Oxford Radiology Research Group, Oxford MRI Centre, John Radcliffe Hospital, Oxford, UK.
Int J Oral Maxillofac Surg. 2013 Nov;42(11):1397-402. doi: 10.1016/j.ijom.2013.06.003. Epub 2013 Jul 10.
The TNM classification for oral malignancies has been criticized for its upstaging to T4a when tumour involves styloglossus, hyoglossus, palatoglossus and genioglossus. The aims of this study were to (1) create an anatomical computer atlas of extrinsic tongue musculature, and (2) reassess the original staging of pre-treatment archived magnetic resonance images (MRI) of tongue carcinomas using the strict extrinsic muscle criteria. The anatomy of the extrinsic tongue muscles was mapped using images from the Visible Human Project (VHP) to create a computer model of the extrinsic tongue muscles. This was co-registered with 87 archived pre-staging MRI scans of tongue carcinomas to assess tumour ingress of the extrinsic tongue muscles. Of the 87 image sets reviewed, 16 were of superficial tumours not visible on MRI. In the remaining 71 cases that showed positive extrinsic muscle tumour ingress, 52% were upstaged from T1/2/3 tumours to cT4a based upon this finding. Extrinsic lateral and genioglossus muscle invasion did not predict occult cervical lymph node invasion or disease-related survival. In conclusion, tumour invasion of styloglossus or hyoglossus would result in the majority of lateral tongue tumours being staged T4a. Such stratification is of little clinical relevance, and an alternative more reliable method is required.
口腔恶性肿瘤的 TNM 分类因其在肿瘤累及茎突舌肌、舌骨舌肌、腭舌肌和颏舌肌时被升级为 T4a 而受到批评。本研究的目的是：(1)创建一个舌外肌解剖学计算机图谱，(2)使用严格的舌外肌标准重新评估舌癌术前存档磁共振成像 (MRI) 的原始分期。使用可见人体计划 (VHP) 的图像绘制舌外肌的解剖结构，以创建舌外肌的计算机模型。该模型与 87 份舌癌术前分期 MRI 扫描进行了配准，以评估肿瘤对舌外肌的入侵。在审查的 87 组图像中，16 组为浅层肿瘤，MRI 上不可见。在显示阳性舌外肌肿瘤入侵的其余 71 例中，根据这一发现，52%的 T1/2/3 肿瘤被升级为 cT4a。外侧和颏舌肌侵犯并不预测隐匿性颈部淋巴结侵犯或疾病相关生存。总之，茎突舌肌或舌骨舌肌的肿瘤侵犯会导致大多数外侧舌肿瘤被分期为 T4a。这种分层在临床相关性方面意义不大，需要一种更可靠的替代方法。
