Preoperative ultrasonography for tumor thickness evaluation in guiding management in patients with early oral tongue squamous cell carcinoma

Anirudh V. Nair; M. Meera; Bindhu M. Rajamma; Soumya Anirudh; P. K. Nazer; P. V. Ramachandran

doi:10.4103/ijri.IJRI_151_17

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(02): 140-145
DOI: 10.4103/ijri.IJRI_151_17

Neuroradiology & Head and Neck Imaging

Preoperative ultrasonography for tumor thickness evaluation in guiding management in patients with early oral tongue squamous cell carcinoma

Authors

Anirudh V. Nair

Department of Radiodiagnosis, Kerala Institute of Medical Science, Trivandrum
M. Meera

Departments of Oral and Maxillofacial Surgery, Kochi
Bindhu M. Rajamma

Pathology Amrita Institute of Medical Science, Kochi
Soumya Anirudh

Department of Pathology, Govt. Medical College Hospital, Trivandrum, Kerala, India
P. K. Nazer

Radiology Amrita Institute of Medical Science, Kochi
P. V. Ramachandran

Radiology Amrita Institute of Medical Science, Kochi

Subject Editor:

Abstract

Objectives: (1) To assess the statistical correlation between the tumor thickness (TT) by ultrasonography (USG) and microscopic measurement in cases of early oral tongue squamous cell carcinoma (OTSCC). (2) To assess the predictive capacity of TT by ultrasound in detecting nodal metastasis. Materials and Methods: Prospective analysis was performed in 24 patients for a period of 2 years from 2012 to 2013. Nodal status and TT measurement was done preoperatively by neck and intraoral USG respectively in cases of early (pT1 & T2, clinically N0) OTSCC. As per the institution protocol after histopathological confirmation of malignancy, all patients underwent resection of primary lesion and ipsilateral elective neck dissection (Level - I to IV). Measurement of TT was obtained intraoperatively from fresh glossectomy specimen and postoperatively from histopathological paraffin section examination. The statistical correlation between TT measured by USG and histopathology was assessed by Pearson’s correlation coefficient. Chi-square test was used to find the association of pathological T stage, TT with pathological nodal status. Results: Significant statistical correlation was seen between TT by USG and microscopic measures. Between the two, TT measurements were within 1 mm in 37.5% (9/24) of cases, within 2 mm in 29.16% (7/24), and was greater than 2 mm in 8 cases. The Pearson’s correlation r is 0.678 (P < 0.001) and ICC (interclass correlation coefficient) is 0.808. The average difference between microscopic and US thickness (Bias) is -0.14637 and the limits of agreement is (4.717, -4.863) with 95% limits of agreement. The rate of occult nodal metastasis was 16.6% and TT of <4 mm had no incidence of nodal metastasis. Conclusion: Ultrasonographic evaluation is reliable and cost-effective tool to measure the TT preoperatively, which will be of help in deciding the management in early OTSCC. TT of 4 mm and above was predictor of occult cervical nodal metastasis.

Keywords

Ultrasound tongue - oral tongue cancer - squamous cell cancer

Full Text

References

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