Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course
Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course
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DOI：
10.1016/j.revsto.2016.06.004
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发表时间：
2016-11-01
影响因子：
--
通讯作者：
Julieron, M.
中科院分区：
文献类型：
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作者：
Farrow, E. S.;Boulanger, T.;Julieron, M.
导论.术前评估口腔鳞状细胞癌对骨的侵袭仍然具有挑战性。我们研究的目的是以组织学结果为参考标准，比较MRI和CT检测口腔鳞状细胞癌下颌骨侵犯的准确性，并评估对手术治疗和术后病程的影响。患者和方法。回顾性纳入临床怀疑口腔癌骨侵犯的患者。由一位资深放射科医生独立审查MRI图像和CT扫描，以确定是否存在下颌骨侵犯。比较两种手术方式的住院时间和手术并发症的发生率。35例患者中有9例（25.7%）发生组织学下颌骨侵犯。所有术前影像学检查均未发现骨侵犯，MRI和CT的敏感性均为100%。CT预测骨侵犯的特异性略高于MRI（分别为61.9%和57.1%），但差异无统计学意义（P = 0.32）。无牙颌组CT和MRI的特异性较高（分别为75%和625%）节段性切除术组的住院时间延长，（25 +/- 14.5天），与边缘切除组（13 +/- 4.6天; P = 0.004）和半下颌骨切除组（15 +/- 7.2天; P = 0.014）相比。所有类别的术后并发症发生率，节段切除组（70%，n = 7/10; P = 0.006）高于边缘切除组（8.3%，n = 1/12）和半下颌骨切除组（23.1%，n = 3/13; P = 0.04）。MRI和CT在检测下颌骨侵犯方面具有相当的价值，我们建议MRI作为口腔SCC术前评估的单一影像学技术。如果与PET/CT结合，可以增加特异性，以减少不必要的下颌骨中断的数量。(C)2016 Elsevier Masson SAS。All rights reserved.
Introduction. Preoperative evaluation of the bone for invasion by oral cavity squamous cell carcinoma remains challenging. The aim of our study was to compare the accuracy of MRI and CT in detecting mandibular invasion by oral squamous cell carcinoma of the oral cavity, with histologic results as the reference standard, and to assess the influence on surgical management and post-operative course.Patients and methods. Patients who were clinically suspected of having bone invasion from oral cavity carcinoma were retrospectively included. A single senior radiologist reviewed MRI images and CT-scans, independently, for the presence or absence of mandibular invasion. The different surgical procedures were compared in terms of length of hospital stay and occurrence of surgical complications.Results. Histological mandibular invasion occurred in 9 of 35 patients (25.7%). None of the preoperative imaging tests failed to detect bone invasion which resulted in a sensitivity of 100% for both MRI and CT. CT had slightly higher specificity than MRI (61.9% and 57.1% respectively) in predicting bone invasion, but no statistically significant difference was found (P = 0.32). Specificity of CT and MRI was higher in the edentulous group (75% and 625% respectively) than in the dentate group (53.8% both), although no statistically significant difference was found. The length of hospital stay was increased in the segmental resection group (25 +/- 14.5 days) compared to the marginal resection group (13 +/- 4.6 days; P = 0.004) and to the hemimandibulectomy group (15 +/- 7.2 days; P = 0.014). Occurrence of post-operative complications, across all categories, was increased in the segmental resection group (70%, n = 7/10; P = 0.006) compared to the marginal resection group (8.3%, n = 1/12) and to the hemimandibulectomy group (23.1%, n = 3/13; P = 0.04).Conclusion. MRI and CT being equivalent in detecting mandibular invasion, we suggest MRI as single imaging technique in the preoperative assessment of oral cavity SCC. Specificity could be increased if combined with PET/CT, in order to reduce the number of unnecessary mandibular interruptions. (C) 2016 Elsevier Masson SAS. All rights reserved.