Amrita Institute of Medical Sciences, Amrita University. Kochi, India. Pin: 682041.
Vydehi Institute of Medical Sciences & Research Centre, Bangalore, India. Pin: 560066.
Gulf J Oncolog. 2022 May;1(39):39-46.
This prospective analysis of patients with squamous cell carcinoma of the buccal mucosa, aimed to analyze the correlation between depth of invasion (DOI) observed in pre-operative imaging and the post-operative histopathological findings, and to assess the predictive value of magnetic resonance imaging.
All cases of squamous cell carcinoma of buccal mucosa, planned for primary surgery followed by adjuvant treatment, between June 2017 to December 2019 were included in the analysis. All patients were taken up for imaging using 3 Tesla MR imaging system and subsequently had undergone surgery. The imaging parameters and the histopathological data were analyzed statistically.
Of the 45 patients analyzed, 86.7% were males. Mean age at presentation was 60.62 years. All had squamous histology, with 62.2% being moderately differentiated. 68.9% were T4, 46.7%, N0 and 31.3%, N3. Six node positive patients showed perinodal invasion on histopathology. The mean DOI observed in MRI was 16.54mm, while that in histopathological evaluation was 20.24mm.
A significant correlation was observed between imaging and histopathology values in terms of the DOI, with Spearman's Rho correlation coefficient showing 0.693 (p-<0.001). Nodal positivity observed in the imaging and the histopathological findings showed only a moderate correlation of 0.409, with p values of 0.005 (Pearson, Spearman's rho) and 0.007 (Kendall's tau_b). A significant correlation was not observed between nodal involvement and DOI assessed by imaging nor with histopathological assessment. With a cut-off value of 5mm as imaging DOI, the positive predictive value (PPV) for nodal positivity was only 37.14%, while the negative predictive value (NPV) was 95%. The sensitivity was 96.3%, and specificity 30.16%. When the cutoff was raised to 10mm, the values for PPV, NPV, sensitivity and specificity were, 44.07%, 61.29%, 68.42% and 36.54%.
Despite being a histopathological parameter, accurate or near accurate evaluation of DOI can be achieved using MR imaging. Our study convincingly shows that magnetic resonance imaging can be considered the imaging of choice for the evaluation of depth of invasion of the tumour in squamous cell carcinoma of the buccal mucosa, though it fails to show any predictive value for nodal involvement.
本研究对颊黏膜鳞状细胞癌患者进行了前瞻性分析，旨在分析术前影像学观察到的浸润深度（DOI）与术后组织病理学发现之间的相关性，并评估磁共振成像的预测价值。
纳入 2017 年 6 月至 2019 年 12 月期间计划行原发手术加辅助治疗的所有颊黏膜鳞状细胞癌患者。所有患者均接受 3T MRI 成像系统检查，然后进行手术。对影像学参数和组织病理学数据进行统计分析。
45 例患者中，86.7%为男性。中位发病年龄为 60.62 岁。所有患者均为鳞状组织学，其中 62.2%为中度分化。68.9%为 T4，46.7%、N0，31.3%、N3。6 例淋巴结阳性患者的组织病理学检查显示有淋巴结周围侵犯。MRI 观察到的平均 DOI 为 16.54mm，而组织病理学评估为 20.24mm。
影像学和组织病理学 DOI 值之间存在显著相关性，Spearman 相关系数为 0.693（p<0.001）。影像学和组织病理学发现的淋巴结阳性仅显示中度相关性，Pearson、Spearman 相关系数和 Kendall's tau_b 的 p 值分别为 0.005、0.007 和 0.007。影像学评估的 DOI 与淋巴结受累之间以及与组织病理学评估之间均未观察到显著相关性。当影像学 DOI 截断值为 5mm 时，淋巴结阳性的阳性预测值（PPV）仅为 37.14%，阴性预测值（NPV）为 95%。灵敏度为 96.3%，特异性为 30.16%。当截断值提高到 10mm 时，PPV、NPV、灵敏度和特异性分别为 44.07%、61.29%、68.42%和 36.54%。
尽管 DOI 是一个组织病理学参数，但使用 MRI 可以准确或接近准确地评估 DOI。我们的研究令人信服地表明，磁共振成像可被视为评估颊黏膜鳞状细胞癌肿瘤浸润深度的首选影像学方法，但对淋巴结受累无预测价值。
