Carnicelli Giorgia, Disconzi Luca, Cerasuolo Michele, Casiraghi Elena, Costa Guido, De Virgilio Armando, Esposito Andrea Alessandro, Ferreli Fabio, Fici Federica, Lo Casto Antonio, Marra Silvia, Malvezzi Luca, Mercante Giuseppe, Spriano Giuseppe, Torzilli Guido, Francone Marco, Balzarini Luca, Giannitto Caterina
Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
Diagnostics (Basel). 2023 May 25;13(11):1846. doi: 10.3390/diagnostics13111846.
(1) Background: The assessment of resection margins during surgery of oral cavity squamous cell cancer (OCSCC) dramatically impacts the prognosis of the patient as well as the need for adjuvant treatment in the future. Currently there is an unmet need to improve OCSCC surgical margins which appear to be involved in around 45% cases. Intraoperative imaging techniques, magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS), have emerged as promising tools in guiding surgical resection, although the number of studies available on this subject is still low. The aim of this diagnostic test accuracy (DTA) review is to investigate the accuracy of intraoperative imaging in the assessment of OCSCC margins. (2) Methods: By using the Cochrane-supported platform Review Manager version 5.4, a systematic search was performed on the online databases MEDLINE-EMBASE-CENTRAL using the keywords "oral cavity cancer, squamous cell carcinoma, tongue cancer, surgical margins, magnetic resonance imaging, intraoperative, intra-oral ultrasound". (3) Results: Ten papers were identified for full-text analysis. The negative predictive value (cutoff < 5 mm) for ioUS ranged from 0.55 to 0.91, that of MRI ranged from 0.5 to 0.91; accuracy analysis performed on four selected studies showed a sensitivity ranging from 0.07 to 0.75 and specificity ranging from 0.81 to 1. Image guidance allowed for a mean improvement in free margin resection of 35%. (4) Conclusions: IoUS shows comparable accuracy to that of ex vivo MRI for the assessment of close and involved surgical margins, and should be preferred as the more affordable and reproducible technique. Both techniques showed higher diagnostic yield if applied to early OCSCC (T1-T2 stages), and when histology is favorable.
(1) 背景：口腔鳞状细胞癌（OCSCC）手术过程中切缘的评估对患者预后以及未来辅助治疗的需求有着重大影响。目前，改善OCSCC手术切缘的需求尚未得到满足，约45%的病例似乎存在切缘受累情况。术中成像技术，如磁共振成像（MRI）和口腔内超声（ioUS），已成为指导手术切除的有前景的工具，尽管关于这一主题的研究数量仍然较少。本诊断试验准确性（DTA）综述的目的是研究术中成像在评估OCSCC切缘方面的准确性。(2) 方法：使用Cochrane支持的平台Review Manager 5.4版本，在在线数据库MEDLINE - EMBASE - CENTRAL上进行系统检索，关键词为“口腔癌、鳞状细胞癌、舌癌、手术切缘、磁共振成像、术中、口腔内超声”。(3) 结果：确定了10篇论文进行全文分析。ioUS的阴性预测值（截断值<5 mm）范围为0.55至0.91，MRI的阴性预测值范围为0.5至0.91；对四项选定研究进行的准确性分析显示，敏感性范围为0.07至0.75，特异性范围为0.81至1。图像引导使切缘阴性切除的平均改善率达到35%。(4) 结论：在评估接近和受累的手术切缘方面，ioUS显示出与离体MRI相当的准确性，并且由于其更经济且可重复，应优先选择。如果应用于早期OCSCC（T1 - T2期）且组织学情况良好，这两种技术都显示出更高的诊断率。
