Steens Stefan C A, Bekers Elise M, Weijs Willem L J, Litjens Geert J S, Veltien Andor, Maat Arie, van den Broek Guido B, van der Laak Jeroen A W M, Fütterer Jürgen J, van der Kaa Christina A Hulsbergen, Merkx Matthias A W, Takes Robert P
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
Int J Comput Assist Radiol Surg. 2017 May;12(5):821-828. doi: 10.1007/s11548-017-1524-6. Epub 2017 Jan 27.
Purpose of this feasibility study was (1) to evaluate whether application of ex-vivo 7T MR of the resected tongue specimen containing squamous cell carcinoma may provide information on the resection margin status and (2) to evaluate the research and developmental issues that have to be solved for this technique to have the beneficial impact on clinical outcome that we expect: better oncologic and functional outcomes, better quality of life, and lower costs.
We performed a non-blinded validation of ex-vivo 7T MR to detect the tongue squamous cell carcinoma and resection margin in 10 fresh tongue specimens using histopathology as gold standard.
In six of seven specimens with a histopathologically determined invasion depth of the tumor of [Formula: see text] mm, the tumor could be recognized on MR, with a resection margin within a 2 mm range as compared to histopathology. In three specimens with an invasion depth of [Formula: see text] mm, the tumor was not visible on MR. Technical limitations mainly included scan time, image resolution, and the fact that we used a less available small-bore 7T MR machine.
Ex-vivo 7T probably will have a low negative predictive value but a high positive predictive value, meaning that in tumors thicker than a few millimeters we expect to be able to predict whether the resection margin is too small. A randomized controlled trial needs to be performed to show our hypothesis: better oncologic and functional outcomes, better quality of life, and lower costs.
本可行性研究的目的是（1）评估对含有鳞状细胞癌的切除舌标本进行离体7T磁共振成像（MR）是否能提供切缘状态的信息，以及（2）评估为使该技术对临床结局产生预期的有益影响（更好的肿瘤学和功能结局、更高的生活质量以及更低的成本）而必须解决的研发问题。
我们对10个新鲜舌标本进行了离体7T MR检测舌鳞状细胞癌和切缘的非盲法验证，以组织病理学作为金标准。
在7个组织病理学确定肿瘤浸润深度为[公式：见正文]毫米的标本中，有6个标本在MR上可识别出肿瘤，与组织病理学相比，切缘在2毫米范围内。在3个浸润深度为[公式：见正文]毫米的标本中，肿瘤在MR上不可见。技术限制主要包括扫描时间、图像分辨率，以及我们使用的是一台可用性较低的小口径7T MR机器这一事实。
离体7T MR可能具有较低的阴性预测值但较高的阳性预测值，这意味着在厚度超过几毫米的肿瘤中，我们预计能够预测切缘是否过小。需要进行一项随机对照试验来验证我们的假设：更好的肿瘤学和功能结局、更高的生活质量以及更低的成本。
