Acton C H, Layt C, Gwynne R, Cooke R, Seaton D
Department of Paediatrics and Child Health, Royal Brisbane Hospital, Queensland, Australia.
Laryngoscope. 2000 Dec;110(12):2050-5. doi: 10.1097/00005537-200012000-00014.
OBJECTIVES/HYPOTHESIS: To compare preoperative investigations with histological findings in squamous cell carcinoma (SCC) of the oral mucosa that abuts the mandible. Both clinical and radiological examinations fail to predict accurately invasion of the mandible by intraoral SCC.
This two-part, prospective study is of a consecutive series of patients whose first malignancy of the upper aerodigestive tract abutted the lingual surface of the mandible.
AR patients presented to the Queensland Radium Institute Head and Neck Clinic between 1993 and 1997 with a biopsy-proven SCC that abutted the mandible. These tumors were investigated clinically, radiologically, and histologically. Sensitivity, specificity, and predictive values were calculated for various approaches. In the second part of the study, single photon emission computed tomography (SPECT) bone scans were included. Quantification ratios of bone scans compared the average counting statistics in visually identified mandibular abnormal uptake with normal cervical spine and jaw.
Sixty-seven patients were followed for 55 months and assessed with orthopantomogram (OPG), computed tomography (CT) scans, and, in the second part of the study, SPECT bone scans. Thirty-six tumors showed histological evidence of bony invasion. Bony involvement was suggested by OPG in 36 and confirmed histologically in 27 patients. CT scans showed evidence of bone invasion in 22 cases, with 18 of these histologically confirmed. Technetium 99m methylene diphosphonate (MDP) bone scans with planar imaging and SPECT were performed in 24 patients, and histological appearance was suitable for analysis in 14. Three patients with tumor (cervical spine ratios greater than 1.5 predicting malignant involvement) had this confirmed histologically.
The first part of the study confirms our hypothesis that currently used investigations, as well as clinical assessment, fail to predict accurately invasion of the mandible by intraoral SCC. The second part suggests that SPECT scanning with high quantification ratios is promising in the prediction of tumor involvement.
目的/假设：比较术前检查结果与紧邻下颌骨的口腔黏膜鳞状细胞癌（SCC）的组织学检查结果。临床和放射学检查均无法准确预测口腔内SCC对下颌骨的侵犯情况。
这项两部分的前瞻性研究针对一系列连续的患者，这些患者的上消化道首个恶性肿瘤紧邻下颌骨舌面。
1993年至1997年间，67例患者因活检证实的紧邻下颌骨的SCC就诊于昆士兰镭研究所头颈诊所。对这些肿瘤进行了临床、放射学和组织学检查。计算了各种检查方法的敏感性、特异性和预测值。在研究的第二部分，纳入了单光子发射计算机断层扫描（SPECT）骨扫描。骨扫描的定量比率比较了在视觉上确定的下颌骨异常摄取与正常颈椎和颌骨的平均计数统计数据。
67例患者随访55个月，并接受了全景曲面断层片（OPG）、计算机断层扫描（CT）检查，在研究的第二部分还接受了SPECT骨扫描。36例肿瘤显示有骨侵犯的组织学证据。OPG提示27例患者有骨受累，其中27例经组织学证实。CT扫描显示22例有骨侵犯证据，其中18例经组织学证实。24例患者进行了锝99m亚甲基二膦酸盐（MDP）骨平面显像和SPECT检查，14例患者的组织学表现适合分析。3例肿瘤患者（颈椎比率大于1.5预测有恶性受累）经组织学证实。
研究的第一部分证实了我们的假设，即目前使用的检查以及临床评估均无法准确预测口腔内SCC对下颌骨的侵犯。第二部分表明，具有高定量比率的SPECT扫描在预测肿瘤受累方面很有前景。
