Kodama Masaaki, Khanal Amit, Habu Manabu, Iwanaga Kenjiro, Yoshioka Izumi, Tanaka Tatsurou, Morimoto Yasuhiro, Tominaga Kazuhiro
Division of Maxillofacial Diagnostic and Surgical Science, Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Japan.
J Oral Maxillofac Surg. 2010 Aug;68(8):1746-52. doi: 10.1016/j.joms.2009.07.110. Epub 2009 Dec 23.
Exact estimation of tumor thickness and the status of the resection margin in tongue carcinoma are important prognostic factors for local recurrence, subclinical nodal metastasis, and survival. This study aims to evaluate the accuracy of intraoral ultrasonography-guided measurement of tumor thickness and define an adequate intraoperative resection margin in squamous cell carcinomas of the tongue.
In this prospective study, 13 patients with presurgical, biopsy-proven, clinical T1N0 or T2N0 tongue squamous cell carcinomas who underwent a partial glossectomy were examined preoperatively with ultrasonography to assess tumor thickness under general anesthesia. Nine cases underwent resection by a conventional method, whereas we introduced elastic needles with a metal core to mark a deep surgical margin of 10 mm from the deepest tumor invasion front under ultrasonographic monitoring as a new technique in the remaining 4 cases. Each resected specimen was immediately immersed in gelatin solution while maintaining its original shape and orientation and was placed under refrigeration to solidify. Ultrasonographic observations of the gelatin-embedded specimens were performed from the superior surface of the gelatin block.
Very fine ultrasonographic images of the resected specimen could be easily obtained without any special skills, and surgical clearance could be verified intraoperatively. The ultrasonographic tumor thickness measurements corresponded well with those of histologic sections, with a consistency ratio of 91.4% to 98.2% (Pearson correlation coefficient = 0.981, P < .05).
Intraoperative ultrasonography is a reliable method to objectively evaluate tumor thickness and surgical margin clearance.
准确估计舌癌的肿瘤厚度及手术切缘状态是局部复发、亚临床淋巴结转移和生存的重要预后因素。本研究旨在评估口腔内超声引导下测量肿瘤厚度的准确性，并确定舌鳞状细胞癌术中合适的手术切缘。
在这项前瞻性研究中，13例经术前活检证实为临床T1N0或T2N0的舌鳞状细胞癌患者接受了部分舌切除术，术前在全身麻醉下用超声检查评估肿瘤厚度。9例采用传统方法切除，而在其余4例中，我们引入了带金属芯的弹性针，在超声监测下从肿瘤最深浸润前沿标记10mm的深部手术切缘作为新技术。每个切除标本立即浸入明胶溶液中，同时保持其原始形状和方向，并置于冷藏下固化。从明胶块的上表面对包埋在明胶中的标本进行超声观察。
无需任何特殊技巧即可轻松获得切除标本的非常清晰的超声图像，并且术中可验证手术切缘。超声测量的肿瘤厚度与组织学切片测量结果高度一致，一致性比率为91.4%至98.2%（Pearson相关系数=0.981，P<.05）。
术中超声是客观评估肿瘤厚度和手术切缘清除情况的可靠方法。
