Smiley Nicholas, Anzai Yoshimi, Foster Sarah, Dillon Jasjit
Resident, Oral and Maxillofacial Surgery, University of Washington, Seattle, WA.
Professor of Radiology, Associate Chief Medical Quality Officer, and Adjunct Professor of Population Health Sciences, University of Utah, Salt Lake City, UT.
J Oral Maxillofac Surg. 2019 Jan;77(1):204-217. doi: 10.1016/j.joms.2018.08.012. Epub 2018 Aug 24.
In patients with oral squamous cell carcinoma (OSCC), depth of tumor invasion (DOI) is correlated with prognosis. Tumor thickness (TT) is often used as a surrogate measurement of DOI. The aim of this study was to estimate TT in a sample of patients with OSCC using ultrasound sonography (USS), magnetic resonance imaging (MRI), and clinical assessment and compare these estimates with TT of the final surgical specimen.
The authors designed and implemented a prospective cohort study and enrolled patients presenting for management of OSCC. Eligible subjects had biopsy-proved OSCC and received clinical assessment, staging by MRI, and USS. The predictor variable was measurement technique by clinical assessment, USS, or MRI. The primary outcome variable was the maximal TT (centimeters) obtained from the final histopathologic specimen. Appropriate uni- and bivariate statistics were computed.
The sample included 10 patients (mean age, 62.7 ± 13.6 yr; 70% men). Two of the 10 tumors (20%) were not adequately visualized with USS. Three of the 10 tumors (30%) were not seen with MRI because of dental artifact. These 3 patients' tumors were visualized by USS. One of the 10 tumors (10%) could not be palpated clinically. Three of the 10 patients (30%) did not go to surgery and were treated with chemoradiation because of the high tumor stage or the patient's health status. USS, MRI, and clinical TT measurements were underestimates compared with the specimen TT measurement (-0.6, -0.5, and -0.3 cm, respectively; P = .9).
All 3 measurement modalities (clinical examination, MRI, and USS) underestimated OSCC TT compared with the final surgical specimen. There were no statistical differences in mean measurement or absolute value mean differences among measurement modalities. Notably, USS visualized the OSCC in the 3 patients (30%) whose tumors were poorly visualized or not visualized with MRI.
在口腔鳞状细胞癌（OSCC）患者中，肿瘤浸润深度（DOI）与预后相关。肿瘤厚度（TT）常被用作DOI的替代测量指标。本研究的目的是使用超声检查（USS）、磁共振成像（MRI）和临床评估来估计OSCC患者样本中的TT，并将这些估计值与最终手术标本的TT进行比较。
作者设计并实施了一项前瞻性队列研究，纳入因OSCC前来治疗的患者。符合条件的受试者经活检证实为OSCC，并接受了临床评估、MRI分期和USS检查。预测变量是通过临床评估、USS或MRI的测量技术。主要结局变量是从最终组织病理学标本中获得的最大TT（厘米）。计算了适当的单变量和双变量统计量。
样本包括10例患者（平均年龄62.7±13.6岁；70%为男性）。10个肿瘤中有2个（20%）在USS检查中显示不充分。10个肿瘤中有3个（30%）由于牙科伪影在MRI检查中未被发现。这3例患者的肿瘤在USS检查中可见。10个肿瘤中有1个（10%）在临床上无法触及。10例患者中有3例（30%）因肿瘤分期高或患者健康状况而未进行手术，接受了放化疗。与标本TT测量值相比，USS、MRI和临床TT测量值均被低估（分别为-0.6、-0.5和-0.3厘米；P =.9）。
与最终手术标本相比，所有3种测量方式（临床检查、MRI和USS）均低估了OSCC的TT。测量方式之间的平均测量值或绝对值平均差异无统计学差异。值得注意的是，USS在3例（30%）肿瘤在MRI检查中显示不佳或未显示的患者中显示出了OSCC。
