agreement is (4.717, -4.863) with 95% limits of agreement. The rate of occult nodal metastasis was 16.6% and TT of <4 mm had no incidence of nodal metastasis. Conclusion: Ultrasonographic evaluation is reliable and cost-effective tool to measure the TT preoperatively, which will be of help in deciding the management in early OTSCC. TT of 4 mm and above was predictor of occult cervical nodal metastasis.
26 July 2021 (online)
© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Shintani S, Matsuura H, Hasegawa Y, Nakayama B, Fujimoto Y. The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue. Oncology 1997; 54: 463-7
- 2 Bruneton JN, Roux P, Caramella E, Manzino JJ, Vallicioni J, Demard F. Tongue and tonsil cancer: Staging with US. Radiology 1986; 158: 743-6
- 3 Fruehwald F, Salomonowitz E, Neuhold A, Pavelka R, Mailath G. Tongue cancer. Sonographic assessment of tumor stage. J Ultrasound Med 1987; 6: 121-37
- 4 Helbig M, Helmke BM, Flechtenmacher C, Hansmann J, Dietz A, Tasman AJ. [Intraoperative endosonographic guided resection of tongue carcinoma.]. HNO 2005; 53: 631-6
- 5 Narayana HM, Panda NK, Mann SB, Katariya S, Vasishta RK. Ultrasound versus physical examination in staging carcinoma of the mobile tongue. J Laryngol Otol 1996; 110: 43-7
- 6 Shintani S, Nakayama B, Matsuura H, Hasegawa Y. Intraoral ultrasonography is useful to evaluate tumor thickness in tongue carcinoma. Am J Surg 1997; 173: 345-7
- 7 Shintani S, Yoshihama Y, Ueyama Y, Terakado N, Kamei S, Fijimoto Y. et al. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxillofac Surg 2001; 30: 139-43
- 8 O’Brien CJ, Lauer CS, Fredricks S, Clifford AR, McNeil EB, Bagia JS. et al. Tumor thickness influences prognosis of T1 and T2 oral cavity cancer--but what thickness?. Head Neck 2003; 25: 937-45
- 9 Shintani S, Matsuura H, Hasegawa Y, Nakayama B, Fujimoto Y. The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue. Oncology 1997; 54: 463-7
- 10 Sparano A, Weinstein G, Chalian A, Yodul M, Weber R. Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg 2004; 131: 472-6
- 11 Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: A review of the literature. Head Neck 2005; 27: 1080-91
- 12 Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow TL. et al. Prognostic factors of clinically stage I and II oral tongue carcinoma-A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck 2002; 24: 513-20
- 13 Roepman P, de Jager A, Groot Koerkamp MJ, Kummer A, Slootweg PJ, Holstege FC. Maintenance of head and neck tumor gene expression profiles upon lymph node metastasis. Cancer Res 2006; 66: 11110-4
- 14 Gourin CG, Conger BT, Porubsky ES, Sheils WC, Bilodeau PA, Coleman TA. The effect of occult nodal metastases on survival and regional control in patients with head and neck squamous cell carcinoma. Laryngoscope 2008; 118: 1191-4
- 15 Pitman KT. Rationale for elective neck dissection. Am J Otolaryngol 2000; 21: 31-7
- 16 Preda L, Chiesa F, Calabrese L, Latronico A, Bruschini R, Leon ME. et al. Relationship between histologic thickness of tongue carcinoma and thickness estimated from preoperative MRI. Eur Radiol. 2006; 16: 2242-8
- 17 Preventing and controlling oral and pharyngeal cancer. Recommendations from a National Strategic Planning Conference. MMWR 1998; 47: 1-12
- 18 Kurokawa H, Hirashima S, Morimoto Y, Yamashita Y, Tominaga K, Takamori K. et al. Preoperative ultrasound assessment of tumour thickness in tongue carcinomas. Asian Journal of Oral and Maxillofacial Surgery. 2005 Sep 1;17 (3):173-8
- 19 Shintani S, Yoshihama Y, Ueyama Y, Terakado N, Kamei S, Fijimoto Y. et al. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxillofac Surg. 2001; 30: 139-43
- 20 Levy R, Segal K, Hadar T, Shvero J, Abraham A. Squamous cell carcinoma of the oral tongue. Eur J Surg Oncol. 1991; 17: 330-4
- 21 Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ. et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994; 168: 391-4
- 22 Matos LL, Manfro G, Santos RV, Stabenow E, Mello ES, Alves VA. et al. Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118: 209-17
- 23 Melchers LJ, Schuuring E, van Dijk BA, de Bock GH, Witjes MJ, van der Laan BF. et al. Tumour infiltration depth ≥4 mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma. Oral Oncology 2012; 48: 337-42
- 24 Chen CH, Hsu MY, Jiang RS, Wu SH, Chen FJ, Liu SA. Shrinkage of head and neck cancer specimens after formalin fixation. J Chin Med Assoc 2012; 75: 109-13