Radiological approach for the newly incorporated T staging factor, depth of invasion (DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection

Baba, Akira; Hashimoto, Kazuhiko; Kayama, Reina; Yamauchi, Hideomi; Ikeda, Koshi; Ojiri, Hiroya

doi:10.1007/s11604-020-00982-w

Cited by 31 publications

(17 citation statements)

References 25 publications

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“…2, 3b). These results are consistent with recent literature regarding ceMRI [13,20], probably due to [ 18 F]FDG accumulation in peritumoral inflammation, spill-over effects on PET images under limited resolution, and high signal intensity on T2-weighted images of the peritumoral edema. They suggest the need for T staging using T1-weighted MR images, especially in OTC patients with a shallow DOI of around 5 mm or less [6].…”

Section: Discussionsupporting

confidence: 93%

“…The radiological DOI was defined as the vertical distance between the deepest point of tumor infiltration and the simulated normal mucosal junction. According to the pathological DOI defined in the 8th edition of the AJCC cancer staging system, the part above the mucosal surface was neglected for exogenous tumors, and the invaginated part was added for ulcerative tumors [12,13]. The radiological size and DOI were independently evaluated by two board-certificated radiologists/nuclear medicine physicians, and then consensus was reached by joint review and discussion.…”

Section: Image Interpretationmentioning

confidence: 99%

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Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer

et al. 2020

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Objective Integrated PET/MRI with [ 18 F]FDG is advantageous in that it enables simultaneous PET and MR imaging with higher soft-tissue contrast, multiplanar image acquisition, and functional imaging capability without using fat suppression and gadolinium-based contrast agents (GBCAs). The aims of this study were to demonstrate the feasibility of [ 18 F]FDG PET/ MRI for assessing the extent of the primary tumor (T) in oral tongue cancer (OTC) based on the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system, and to compare the diagnostic accuracy between [ 18 F]FDG PET/ MRI and contrast-enhanced MRI (ceMRI). Methods 18 patients with biopsy-proven operable OTC underwent preoperative regional [ 18 F]FDG PET/MRI and ceMRI within 2 weeks. For [ 18 F]FDG PET/MRI, rainbow-colored PET images were overlaid on the corresponding MR images. Tumor size and the depth of invasion (DOI) were visually measured on [ 18 F]FDG PET/MRI and ceMRI. The size, DOI, and clinical T stage were evaluated using the final surgical pathology as the reference. Results Of the 18 OTCs, one was not detected by ceMRI due to metal artifacts from an artificial denture, and another due to superficial type (pathological DOI = 0 mm). Tumor sizes measured by ceMRI and [ 18 F]FDG PET/MRI had significant positive correlations with the pathological size (r = 0.80 and r = 0.90, respectively), and DOIs measured by ceMRI and [ 18 F] FDG PET/MRI had significant positive correlations with the pathological DOI (r = 0.74 and r = 0.64, respectively). The means ± SD of size (mm) were 20.4 ± 9.1, 22.9 ± 10.9, and 26.2 ± 10.0, and those of DOI (mm) were 7.1 ± 2.5, 6.9 ± 2.2, and 5.8 ± 3.2 for ceMRI, [ 18 F]FDG PET/MRI, and pathology, respectively. A significant difference was observed in tumor size between ceMRI and pathology (p < 0.05), whereas no significant differences were observed between any other sizes, DOIs, or T stages. The accuracy for T status was 72% (13/18 including 2 undetectable cases) for ceMRI and 89% (16/18) for [ 18 F]FDG PET/MRI. Conclusions Although shallow DOIs are often overestimated, regional [ 18 F]FDG PET/MRI without fat suppression and gadolinium enhancement is comparable to and may be substituted for ceMRI in preoperative T staging for OTC patients, reducing metal artifacts and avoiding the adverse effects of GBCAs. Keywords PET/MRI • Oral tongue cancer • DOI • T staging Abbreviations PET Positron emission tomography MRI Magnetic resonance imaging [ 18 F]FDG 2-[ 18 F]-Fluoro-2-deoxy-d-glucose GBCAs Gadolinium-based contrast agents ceMRI Contrast-enhanced MRI CT Computed tomography AJCC American Joint Committee on Cancer OCC Oral cavity cancer OTC Oral tongue cancer DOI Depth of invasion T The extent of the primary tumor * Tetsuya Tsujikawa

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Section: Discussionsupporting

confidence: 93%

Section: Image Interpretationmentioning

confidence: 99%

Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer

et al. 2020

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“…We used MRI for cases with p-DOI > 3 mm, because 3 mm is an MRI cutoff value of detectable lesions. Similarly, Baba et al reported that the cutoff value of p-DOI for detectable lesion on MRI was 4 mm 25 . Therefore, the detection limit of p-DOI on the MRI is likely 3–4 mm.…”

