Kim Y J, Jeong W-J, Bae Y J, Kim H, Choi B S, Jung Y H, Baik S H, Sunwoo L, Kim J H
From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.).
Otolaryngology-Head and Neck Surgery (W.-J.J., Y.H.J.).
AJNR Am J Neuroradiol. 2020 Dec;41(12):2320-2326. doi: 10.3174/ajnr.A6806. Epub 2020 Oct 15.
Transoral robotic surgery is an emerging strategy for treating human papillomavirus-positive cancers, but the role of MR imaging in predicting the surgical outcome has not been established. We aimed to identify preoperative MR imaging characteristics that predispose the outcome of transoral robotic surgery toward an insecure (positive or close) surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma.
Between December 2012 and May 2019, sixty-nine patients underwent transoral robotic surgery at our institution. Among these, 29 who were diagnosed with human papillomavirus-positive tonsillar squamous cell carcinoma, did not receive neoadjuvant treatment, underwent preoperative 3T MR imaging, and had postoperative pathologic reports and were included in this retrospective study. Two neuroradiologists evaluated the preoperative MR imaging scans to determine the tumor spread through the pharyngeal constrictor muscle using a 5-point scale: 1, normal constrictor; 2, bulging constrictor; 3, thinning constrictor; 4, obscured constrictor; and 5, tumor protrusion into the parapharyngeal fat. The risk of an insecure surgical margin (involved or <1 mm) according to the MR imaging scores was predicted using logistic regression with the Firth correction.
The interobserver agreement for the MR imaging scores was excellent (κ = 0.955, < .001). A score of ≥4 could predict an insecure margin with 87.5% sensitivity and 92.3% specificity (area under the curve = 0.899) and was the only significant factor associated with an insecure margin in the multivariable analysis (OR, 6.59; 95% CI, 3.11-22.28; < .001).
The pre-transoral robotic surgery MR imaging scoring system for the pharyngeal constrictor muscle is a promising predictor of the surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma.
经口机器人手术是治疗人乳头瘤病毒阳性癌症的一种新兴策略，但磁共振成像在预测手术结果中的作用尚未明确。我们旨在确定术前磁共振成像特征，这些特征使人乳头瘤病毒阳性扁桃体鳞状细胞癌经口机器人手术的结果倾向于手术切缘不安全（阳性或切缘接近）。
2012年12月至2019年5月期间，69例患者在我们机构接受了经口机器人手术。其中，29例被诊断为人乳头瘤病毒阳性扁桃体鳞状细胞癌，未接受新辅助治疗，术前行3T磁共振成像检查，并有术后病理报告，纳入本回顾性研究。两名神经放射科医生评估术前磁共振成像扫描，使用5分制确定肿瘤通过咽缩肌的扩散情况：1分，咽缩肌正常；2分，咽缩肌膨出；3分，咽缩肌变薄；4分，咽缩肌模糊；5分，肿瘤突入咽旁脂肪。使用带Firth校正的逻辑回归预测根据磁共振成像评分出现手术切缘不安全（受累或<1毫米）的风险。
磁共振成像评分的观察者间一致性极佳（κ=0.955，P<0.001）。评分≥4分可预测切缘不安全，敏感性为87.5%，特异性为92.3%（曲线下面积=0.899），并且是多变量分析中与切缘不安全相关的唯一显著因素（比值比，6.59；95%置信区间，3.11-22.28；P<0.001）。
用于咽缩肌的经口机器人手术前磁共振成像评分系统是预测人乳头瘤病毒阳性扁桃体鳞状细胞癌手术切缘的一个有前景的指标。
