Ultrasonography for Intraoperative Determination of Tumor Thickness and Resection Margin in Tongue Carcinomas
Ultrasonography for Intraoperative Determination of Tumor Thickness and Resection Margin in Tongue Carcinomas
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DOI：
10.1016/j.joms.2009.07.110
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发表时间：
2010-08-01
影响因子：
1.9
通讯作者：
Tominaga, Kazuhiro
中科院分区：
文献类型：
--
作者：
Kodama, Masaaki;Khanal, Amit;Tominaga, Kazuhiro
目的：准确估计舌癌的肿瘤厚度和切缘状态是影响局部复发、亚临床淋巴结转移和生存率的重要预后因素。本研究旨在评估口腔内超声引导下测量肿瘤厚度的准确性，并确定舌鳞状细胞癌术中适当的切缘。材料与方法：在这项前瞻性研究中，13例术前活检证实，临床T1 N 0或T2 N 0舌鳞状细胞癌行部分舌切除术，术前超声检查，以评估肿瘤全身麻醉下的厚度。9例采用传统方法切除，而我们在其余4例中引入了带金属芯的弹性针，在超声监测下从最深肿瘤浸润前沿标记10 mm深的手术切缘，作为一种新技术。将每个切除的标本立即浸入明胶溶液中，同时保持其原始形状和方向，并置于冷藏条件下固化。明胶包埋标本的超声观察从明胶块的上级表面进行。结果：切除标本的非常精细的超声图像可以很容易地获得，无需任何特殊技能，手术间隙可以在术中验证。超声测量肿瘤厚度与组织切片结果符合率为91.4%~ 98.2%（Pearson相关系数= 0.981，P <0.05）。结论：术中超声是客观评价肿瘤厚度和手术切缘清除的可靠方法。(C)2010年美国口腔颌面外科医师协会J Oral Maxillofac Surg 68：1746-1752，2010
Purpose: Exact estimation of tumor thickness and the status of the resection margin in tongue carcinoma are important prognostic factors for local recurrence, subclinical nodal metastasis, and survival. This study aims to evaluate the accuracy of intraoral ultrasonography-guided measurement of tumor thickness and define an adequate intraoperative resection margin in squamous cell carcinomas of the tongue.Materials and Methods: In this prospective study, 13 patients with presurgical, biopsy-proven, clinical T1N0 or T2N0 tongue squamous cell carcinomas who underwent a partial glossectomy were examined preoperatively with ultrasonography to assess tumor thickness under general anesthesia. Nine cases underwent resection by a conventional method, whereas we introduced elastic needles with a metal core to mark a deep surgical margin of 10 mm from the deepest tumor invasion front under ultrasonographic monitoring as a new technique in the remaining 4 cases. Each resected specimen was immediately immersed in gelatin solution while maintaining its original shape and orientation and was placed under refrigeration to solidify. Ultrasonographic observations of the gelatin-embedded specimens were performed from the superior surface of the gelatin block.Results: Very fine ultrasonographic images of the resected specimen could be easily obtained without any special skills, and surgical clearance could be verified intraoperatively. The ultrasonographic tumor thickness measurements corresponded well with those of histologic sections, with a consistency ratio of 91.4% to 98.2% (Pearson correlation coefficient = 0.981, P < .05).Conclusion: Intraoperative ultrasonography is a reliable method to objectively evaluate tumor thickness and surgical margin clearance. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:1746-1752, 2010