Barrett A W, Tighe J V, Gulati A, Newman L, Norris P M, Bisase B S, Nicholls M K
Department of Histopathology, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ.
Maxillofacial Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ.
Br J Oral Maxillofac Surg. 2017 Nov;55(9):921-926. doi: 10.1016/j.bjoms.2017.08.008. Epub 2017 Sep 28.
Our aim was to find out first whether the extrinsic muscles of the tongue are histologically identifiable, and secondly to what degree the use of the new criteria in the 8th editions of the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control (UICC) manuals (which have recognised the importance of depth of invasion of tumour, rather than invasion of the extrinsic muscles of the tongue and extranodal extension), will alter staging of lingual squamous cell carcinoma (SCC). The histological sections from 165 patients who had had primary resection of lingual SCC were reviewed, and one or more extrinsic muscles of the tongue was identified in 100 patients (61%), with the genioglossus seen the most often (in 96). By contrast, the hyoglossus was identified in only eight patients, the styloglossus in two, and the palatoglossus in none. Identification was straightforward only in extensive resections. Applying the criteria from the 8th edition increased the number of pT3 SCC with a simultaneous reduction in pT4a tumours. The number of pN2b SCC was also reduced, but the new category of pN3b meant that overall 53% of tumours were upstaged. The kappa scores for agreement between the two sets of criteria were 0.221 (weighted 0.410) for the pT values, 0.508 (0.713) for pN values (but 0.227, weighted 0.386, if the pN0 values were removed before calculation), and 0.243 (0.514) for overall stage, indicating poor to fair agreement. We conclude that the removal of invasion of extrinsic muscles of the tongue as a criterion for a pT4a SCC is justified, and that many SCC of the tongue will be upstaged as a result of implementation of the 8th editions.
我们的目的，一是要弄清楚舌的外在肌在组织学上是否可识别，二是要了解美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）第8版手册中采用的新标准（该标准认可肿瘤浸润深度的重要性，而非舌外在肌浸润和结外扩展）在多大程度上会改变舌鳞状细胞癌（SCC）的分期。回顾了165例接受舌SCC原发灶切除患者的组织学切片，100例（61%）患者中识别出一条或多条舌外在肌，其中颏舌肌最为常见（96例）。相比之下，仅8例患者识别出舌骨舌肌，2例识别出茎突舌肌，未识别出腭舌肌。仅在广泛切除时识别工作才较为简单。应用第8版标准增加了pT3 SCC的数量，同时减少了pT4a肿瘤的数量。pN2b SCC的数量也有所减少，但新的pN3b类别意味着总体上53%的肿瘤分期上调。两组标准之间的pT值kappa一致性评分是0.221（加权后为0.410），pN值为0.508（0.713）（但如果在计算前去除pN0值，则为0.227，加权后为0.386），总体分期为0.243（0.514），表明一致性从差到一般。我们得出结论，将舌外在肌浸润作为pT4a SCC的标准去除是合理的，并且由于第8版标准的实施，许多舌SCC的分期将会上调。
