A comparative study between CT, MRI, and intraoral US for the evaluation of the depth of invasion in early stage (T1/T2) tongue squamous cell carcinoma

Abstract

Objectives This study aimed to clarify the accuracy of intraoral ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in preoperative image depth of invasion (DOI) measurement of T1/T2 tongue cancer through comparison with histopathological measurements. Methods Imaging of the primary lesions was performed at our hospital; the lesions were classified into T1 and T2 based on the 8th edition of the AJCC/UICC, and surgery performed. There was histopathological confirmation of lesions as squamous cell carcinoma in 48 patients with tongue cancer. T3 and T4 cases, cases in which preoperative chemotherapy and radiation therapy were performed, and cases where biopsy was performed before imaging were excluded. The radiological DOI in US, CT, and MRI and the histopathological DOI as base were comparatively investigated and statistical analyses were performed by Bland–Altman analysis and Spearman's rank correlation coefficient. Results Bland–Altman analysis showed that the US radiological DOI was overestimated by an average of 0.2 mm compared to the histopathological DOI, while CT and MRI radiological DOI were overestimated by an average of 2–3 mm. The comparison of CT and MRI revealed that the difference between the MRI and histopathological DOI, as well as the 95% limit of agreement, were smaller than those of the CT radiological DOI. Conclusions US is the most accurate preoperative diagnostic tool for T1 and T2 squamous cell carcinoma; CT and MRI tend to have an overestimation of about 2–3 mm and so caution is required.

Neck Management in cT1N0 Tongue Squamous Cell Carcinoma as Determined by Sonographic Depth of Invasion

“…Sonographic DOI was defined as the vertical distance between the deepest part of the tumor and the virtual line connecting the normal mucosal basal portion adjacent to the tumor ( 17 ). Before evaluation, all patients were required to rinse the mouth.…”

“…Takamura et al. ( 17 ) reported that compared to pathologic DOI, clinical DOI derived by ultrasound was overestimated by an average of 0.2 mm, while CT and MRI-based radiological DOIs were overestimated by an average of 2–3 mm. These findings, combined with the reports of Klein et al.…”

“…Intraoral ultrasound, CT, and MRI are used to evaluate clinical DOI (17,18). Takamura et al (17) reported that compared to pathologic DOI, clinical DOI derived by ultrasound was overestimated by an average of 0.2 mm, while CT and MRI-based radiological DOIs were overestimated by an average of 2-3 mm.…”

“…Intraoral ultrasound, CT, and MRI are used to evaluate clinical DOI (17,18). Takamura et al (17) reported that compared to pathologic DOI, clinical DOI derived by ultrasound was overestimated by an average of 0.2 mm, while CT and MRI-based radiological DOIs were overestimated by an average of 2-3 mm. These findings, combined with the reports of Klein et al (19) and Marchi et al (20), highlight the accuracy of ultrasound in determining the clinical DOI.…”

Ultrasound accurately assesses depth of invasion in T1‐T2 oral tongue cancer

“… 15 , 18 , 19 There are also some recent US studies assessing DOI reporting promising results. 20 , 21 , 22 Moreover there are several optical methods used in oral cancer to assist in the diagnosis of mucosal lesions, such as optical coherence tomography, even though the depth limit of 1.5–2.0 mm makes it less useful for assessing DOI. 23 , 24…”