Voizard Béatrice, Dayan Gabriel S, Gologan Olguta-Ecaterina, Ayad Tareck, Bissada Eric, Guertin Louis, Tabet Paul, Cardin Guillaume B, Létourneau-Guillon Laurent, Christopoulos Apostolos
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, QC, Canada.
Division of Otolaryngology - Head and Neck Surgery, Center Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251321452. doi: 10.1177/19160216251321452. Epub 2025 Apr 1.
ImportanceThe inclusion of depth of invasion (DOI) in the American Joint Committee on Cancer's staging system for oral tongue squamous cell carcinoma (OTSCC) has major clinical implications. Few studies have evaluated the accuracy of preoperative biopsy to predict DOI.ObjectiveTo evaluate the reliability of preoperative punch biopsy for measuring DOI in early OTSCC and compare it to evaluation by digital palpation. Secondarily, to assess the punch biopsy's ability to differentiate between carcinoma in situ (Tis) and invasive carcinoma.DesignA prospective single-center cohort study.SettingCenter Hospitalier de l'Université de Montréal, a tertiary center in Canada.ParticipantsPatients with suspected early stage OTSCC.InterventionPunch biopsy was used to sample the deepest part of tumors to measure biopsy-derived DOI (bDOI). In addition, DOI was estimated via digital palpation: clinical DOI (cDOI) by surgeons.Main Outcome MeasuresPathologic DOI (pDOI) from final histopathology reports was the gold standard. Spearman's correlations were calculated between cDOI, bDOI, and pDOI. Diagnostic performance metrics were calculated for the ability to distinguish pDOI of ≥2 mm, and to differentiate Tis from invasive carcinoma.ResultsAmong 27 patients, correlation coefficients between bDOI and pDOI, and cDOI and pDOI were 0.603 (95% CI: 0.202-0.884) and 0.894 (95% CI: 0.749-0.955), respectively. Punch biopsy sensitivity and specificity were 0.88 (95% CI: 0.62-0.98) and 0.91 (95% CI: 0.59-0.99) to detect pDOI ≥ 2 mm, and 0.89 (95% CI: 0.65-0.99) and 0.86 (95% CI: 0.42-1.00) for distinguishing Tis from invasive carcinoma. Digital palpation sensitivity and specificity for pDOI ≥ 2 mm were 0.86 (95% CI: 0.57-0.98) and 1.00 (95% CI: 0.63-1.00).ConclusionsPunch biopsy and clinical palpation demonstrate high diagnostic yield for identifying lesions with pDOI ≥ 2 mm. Punch biopsy appears to be reliable to distinguish Tis from invasive carcinoma.RelevanceLarger studies are needed to corroborate these findings and assess the role of punch biopsy in guiding elective neck dissection decisions.
重要性
美国癌症联合委员会口腔舌鳞状细胞癌（OTSCC）分期系统纳入浸润深度（DOI）具有重大临床意义。很少有研究评估术前活检预测DOI的准确性。
目的
评估术前穿刺活检测量早期OTSCC中DOI的可靠性，并将其与数字触诊评估进行比较。其次，评估穿刺活检区分原位癌（Tis）和浸润性癌的能力。
设计
一项前瞻性单中心队列研究。
地点
加拿大三级中心蒙特利尔大学中心医院。
参与者
疑似早期OTSCC患者。
干预
采用穿刺活检对肿瘤最深部位进行取样，以测量活检得出的DOI（bDOI）。此外，通过数字触诊估计DOI：由外科医生评估临床DOI（cDOI）。
主要结局指标
最终组织病理学报告中的病理DOI（pDOI）为金标准。计算cDOI、bDOI和pDOI之间的Spearman相关性。计算区分pDOI≥2mm以及区分Tis与浸润性癌能力的诊断性能指标。
结果
27例患者中，bDOI与pDOI、cDOI与pDOI之间的相关系数分别为0.603（95%CI：0.202 - 0.884）和0.894（95%CI：0.749 - 0.955）。穿刺活检检测pDOI≥2mm的敏感性和特异性分别为0.88（95%CI：0.62 - 0.98）和0.91（95%CI：0.59 - 0.99），区分Tis与浸润性癌的敏感性和特异性分别为0.89（95%CI：0.65 - 0.99）和0.86（95%CI：0.42 - 1.00）。数字触诊检测pDOI≥2mm的敏感性和特异性分别为0.86（95%CI：0.57 - 0.98）和1.00（95%CI：0.63 - 1.00）。
结论
穿刺活检和临床触诊在识别pDOI≥2mm的病变方面显示出高诊断率。穿刺活检在区分Tis与浸润性癌方面似乎是可靠的。
相关性
需要更大规模的研究来证实这些发现，并评估穿刺活检在指导选择性颈清扫决策中的作用。
