de Koning Klijs J, Koppes Sjors A, de Bree Remco, Dankbaar Jan Willem, Willems Stefan M, van Es Robert J J, Noorlag Rob
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
Oral Oncol. 2021 May;116:105249. doi: 10.1016/j.oraloncology.2021.105249. Epub 2021 Mar 26.
Squamous cell carcinoma of the tongue (SCCT) is preferably treated by surgery. Free resection margins (≥5 mm) provide local control and disease-free survival. However, close (1-5 mm) and positive margins (<1 mm) are frequently encountered. We present our first experience of in-vivo ultrasound (US) guided SCCT resections followed by ex-vivo US control on the resection specimen to obtain free margins. We compare the results with those from a hisorical cohort of 91 conventionally treated SCCT patients.
Ten patients with SCCT were included in a consecutive US-cohort. We aimed for a 5-10 mm margin during surgery, while we visualized the resection plane on US. Ex-vivo US measurements on the resection specimen determined whether there was any need for an immediate re-resection. US measurements were then compared with histopathology. Histopathological margins were compared with a consecutive cohort of 91 patients who had undergone conventional surgery for a SCCT.
In the US cohort, 70% of the margins were free. In the conventional cohort, this figure was 17% (P = 0.005). US predicted minimal histopathological margin distance with a mean ± SD error of 1.9 ± 1.8 mm. The mean ± SD of the histopathological overall submucosal/deep margin distance was 7.9 ± 2.1 mm in the US cohort and 7.0 ± 2.2 mm in the conventional cohort (P = 0.188). Ex-vivo examination through use of US indicated an immediate re-resection, which prevented local adjuvant treatment.
Use of US-guided SCCT resection is feasible and improves margin control.
舌鳞状细胞癌（SCCT）首选手术治疗。切缘阴性（≥5mm）可实现局部控制并提高无病生存率。然而，切缘接近（1 - 5mm）和阳性（<1mm）的情况却很常见。我们介绍了我们首次在体内超声（US）引导下进行SCCT切除术，随后对切除标本进行体外超声检查以获得阴性切缘的经验。我们将结果与91例接受传统治疗的SCCT患者的历史队列进行了比较。
连续纳入10例SCCT患者组成超声队列。我们在手术过程中力求切缘达到5 - 10mm，同时通过超声观察切除平面。对切除标本进行体外超声测量，以确定是否需要立即再次切除。然后将超声测量结果与组织病理学结果进行比较。将组织病理学切缘与91例接受SCCT传统手术的连续队列患者进行比较。
在超声队列中，70%的切缘为阴性。在传统队列中，这一数字为17%（P = 0.005）。超声预测的最小组织病理学切缘距离的平均±标准差误差为1.9±1.8mm。在超声队列中，组织病理学总体黏膜下/深部切缘距离的平均±标准差为7.9±2.1mm，在传统队列中为7.0±2.2mm（P = 0.188）。通过超声进行的体外检查表明需要立即再次切除，从而避免了局部辅助治疗。
使用超声引导下的SCCT切除术是可行的，并且可以改善切缘控制。