Section: Discussionmentioning

confidence: 86%

MRI before biopsy correlates with depth of invasion corrected for shrinkage rate of the histopathological specimen in tongue carcinoma

Harada

Tomioka

Hirai

et al. 2021

Sci Rep

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The purpose of this study was to evaluate which radiological depth of invasion (r-DOI) measurement is the most concordant to clinical DOI (c-DOI) derived from correction for the shrinkage rate of the histopathological specimens. We retrospectively reviewed 128 patients with tongue carcinoma who had undergone glossectomy between 2006 and 2019. At first, the width shrinkage rate during formalin fixation and preparation process of histopathological specimens was evaluated. From the shrinking rates, a formula to calculate c-DOI from pathological DOI (p-DOI) was developed. The correlation between c-DOI and r-DOI was evaluated. The specimen shrinkage rate during the histopathological specimen preparation process was 10.3%. Based on that, we yielded the correct formula for c-DOI based on p-DOI and preparation shrinkage rate: c-DOI = p-DOI × 100/89.7. The regression equations for the association of c-DOI with r-DOI measured by ultrasound (n = 128), MRI before biopsy (n = 18), and MRI after biopsy (n = 110) were y = 1.12 * x + 0.21, y = 0.89 * x − 0.26, and y = 0.52 * x + 2.63, respectively, while the coefficients of determination were 0.664, 0.891, and 0.422, respectively. In conclusion, r-DOI using MRI before biopsy most strongly correlated with c-DOI.

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“…Third, we did not consider the shrinkage factor of fixation when comparing radiological/pathological measurements. It is well-established that the radiological DOI is larger than the pathological DOI because specimens shrink when fixed or if inflammation occurs [1,5,[31][32][33][34]. Furthermore, tumor sizes may change between CT, MRI, and surgery.…”

Section: Discussionmentioning

confidence: 99%

Subtraction iodine imaging with area detector CT to improve tumor delineation and measurability of tumor size and depth of invasion in tongue squamous cell carcinoma

et al. 2021

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Purpose Tumor size and depth of invasion (DOI) are mandatory assessments for tumor classification in tongue cancer but are often non-assessable on CT due to dental artifacts. This study investigated whether subtraction iodine imaging (SII) would improve tumor delineation and measurability. Materials and methods Fifty-seven consecutive patients with tongue cancer, who underwent scanning with a 320-row area detector CT with contrast administration and were treated with surgical resection, were retrospectively evaluated. CT was reconstructed with single-energy projection-based metallic artifact reduction (sCT). SII was generated by subtracting the pre-contrast volume scans from the post-contrast volume scans using a high-resolution deformable registration algorithm. MRI scans were also evaluated for comparing the ability of measurements. Two radiologists visually graded the tumor delineation using a 5-point scale. Tumor size and DOI were measured wherever possible. The tumor delineation score was compared using the Wilcoxon signed-rank method. Spearman’s correlations between imaging and pathological measurements were calculated. Intraclass correlation coefficients of measurements between readers were estimated. Results The tumor delineation score was greater on sCT-plus-SII than on sCT alone (medians: 3 and 1, respectively; p < 0.001), with higher number of detectable cases observed with sCT-plus-SII (36/57 [63.2%]) than sCT alone (21/57 [36.8%]). Tumor size and DOI measurability were higher with sCT-plus-SII (29/57 [50.9%]) than with sCT alone (17/57 [29.8%]). MRI had the highest detectability (52/57 [91.2%]) and measurability (46/57 [80.7%]). Correlation coefficients between radiological and pathological tumor size and DOI were similar for sCT (0.83–0.88), sCT-plus-SII (0.78–0.84), and MRI (0.78–0.90). Intraclass correlation coefficients were higher than 0.95 for each modality. Conclusions SII improves detectability and measurability of tumor size and DOI in patients with oral tongue squamous cell carcinoma, thus increasing the diagnostic potential. SII may also be beneficial for cases unevaluable on MRI due to artifacts or for patients with contraindications to MRI.

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Radiological approach for the newly incorporated T staging factor, depth of invasion (DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection

Cited by 31 publications

References 25 publications

Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer

Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer

MRI before biopsy correlates with depth of invasion corrected for shrinkage rate of the histopathological specimen in tongue carcinoma

Subtraction iodine imaging with area detector CT to improve tumor delineation and measurability of tumor size and depth of invasion in tongue squamous cell carcinoma

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