Clinical Paper Head and Neck Oncology| Volume 50, ISSUE 8, P981-988, August 2021

Do we have a robust method for preoperative tumour depth assessment for oral cavity tumours with clinically negative necks?

Published:December 24, 2020DOI:


      Tumour depth is an important prognostic factor in head and neck cancer and has recently been included in the eighth edition of the Union for International Cancer Control TNM classification of malignant tumours for oral squamous cell carcinoma (OSCC). It is important to appraise the accuracy of depth assessments; however, there is little current evidence in the literature. Accurate depth assessment is particularly pertinent in cT1–T2N0 OSCC where it may influence neck management. A retrospective study was performed at two tertiary referral centres, in which surgically treated patients with cT1–T4N0 OSCC were audited. Preoperative tumour depth assessments from multimodality radiological staging scans were compared with the final histopathological depth. The predictive accuracy of intraoral ultrasound (IOUS), computed tomography (CT), and magnetic resonance imaging (MRI) for tumour depth was evaluated. Accuracy to within 3 mm of the histopathological depth was seen in 56.7% of MRI scans and 57.1% of CT scans. IOUS appeared to have superior prediction, with 78.2% of measurements within 3 mm. Over one third of CT and MRI imaging failed to detect a lesion; IOUS scans detected the lesions in all of these case. In conclusion, the reliability of preoperative imaging assessment of tumour depth should be considered when recommending treatment.

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        • Brierley J.D.
        • Gospodarowicz M.K.
        • Wittekind C.
        The TNM classification of malignant tumours.
        eighth edition. Union for International Cancer Control, 2016
        • British Association of Head and Neck Oncologists
        BAHNO standards.
        BAHNO, London2009
        • International Consortium for Outcome Research (ICOR) in Head and Neck Cancer
        • Ebrahimi A.
        • Gil Z.
        • Amit M.
        • Yen T.C.
        • Liao C.T.
        • Chaturvedi P.
        • Agarwal J.P.
        • Kowalski L.P.
        • Kreppel M.
        • Cernea C.R.
        • Brandao J.
        • Bachar G.
        • Bolzoni Villaret A.
        • Fliss D.
        • Fridman E.
        • Robbins K.T.
        • Shah J.P.
        • Patel S.G.
        • Clark J.R.
        Primary tumour staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study.
        JAMA Otolaryngol Head Neck Surg. 2014; 140: 1138-1148
        • Yuen A.P.
        • Lam K.Y.
        • Wei W.I.
        • Lam K.Y.
        • Ho C.M.
        • Chow T.L.
        • Yuen W.F.
        A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma.
        Head Neck. 2002; 24: 513-520
        • de Matos L.L.
        • Manfro G.
        • Santos R.V.
        • Stabenow E.
        • Mello E.S.
        • Alves V.A.
        • Pinto F.R.
        • Kulcsar M.A.
        • Brandão L.G.
        • Cernea C.R.
        Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue.
        Oral Surg Oral Med Oral Pathol. 2014; 118: 209-217
        • D’Cruz A.K.
        • Vaish R.
        • Kapre N.
        • Dandekar M.
        • Gupta S.
        • Hawaldar R.
        • Agarwal J.P.
        • Pantvaidya G.
        • Chaukar D.
        • Deshmukh A.
        • Kane S.
        • Arya S.
        • Ghosh-Laskar S.
        • Chaturvedi P.
        • Pai P.
        • Nair S.
        • Nair D.
        • Badwe R.
        Elective versus therapeutic neck dissection in node-negative oral cancer.
        N Engl J Med. 2015; 373: 521-529
      1. National Cancer Institute. Lip and oral cavity cancer treatment (adult) (PDQ). PDQ Cancer Information Summaries [Internet]. NCBI Bookshelf, 2018. [Accessibility verified October 19, 2020].

