Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
Oral Oncol. 2012 Apr;48(4):361-6. doi: 10.1016/j.oraloncology.2011.11.009. Epub 2011 Dec 11.
In patients with oral squamous cell carcinomas (OSSC) it is desirable to avoid unnecessary bone resection without neglecting the overall surgical treatment goal of tumor-free margins. Whereas computed tomography (CT) is most commonly used to detect mandibular invasion, there are conflicting reports regarding the accuracy of CT. Therefore, the aim of this study was to reinvestigate the accuracy of CT in predicting mandibular involvement by OSSC. One hundred and seven patients with OSSC who received a mandibulectomy were included. Before treatment all patients underwent a contrast-enhanced multi-detector CT. Axial 3 or 1.25 mm thick images were reconstructed for evaluation in overlapping technique and displayed in a bone (1400/400 HU) and a soft tissue window (350/50 HU). CT scans were examined by three investigators and compared with the histological findings. The radiological examination showed a high interrater reliability (Cronbachs alpha 0.982). Comparing the radiological findings with the histological results the CT showed 8 false-positive results and 8 false-negative patients. The quality criteria for detecting bone involvement of OSSC by CT were calculated as follows: sensitivity 82.6%; specificity 86.9%; positive predictive value 82.6%; negative predictive value 86.9%. However, in all false-positive patients a sagittal bone defect of 15.1mm could be found presumably caused by pressure of the tumor, but no histologically detectable bone infiltration. Modern CT (1-2 mm sections) is a valuable tool for surgical treatment planning. If bone invasion is detected, a mandibulectomy seems always reasonable. In radiologically negative cases histological assessment is necessary to detect mandibular involvement.
在口腔鳞状细胞癌（OSSC）患者中，理想情况下是避免不必要的骨切除，同时不忽视肿瘤无边缘的总体手术治疗目标。虽然计算机断层扫描（CT）最常用于检测下颌骨侵犯，但关于 CT 的准确性存在相互矛盾的报道。因此，本研究旨在重新调查 CT 预测 OSSC 下颌骨受累的准确性。纳入了 107 例接受下颌骨切除术的 OSSC 患者。在治疗前，所有患者均接受了对比增强多探测器 CT 检查。在重叠技术中对轴向 3 或 1.25 毫米厚的图像进行重建，并在骨（1400/400 HU）和软组织窗（350/50 HU）中进行显示。由三位研究者对 CT 扫描进行检查，并与组织学发现进行比较。放射学检查显示出很高的组内一致性（Cronbach's alpha 0.982）。将放射学发现与组织学结果进行比较，CT 显示 8 例假阳性和 8 例假阴性患者。CT 检测 OSSC 骨受累的质量标准计算如下：敏感性 82.6%；特异性 86.9%；阳性预测值 82.6%；阴性预测值 86.9%。然而，在所有假阳性患者中，都可以发现 15.1 毫米的矢状骨缺损，可能是由于肿瘤的压力所致，但没有组织学上可检测到的骨浸润。现代 CT（1-2 毫米切片）是手术治疗计划的有价值工具。如果检测到骨侵犯，似乎总是需要进行下颌骨切除术。在放射学阴性的情况下，需要进行组织学评估以检测下颌骨受累。
