Intraoperative Ultrasound in Oral Tongue Cancer Resection: Feasibility Study and Early Outcomes

Abstract

The current standard of care in oral tongue cancer surgery is complete resection with a target of 5-mm microscopic clearance at all margins on final pathologic review. While current methods of resection are often successful at determining the mucosal margins of the lesion, they may be limited when attempting to achieve an adequate deep margin. A number of previous studies suggested that ultrasound is superior to manual palpation and other imaging modalities (computed tomography, magnetic resonance imaging) at demarcating the margins of tongue lesions. Recent clinical reports of the intraoperative use of this modality have used an invasive method to mark the proposed deep resection margin. In this communication, we report our initial experience with the use of intraoperative ultrasound as an adjunct to oral tongue cancer surgery without the use of an invasive method to mark the deep resection margin.

Utility of intraoral ultrasound in managing oral tongue squamous cell carcinoma: Systematic review

“…Four cases were successfully performed with this approach, and favorable margin clearance was achieved (>10 mm). In a series of 12 patients, we reported the use of US intraoperatively for deep margin identification and resection without the addition of an invasive method to mark the deep margin, such as with a needle or suture . All but one of the patients with a deep margin of 4 mm achieved a >5 mm distance at the deep margin on final pathological analysis.…”

“…9,10 The utility of US coupled with its widespread availability and the mobility of involved equipment has lead to its recently being reported as an intraoperative tool to assess deep margin location and confirm clearance. [11][12][13] Transcervical US has also been studied as a means of staging oral tongue tumors, [14][15][16] but has not been as widely studied for this purpose as intraoral US, particularly in the last 2 decades.…”

“…Multiple reports have shown that tumor thickness on US correlates well with thickness measures on final histopathology, and that US's ability to determine tumor dimensions surpasses that of other imaging modalities (computed tomography [CT]/magnetic resonance imaging [MRI]) . The utility of US coupled with its widespread availability and the mobility of involved equipment has lead to its recently being reported as an intraoperative tool to assess deep margin location and confirm clearance . Transcervical US has also been studied as a means of staging oral tongue tumors, but has not been as widely studied for this purpose as intraoral US, particularly in the last 2 decades.…”

Magnetic Resonance vs. Intraoral Ultrasonography in the Preoperative Assessment of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

“…In this respect, Iida and coworkers (28) reported a T-shape linear probe fitted with a rubber sheath and filled with water as an ideal tool to preoperatively measure DOI. The aforementioned features, however, allow the surgeon to better delineate the actual three-dimensional extension of the disease, especially considering that intraoral US may be repeated in the operatory room, just before surgery; it also may be used intraoperatively to check the resection margins and even ex vivo on the resected specimen (34,36,49).…”

Highlights from the Current Issue: April 2018

“…In our first paper, Tarabichi and colleagues examine the utility of ultrasound in determining the margins of resection in the surgical treatment of oral tongue cancer. 1 Using ultrasound in a pilot sample of 12 patients, the authors assessed the accuracy of the technique in determining the deep margin of resection, comparing ultrasound guidance with manual palpation and final histopathology. They were able to demonstrate that through the use of ultrasound, they accurately identified the deep margin in all 12 cases.…”