        • Huang S.H.
        • Hwang D.
        • Lockwood G.
        • Goldstein D.P.
        • O’Sullivan B.
        Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity.
        Cancer. 2009; 115: 1489-1497
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology (NCCN guidelines)—head and neck cancers.
        NCCN, Pennsylvania, USA2019
        • National Institute for Health and Care Excellence
        Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (NG36).
        National Collaborating Centre for Cancer, London, UK2016
        • Lam P.
        • Au-Yeung K.M.
        • Cheng P.W.
        • Wei W.I.
        • Yuen A.P.
        • Trendell-Smith N.
        • Li J.H.
        • Li R.
        Correlating MRI and histologic tumor thickness in the assessment of oral tongue cancer.
        AJR Am J Roentgenol. 2004; 182: 803-808
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2019
        • Shah A.
        Postoperative pathologic assessment of surgical margins in oral cancer: a contemporary review.
        J Oral Maxillofac Pathol. 2018; 22: 78-85
        • Hutchison I.L.
        • Ridout F.
        • Cheung S.M.Y.
        • Shah N.
        • Hardee P.
        • Surwald C.
        • Thiruchelvam J.
        • Cheng L.
        • Mellor T.K.
        • Brennan P.A.
        • Baldwin A.J.
        • Shaw R.J.
        • Halfpenny W.
        • Danford M.
        • Whitley S.
        • Smith G.
        • Bailey M.W.
        • Woodwards B.
        • Patel M.
        • McManners J.
        • Chan C.H.
        • Burns A.
        • Praveen P.
        • Camilleri A.C.
        • Avery C.
        • Putnam G.
        • Jones K.
        • Webster K.
        • Smith W.P.
        • Edge C.
        • McVicar I.
        • Grew N.
        • Hislop S.
        • Kalavrezos N.
        • Martin I.C.
        • Hackshaw A.
        Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort.
        Br J Cancer. 2019; 121: 827-836
        • Shintani S.
        • Yoshihama Y.
        • Ueyama Y.
        • Terakado N.
        • Kamei S.
        • Fijimoto Y.
        • Hasegawa Y.
        • Matsuura H.
        • Matsumura T.
        The usefulness of intraoral ultrasonography in the evaluation of oral cancer.
        Int J Oral Maxillofac Surg. 2001; 30: 139-143
        • Yuen A.P.W.
        • Ng R.W.M.
        • Lam P.K.Y.
        • Ho A.
        Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography.
        Head Neck. 2008; 30: 230-234
        • Lwin C.T.
        • Hanlon R.
        • Lowe D.
        • Brown J.S.
        • Woolgar J.A.
        • Triantafyllou A.
        • Rogers S.N.
        • Bekiroglu F.
        • Lewis-Jones H.
        • Wieshmann H.
        • Shaw R.J.
        Accuracy of MRI in prediction of tumour thickness and nodal stage in oral squamous cell carcinoma.
        Oral Oncol. 2012; 48: 149-154
        • Alsaffar H.A.
        • Goldstein D.P.
        • King E.V.
        • de Almeida J.R.
        • Brown D.H.
        • Gilbert R.W.
        • Gullane P.J.
        • Espin-Garcia O.
        • Xu W.
        • Irish J.C.
        Correlation between clinical and MRI assessment of depth of invasion in oral tongue squamous cell carcinoma.
        J Otolaryngol Head Neck Surg. 2016; 45: 61
        • Goel V.
        • Parihar P.S.
        • Parihar A.
        • Goel A.K.
        • Waghwani K.
        • Gupta R.
        • Bhutekar U.
        Accuracy of MRI in prediction of tumour thickness and nodal stage in oral tongue and gingivobuccal cancer with clinical correlation and staging.
        J Clin Diagn Res. 2016; 10 (TC01–TC05)
        • Fujimoto J.G.
        • Pitris C.
        • Boppart S.A.
        • Brezinski M.E.
        Optical coherence tomography: an emerging technology for biomedical imaging and optical biopsy.
        Neoplasia. 2000; 2: 9-25
        • Gentile E.
        • Maio C.
        • Romano A.
        • Laino L.
        • Lucchese A.
        The potential role of in vivo optical coherence tomography for evaluating oral soft tissue: a systematic review.
        J Oral Pathol Med. 2017; 46: 864-876