Fu J-Y, Zhu L, Li J, Chen P-Q, Zhang C-Y, Shi W-T, Shen S-K, Zhang C-P, Zhang Z-Y
Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, PR China.
Department of Radiology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, PR China.
Br J Oral Maxillofac Surg. 2020 Oct;58(8):997-1002. doi: 10.1016/j.bjoms.2020.05.014. Epub 2020 Jul 3.
Preoperative staging is essential for the planning of treatment of cancer. This study was designed to evaluate the accuracy of computed tomography (CT) in predicting the local stage of tongue cancer by comparing it with the gold standard of histopathology. A total of 233 patients with newly-diagnosed tongue cancer was retrospectively reviewed, and the size of the tumour and the status of the cervical lymph node were compared between CT images and histopathological results. Patients with stage II cancer were followed up to assess the influence of inaccurate preoperative staging on prognosis. The accuracy of local staging by CT was 47.6% (111/233), with 59.7% (139/233) for tumour stage, and 70.4% (164/233) for nodal stage. The greatest dimension of the tumour on the CT image was about 2mm less than that measured by histopathology. The estimated volume of tumour was a quarter smaller. The accuracy of predicting malignant lymph nodes by CT was 68.9% (n=161). Among patients with stage II disease, simultaneous neck dissection was less likely in the understaged group than in the accurately staged one. The reoperation rate was a little higher but not significantly so. We conclude that the accuracy of CT in predicting local staging for tongue cancer was only moderate, because it underestimated the size of the tumour and needed to improve the criteria for detecting malignant lymph nodes. Understaging on CT images may influence the prognosis of patients with early stage tongue cancer.
术前分期对于癌症治疗方案的规划至关重要。本研究旨在通过将计算机断层扫描（CT）与组织病理学这一金标准进行比较，评估其预测舌癌局部分期的准确性。对233例新诊断的舌癌患者进行了回顾性研究，比较了CT图像与组织病理学结果之间的肿瘤大小及颈部淋巴结状态。对II期癌症患者进行随访，以评估术前分期不准确对预后的影响。CT对局部分期的准确率为47.6%（111/233），肿瘤分期准确率为59.7%（139/233），淋巴结分期准确率为70.4%（164/233）。CT图像上肿瘤的最大径比组织病理学测量值小约2mm。估计的肿瘤体积小四分之一。CT预测恶性淋巴结的准确率为68.9%（n = 161）。在II期疾病患者中，分期过低组同期行颈部清扫术的可能性低于分期准确组。再次手术率略高，但差异无统计学意义。我们得出结论，CT预测舌癌局部分期的准确性仅为中等，因为它低估了肿瘤大小，且需要改进检测恶性淋巴结的标准。CT图像分期过低可能会影响早期舌癌患者的预后。
