Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Oral and Maxillofacial Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Oral Oncol. 2022 Oct;133:106023. doi: 10.1016/j.oraloncology.2022.106023. Epub 2022 Jul 25.
Surgical removal of squamous cell carcinoma of the tongue (SCCT) with tumour-free margin status (≥5 mm) is essential for loco-regional control. Inadequate margins (<5 mm) often indicate adjuvant treatment, which results in increased morbidity. Ultrasound (US)-guided SCCT resection may be a useful technique to achieve more adequate resection margins compared to conventional surgery. This study evaluates the application and accuracy of this technique.
Forty patients with SCCT were included in a consecutive US cohort. During surgery, the surgeon aimed for a 10-mm echographic resection margin, while the tumour border and resection plane were captured in one image. Ex-vivo US measurements of the resection specimen determined whether there was a need for an immediate re-resection. The margin status and the administration of adjuvant treatment were compared those of with a consecutive cohort of 96 tongue cancer patients who had undergone conventional surgery. A receiver operating characteristic analysis was done to assess the optimal margin of ex-vivo US measurements to detect histopathologically inadequate margins.
In the US cohort, the frequency of free margin status was higher than in the conventional cohort (55% vs. 16%, p < 0.001), and the frequency of positive margins status (<1 mm) was lower (5% vs. 15%, respectively, p < 0.001). Adjuvant radiotherapy was halved (10% vs. 21%), and the need for re-resection was comparable (10% vs. 9%). A cut-off value of 8 mm for ex-vivo measurements prevented histopathologically inadequate margins in 76%.
US-guided SCCT resections improve margin status and reduce the frequency of adjuvant radiotherapy.
舌鳞状细胞癌（SCCT）手术切除时，切缘无肿瘤（≥5mm）是局部控制的关键。切缘不足（<5mm）常提示需要辅助治疗，这会增加发病率。与传统手术相比，超声（US）引导的 SCCT 切除术可能是一种获得更充分切除边缘的有用技术。本研究评估了该技术的应用和准确性。
连续纳入 40 例 SCCT 患者进行 US 队列研究。手术过程中，外科医生的目标是达到 10mm 的超声切除边缘，同时在一个图像中捕获肿瘤边界和切除平面。对切除标本进行离体 US 测量，以确定是否需要立即再次切除。比较了切缘状态和辅助治疗的应用情况，并与连续的 96 例舌癌患者的传统手术队列进行了比较。进行了受试者工作特征分析，以评估离体 US 测量切缘的最佳宽度，以检测组织病理学上不足的切缘。
在 US 队列中，无肿瘤切缘的频率高于传统队列（55% vs. 16%，p<0.001），而阳性切缘（<1mm）的频率较低（5% vs. 15%，分别，p<0.001）。辅助放疗减少了一半（10% vs. 21%），再次切除的需求相当（10% vs. 9%）。离体测量的截断值为 8mm 可防止 76%的组织病理学上不足的切缘。
US 引导的 SCCT 切除可改善切缘状态并减少辅助放疗的频率。
