Depth of Invasion in Carcinoma Tongue: Evaluation of Clinical and Imaging Techniques

Abstract

Background“Depth of invasion” is an additional index incorporated in 8th AJCC staging system for oral cavity squamous cell carcinoma based on its prognostic significance. Pre‐operative assessment by clinical palpation and imaging modalities has been used with limitations. The aim of the study is to compare different techniques including clinical palpation, ultrasound, and magnetic resonance imaging with histopathology for assessment of depth of tumor invasion.MaterialsFifty patients of carcinoma tongue (T1–T3) were enrolled. Clinical palpation, Ultrasound tongue, and Magnetic resonance imaging were used to assess depth of tumor invasion. Microscopic depth of invasion was considered as reference. Statistical analysis was done to assess the level of agreement, reliability, and internal consistency. ROC analysis was done to find the “Area Under Curve” for microscopic depth versus ultrasound, MRI, and gross histopathological “depth of invasion”.ResultsUltrasound tongue showed highest “area under curve”, Intra class correlation (ICC:0.786) with a good consistency (Cronbach's Alpha:0.880) with histological reference compared to MRI(ICC:0.689;CA:0.816). Clinical palpation showed weak agreement (Kappa:0.43) for assessing depth. To observe the concordance between ultrasound and microscopic depth, Lin's Concordance Correlation Coefficient (CCC = 0.782) was calculated with 95% limits of agreement. Lin's concordance correlation between ultrasound and microscopic depth showed a good agreement.ConclusionsUltrasound tongue is a reliable imaging modality for pre‐operative T staging by assessing tumor “depth of invasion” in carcinoma tongue patients with good internal consistency as per 8th AJCC staging system.Level of EvidenceLevel 2 (CEBM‐Level of Evidence‐2.1) Laryngoscope, 2023

The Reliability of Ultrasonographic Assessment of Depth of Invasion: A Systematic Review with Meta-Analysis

“…Full text analysis was performed on the remaining 33 articles, and 17 articles were further excluded. The final review included 16 articles [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], which all met the criteria for inclusion in the meta-analysis (Figure 1).…”

“…The study population consisted of 729 patients, with a mean age of 61.82 ± 5.56 years. Information on gender distribution was available for 14 out of 16 articles [13,[15][16][17][18][19][20][21][22][23][24][25][26]28], accounting for a population of 696 patients, 420 males and 276 females.…”

“…In 12 studies [13][14][15]17,19,20,[22][23][24][25][26]28], the AJCC/UICC classification was employed for tumor staging, while two studies did not report the classification system employed.…”

“…In 13 studies [13,[15][16][17][20][21][22][23][24][25][26][27][28], ultrasonography was performed preoperatively. The frequencies employed ranged between a minimum of 5 and a maximum of 70 MHz (Table 1).…”

Efficacy of Computed Tomography and Magnetic Resonance Imaging in the Assessment of Depth of Invasion in Oral Squamous Cell Carcinoma: Analysis of 125 Clinical Cases

“…Cases of extensive OSCC are particularly demanding when the possibility of radicality is determined based on imaging studies alone. A presurgical DOI assessment may include standard tests such as MRI or CT [10][11][12]. Intraoral ultrasound (US) is a useful and accurate method of DOI assessment [13], but its use is limited to locations allowing free access to the ultrasound head [14].…”