Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

Steens, Stefan C. A.; Bekers, Elise M.; Weijs, W.L.J.; Litjens, Geert; Veltien, Andor; Maat, Arie; Broek, Guido B. van den; Laak, Jeroen van der; Fütterer, Jurgen J.; Kaa, Christina A. Hulsbergen van der; Merkx, Matthias A.W.; Takes, Robert P.

doi:10.1007/s11548-017-1524-6

Cited by 24 publications

(16 citation statements)

References 29 publications

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“…Also, Songra 18 used a metal retractor into the surgical cut, halfway during resection to evaluate the resection margin with US. Other research on this topic focused on ex-vivo evaluation of the resection margins, e.g., by MR. Steens et al, 22 reported in six out of seven patients a resection margin within a 2-mm range of the resection margin reported by histopathology. Both US and MR provide image guidance during surgery, while we aim to use DRS for tissue characterization.…”

Section: Discussionmentioning

confidence: 77%

Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe

et al. 2018

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This ex-vivo study evaluates the feasibility of diffuse reflectance spectroscopy (DRS) for discriminating tumor from healthy tissue, with the aim to develop a technology that can assess resection margins for the presence of tumor cells during oral cavity cancer surgery. Diffuse reflectance spectra were acquired on fresh surgical specimens from 28 patients with oral cavity squamous cell carcinoma. The spectra (400 to 1600 nm) were detected after illuminating tissue with a source fiber at 0.3-, 0.7-, 1.0-, and 2.0-mm distances from a detection fiber, obtaining spectral information from different sampling depths. The spectra were correlated with histopathology. A total of 76 spectra were obtained from tumor tissue and 110 spectra from healthy muscle tissue. The first-and second-order derivatives of the spectra were calculated and a classification algorithm was developed using fivefold cross validation with a linear support vector machine. The best results were obtained by the reflectance measured with a 1-mm source-detector distance (sensitivity, specificity, and accuracy are 89%, 82%, and 86%, respectively). DRS can accurately discriminate tumor from healthy tissue in an ex-vivo setting using a 1-mm source-detector distance. Accurate validation methods are warranted for larger sampling depths to allow for guidance during oral cavity cancer excision.

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Section: Discussionmentioning

confidence: 77%

Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe

et al. 2018

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“…Several authors have pursued similar methods in an effort to provide surgeons with accurate perioperative information on the margin status in tumors other than VSCC. Previously, breast, bone, gastric, esophageal, tongue and prostate specimens have been examined by ex vivo MRI. As far as we are aware, employing ex vivo MRI in RLE specimens is new, but other (imaging) techniques such as FSA and optical coherence tomography (OCT) have been investigated as a means to assess the surgical tumor‐free margins.…”

Section: Discussionmentioning

confidence: 99%

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

et al. 2018

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In the surgical treatment of vulvar squamous‐cell carcinoma (VSCC), tumor‐free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor‐free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor‐free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy‐proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR‐scanner. Whole mount H&E‐stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor‐free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non‐blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty‐four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non‐blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor‐free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.

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“…With an intra-oral coil, the highest sensitivity could be obtained for high-resolution anatomical MRI of the tongue ( 10 ). However, even in ex vivo MRI measurements where artefacts due to motion and field non-uniformity are minimal, surgical margins could not be assessed accurately in the anatomical MR images when compared to whole mount histopathology ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

RF Coil Setup for 31P MRSI in Tongue Cancer in vivo at 7 T

et al. 2021

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Surgery for tongue cancer often results in a major loss in quality of life. While MRI may be used to minimise the volume of excised tissue, often the full tumour extent is missed. This tumour extent may be detected with metabolic imaging. One of the main reasons for the lack of metabolic information on tongue cancer would be the absence of an x-nuclear coil with the tongue as a focus target. Metabolic MRI through 31P MRSI is known as a powerful tool to non-invasively study elevated cell proliferation and disturbed energy metabolism in tumours. Severe magnetic field non-uniformities are inherently caused by the substantial difference in magnetic susceptibilities of tissue and air in the mouth and its environs. Despite this, the wide chemical shift dispersion of 31P could still facilitate precise detection of the cell proliferation biomarkers, phospomonoesters and diesters, as well as energy metabolites ATP, inorganic phosphate, and phosphocreatine potentially mapped over the tongue or tumour in vivo. In this study, we present the first 31P MRSI data of the human tongue in vivo from healthy volunteers and a patient with a tongue tumour at 7 T MRI using a 1H 8-channel transceiver setup placed inside a body 31P transmitter, which is able to get a uniform excitation from the tongue while providing comfortable access to the patient. In addition, a user-friendly external 31P receiver array is used to provide high sensitivity (80%) comparable to an uncomfortable inner mouth loop coil positioned on the tongue. The primary aim is the demonstration of 31P metabolite profiles in the tongue and the differences between healthy and malignant tissue. Indeed, clear elevated cell proliferation expressed as enhanced phosphomonoesters is observed in the tumour vs. the healthy part of the tongue. This can be performed within a total scan duration of 30 min, comparable to clinical scans, with a spatial resolution of 1.5 cm for the 10-min 31P MRSI scan.

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Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

Cited by 24 publications

References 29 publications

Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe

Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

RF Coil Setup for 31P MRSI in Tongue Cancer in vivo at 7 T

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