Is ultrasound a useful adjunct in the management of oral squamous cell carcinoma?

Publication date: Available online 24 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Nicholas Smiley, Yoshimi Anzai, Sarah Foster, Jasjit Dillon

Abstract

Purpose

Among patients with oral squamous cell carcinoma (OSCC), depth of tumor invasion (DOI) is correlated with prognosis. Tumor thickness (TT) is often used as a surrogate measure of DOI. The aim of this study was to estimate TT in a sample of OSCC patients using ultrasound sonography (USS), magnetic resonance imaging (MRI) and clinical assessment and compare these estimates to TT from the final surgical specimen.

Methods

The authors designed and implemented a prospective cohort study and enrolled patients presenting for the management of OSSC. Eligible subjects had biopsy proven OSSC and received clinical assessment, staging MRI, and USS. The predictor variable was measurement technique; clinical assessment, USS, or MRI. The primary outcome variable was maximal TT (cm) obtained from the final histopathological specimen. Appropriate uni- and bivariate statistics were computed.

Results

The sample included ten subjects with a mean age 62.7 + 13.6 years and 70% male. Two of the ten (20%) tumors were not adequately visualized with USS. Three of the ten (30%) tumors were not seen with MRI due to dental artifact. These three patient's tumors were visualized by USS. One of the ten (10%) tumors could not be palpated clinically. Three of the ten (30%) patients did not go to surgery and were treated with chemoradiation given high tumor stage and/or patient's health status. USS, MRI and clinical TT measures when compared to the specimen TT all underestimated, TT, -0.6cm, -0.5cm, and -0.3 cm, respectively (p=0.9).

Conclusion

All three measurement modalities clinical examination, MRI and USS underestimated OSCC TT compared with the final surgical specimen. There were no statistical differences of mean measurement or absolute value mean difference between measurement modalities. Notably, USS was able to visualize the OSCC in all three patients (30%) whose tumors were poorly visualized or not visualized with MRI.

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