An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer

Terada, Hoshino; Sasaki, Eiichi; Suzuki, Hitomi; Nishikawa, Daisuke; Beppu, Shintaro; Hanai, Nobuhiro

doi:10.1080/00016489.2020.1717606

Cited by 13 publications

(17 citation statements)

References 18 publications

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“…In early stage (T1/T2) OSCC, DOI >4 mm had been shown to be associated with a worse outcome, and clinically, it was a strong predictor of occult metastatic neck disease 13–16 . Many studies have been published to discuss this issue although most of these studies had included both T1 and T2 OSCC.…”

Section: Discussionmentioning

confidence: 99%

“…In early stage (T1/T2) OSCC, DOI >4 mm had been shown to be associated with a worse outcome, and clinically, it was a strong predictor of occult metastatic neck disease. 13 , 14 , 15 , 16 Many studies have been published to discuss this issue although most of these studies had included both T1 and T2 OSCC. However, patients with cT1N0 and cT2N0 OSCCs have significantly different risks of local recurrence, neck lymph node metastasis, and different prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Patients of stage I oral cancer with pathologically low‐risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis

Tsai

Huang

Chuang

et al. 2022

Laryngoscope Investig Oto

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Objectives: To evaluate the importance of depth of invasion (DOI) in patients with pathologically low-risk feature stage I oral squamous cell carcinoma (OSCC) managed by primary tumor resection alone.Methods: Patients with stage I OSCC, at pathologically low risk, underwent primary tumor resection without neck dissection were enrolled retrospectively between 2007 and 2015. Low risk was defined as the absence of positive or close margins, lymphovascular invasion, perineural invasion, worst pattern of invasion-5, and poor differentiation in histologic grade. The primary endpoints included overall survival (OS), cancer specific survival (CSS), local recurrence free survival (LRFS), and regional recurrence free survival (RRFS). A nomogram based on the DOI was established for predicting RRFS.Results: A total of 198 patients were enrolled in this study. DOI was the only prognosticator to achieve statistical significance in all primary endpoints according to univariate analysis. Patients with DOI <3 mm tumor showed better five-year OS, CSS, LRFS, and RRFS than those with DOI ≥3 mm tumor. The concordance index of the nomogram model without DOI was 0.684, which could increase to 0.733 when DOI was included in the calculation. Conclusion:Patients with pathologically low-risk stage I OSCC correlate with a higher chance in occult neck metastasis if increasing DOI (≥3 mm) is noticed. Indeed, the chance of occult neck metastasis is significantly higher in this group (14% vs. 2%) than in those with DOI <3 mm. Elective neck dissection is advised if DOI is ≥3 mm to achieve better clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patients of stage I oral cancer with pathologically low‐risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis

Tsai

Huang

Chuang

et al. 2022

Laryngoscope Investig Oto

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“…Since MRI is less susceptible to metal artifacts, it is expected to be superior to CT for DOI measurement. The accuracy varies across reports, with some suggesting it was almost consistent with the histopathological DOI [ 26 ] or overestimated by about 2 mm [ 21 , 24 , 28 ]. In this study, an overestimation of about 2–3 mm was observed overall.…”

Section: Discussionmentioning

confidence: 99%

“…Although the UICC and AJCC state that ultrasonography is not suitable for the evaluation of primary lesions [9], some studies have evaluated primary lesions with intraoral ultrasonography (US) and have shown a strong correlation with histopathological thickness or DOI [10][11][12][13]. To date, several reports have been made on CT, MRI, and US preoperative radiological DOI evaluations, but there is no report of a study where these were all performed in a single institution [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Therefore, this study was aimed to investigate the accuracy of preoperative radiological DOI measurement with CT, MRI, and US in the same target group based on histopathologically measured DOI for T1 and T2 tongue cancers, where a diagnosis of DOI around 5 mm is an important diagnostic finding and examine the effectiveness of each imaging modalities with retrospective approach.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…Occult LN metastasis is estimated to be present in 23.9%-26.4% of clinical stage I/II oral cancer. 8 , 9 Efforts, therefore, are being made to detect indicators that can predict LN metastasis. Tumor thickness (TT), depth of invasion (DOI), and ultrasound (US) with/without US-guided fine needle aspiration (FNA) are parameters that have been studied for the prediction of nodal metastasis and correlate with locoregional recurrence.…”

Section: Introductionmentioning

confidence: 99%

The Applications and Potential Developments of Ultrasound in Oral Cancer Management

Chang

Cheng

et al. 2022

Technol Cancer Res Treat

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Oral cancer is endemic and causes a great burden in Southern Asia. It is preferably treated by surgery with/without adjuvant radiotherapy (RT) or chemoradiation therapy, depending on the stage of the disease. Close or positive resection margin and cervical lymph node (LN) metastasis are important prognostic factors that have been presented to be related to undesirable locoregional recurrence and poor survival. Ultrasound (US) is a simple, noninvasive, time-saving, and inexpensive diagnostic modality. It can depict soft tissues very clearly without the risk of radiation exposure. Additionally, it is real-time and continuous image is demonstrated during the exam. Furthermore, the clinician can perform US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at the same time. US with/without US-guided FNA/CNB is reported to be of value in determining tumor thickness (TT), depth of invasion (DOI), and cervical LN metastasis, and in aiding the staging of oral cancer. DOI has a relevant prognostic value as reported in the eighth edition of the American Joint Committee on Cancer staging of oral cancer. In the present review, we describe the clinical applications of US in oral cancer management in different phases and potential applications in the future. In the pretreatment and surgical phase, US can be used to evaluate TT/DOI and surgical margins of oral cancer in vivo and ex vivo. The prediction of a malignant cervical LN (nodal metastasis) by the US-based prediction model can guide the necessity of FNA/CNB and elective neck dissection in clinical early-stage oral cancer. In the posttreatment surveillance phase, US with/without US-guided FNA or CNB is helpful in the detection of nodal persistence or LN recurrence, and can assess the possibility and extent of carotid artery stenosis after irradiation therapy. Both US elastography and US swallowing assessment are potentially helpful to the management of oral cancer.

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An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer

Cited by 13 publications

References 18 publications

Patients of stage I oral cancer with pathologically low‐risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis

Patients of stage I oral cancer with pathologically low‐risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis

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

The Applications and Potential Developments of Ultrasound in Oral Cancer Management

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