From the Departments of Radiology (B.C.Y.).
Departments of Otolaryngology Head and Neck Surgery (M.D.B., M.A.V.).
AJNR Am J Neuroradiol. 2020 Jul;41(7):1245-1250. doi: 10.3174/ajnr.A6625. Epub 2020 Jun 18.
For primary squamous cell carcinoma of the oral tongue, accurate assessment of tumor thickness and depth of invasion is critical for staging and operative management. Currently, typical imaging modalities used for preoperative staging are CT and MR imaging. Intraoperatively, CT or MR imaging cannot provide real-time guidance, and assessment by manual palpation is limited in precision. We investigated whether intraoperative sonography is a feasible technique for assessment of tumor thickness and depth of invasion and validated its accuracy by comparing it with histopathologic evaluation of the resected specimen.
Twenty-six patients with squamous cell carcinoma of the oral tongue who underwent tumor resection by a single surgeon between March 31, 2016, and April 26, 2019, were prospectively identified. Intraoperative sonography was obtained in planes longitudinal and transverse to the long axis of the tumor. Twenty-two patients had archived images that allowed measurements of tumor thickness and depth of invasion sonographically. Two patients had dysplasia and were excluded. The remaining 20 patients had histologic tumor thickness and histologic depth of invasion measured by a single pathologist.
The mean sonographic tumor thickness was 7.5 ± 3.5 mm, and the mean histologic tumor thickness was 7.0 ± 4.2 mm. Mean sonographic depth of invasion and histologic depth of invasion were 6.6 ± 3.4 and 6.4 ± 4.4 mm, respectively. There was excellent correlation between sonographic and histologic measurements for both tumor thickness and depth of invasion with Pearson correlation coefficients of 0.95 (95% CI, 0.87-0.98) and 0.95 (95% CI, 0.87-0.98), respectively.
Intraoperative sonography can provide reliable, real-time assessment of the extent of tongue tumors.
对于原发性口腔舌鳞状细胞癌，准确评估肿瘤厚度和浸润深度对于分期和手术管理至关重要。目前，用于术前分期的典型影像学方法是 CT 和 MRI 成像。术中，CT 或 MRI 无法提供实时指导，手动触诊评估的精度有限。我们研究了术中超声是否可用于评估肿瘤厚度和浸润深度，并通过与切除标本的组织病理学评估进行比较来验证其准确性。
2016 年 3 月 31 日至 2019 年 4 月 26 日期间，前瞻性地识别了 26 例接受单一外科医生舌鳞状细胞癌肿瘤切除术的患者。在与肿瘤长轴纵轴和横轴平行的平面上进行术中超声检查。22 例患者有存档的图像，允许超声测量肿瘤厚度和浸润深度。2 例患者有发育不良，被排除在外。其余 20 例患者的肿瘤厚度和组织学浸润深度由同一位病理学家测量。
超声测量的平均肿瘤厚度为 7.5 ± 3.5mm，组织学测量的平均肿瘤厚度为 7.0 ± 4.2mm。平均超声测量的浸润深度和组织学浸润深度分别为 6.6 ± 3.4mm 和 6.4 ± 4.4mm。超声和组织学测量的肿瘤厚度和浸润深度均具有极好的相关性，Pearson 相关系数分别为 0.95（95%CI，0.87-0.98）和 0.95（95%CI，0.87-0.98）。
术中超声可以提供可靠的、实时的舌肿瘤评估。
