• Usman Bashir
  • Muhammad Usman Manzoor
  • Yasir Majeed
  • Rizwan Ullah Khan
  • Usman Hassan
  • Ahmed Murtaza
  • Khurram Aftab
  • Syed Raza Hussain
  • Arif Jamshed
  • Najam Uddin
  • Zia Salman Faruqui


Background: Tongue tumour thickness has been shown to have a correlation with neck nodalmetastasis and hence patient survival. Current AJCC guidelines recommend inclusion of tongue tumourthickness measurement in routine radiologic staging. Several studies have attempted to define theaccuracy of MRI in measuring tongue tumour thickness. The aim of our study was to compare tonguetumour thickness measured at T2-weighted and STIR sequences with histologic tongue tumourthickness. Methods: Twenty-eight consecutive patients of tongue cancer who had undergoneglossectomy were selected retrospectively. Tumours were measured in both STIR axial and T2-weighted coronal images and compared with histologic tumour thickness on resected specimens.Pearson’s analysis was performed to determine the degree of correlation. Paired samples t-test was alsoused for comparison of mean tumour thicknesses measured on MRI with mean histologic tumourthickness. Results: Pearson correlation analysis showed good correlation of tumour thickness measuredon MRI with actual histologic tumour thickness (R=0.876). Conclusion: MRI provides a satisfactoryprediction of tongue tumour thickness which in turn can be used to determine the need for elective neckdissection in these patients.Keywords: Lymphatic Metastasis, Magnetic Resonance Imaging/methods, Tongue Neoplasms


Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor

thickness and depth of invasion in nodal involvement and

prognosis of oral squamous cell carcinoma: a review of the

literature. Head Neck 2005;27:1080–91.

Yuen AP, Lam KY, Wei WI, Lam KY, Ho CM, Chow TL, et al. A

comparison of the prognostic significance of tumor diameter,

length, width, thickness, area, volume, and clinicopathological

features of oral tongue carcinoma. Am J Surg 2000;180(2):139–43.

Bonnardot L, Bardet E, Steichen O, Cassagnau E, Piot B, Salam

AP, et al. Prognostic factors for T1-T2 squamous cell carcinomas

of the mobile tongue: A retrospective cohort study. Head Neck


Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow

TL, et al. Prognostic factors of clinically stage I and II oral tongue

carcinoma-A comparative study of stage, thickness, shape, growth


J Ayub Med Coll Abbottabad 2011;23(3)

pattern, invasive front malignancy grading, Martinez-Gimeno

score, and pathologic features. Head Neck 2002;24:513–20.

Anzai Y, Brunberg JA, Lufkin RB. Imaging of nodal metastases

in the head and neck. J Magn Reson Imaging 1997;7:774–83.

Akoğlu E, Dutipek M, Bekiş R, Değirmenci B, Ada E, Güneri A.

Assessment of cervical lymph node metastasis with different

imaging methods in patients with head and neck squamous cell

carcinoma. J Otolaryngol 2005;34:384–94.

Brandwein-Gensler M, Smith RV. Prognostic indicators in head

and neck oncology including the new 7th edition of the AJCC

staging system. Head Neck Pathol 2010;4(1):53–61.

Yuen AP-W, Ho CM, Chow TL, Tang LC, Cheung WY, Ng

RW-M, et al. Prospective randomized study of selective neck

dissection versus observation for N0 neck of early tongue

carcinoma. Head Neck 2009;31:765–72.

Edge S, American Joint Committee on Cancer. AJCC cancer

staging manual. 7th ed. New York: Springer; 2010.

Ross MR, Schomer DF, Chappell P, Enzmann DR. MR imaging

of head and neck tumors: comparison of T1-weighted contrastenhanced fat-suppressed images with conventional T2-weighted

and fast spin-echo T2-weighted images. Am J Roentgenol


Lufkin RB, Wortham DG, Dietrich RB, Hoover LA, Larsson SG,

Kangarloo H, et al. Tongue and oropharynx: findings on MR

imaging. Radiology 1986;161(1):69–75.

Unger JM. The oral cavity and tongue: magnetic resonance

imaging. Radiology 1985;155:151–53.

Lam P, Au-Yeung KM, Cheng PW, Wei WI, Yuen AP-W,

Trendell-Smith N, et al. Correlating MRI and histologic tumor

thickness in the assessment of oral tongue cancer. Am J

Roentgenol 2004;182(3):803–8.

Okura M, Iida S, Aikawa T, Adachi T, Yoshimura N, Yamada T,

et al. Tumor thickness and paralingual distance of coronal MR

imaging predicts cervical node metastases in oral tongue

carcinoma. Am J Neuroradiol 2008;29(1):45–50.

Preda L, Chiesa F, Calabrese L, Latronico A, Bruschini R, Leon

ME, et al. Relationship between histologic thickness of tongue

carcinoma and thickness estimated from preoperative MRI. Eur

Radiol 2006;16:2242–8.

Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry

NH, et al. Can we detect or predict the presence of occult nodal

metastases in patients with squamous carcinoma of the oral

tongue? Head Neck 1998;20(2):138–44.

Brown B, Barnes L, Mazariegos J, Taylor F, Johnson J, Wagner

RL. Prognostic factors in mobile tongue and floor of mouth

carcinoma. Cancer 1989;64:1195–202.

Asakage T, Yokose T, Mukai K, Tsugane S, Tsubono Y, Asai M,

et al. Tumor thickness predicts cervical metastasis in patients with

stage I/II carcinoma of the tongue. Cancer 1998;82:1443–8.

O-charoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S, et

al. Tumour thickness predicts cervical nodal metastases and

survival in early oral tongue cancer. Oral Oncol 2003;39:386–90.

Yamazaki H, Inoue T, Teshima T, Tanaka E, Koizumi M,

Kagawa K, et al. Tongue cancer treated with brachytherapy: is

thickness of tongue cancer a prognostic factor for regional

control? Anticancer Res 1998;18:1261–5.

Matsuura K, Hirokawa Y, Fujita M, Akagi Y, Ito K. Treatment

results of stage I and II oral tongue cancer with interstitial

brachytherapy: maximum tumor thickness is prognostic of nodal

metastasis. Int J Radiat Oncol Biol Phys 1998;40:535–9.

Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of

invasion as a predictive factor for cervical lymph node metastasis

in tongue carcinoma. Head Neck 1997;19:205–10.

Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong

EW. Predictive value of tumor thickness in squamous carcinoma

confined to the tongue and floor of the mouth. Am J Surg


Moore C, Kuhns JG, Greenberg RA. Thickness as Prognostic

Aid in Upper Aerodigestive Tract Cancer. Arch Surg


Woolgar JA, Scott J. Prediction of cervical lymph node

metastasis in squamous cell carcinoma of the tongue/floor of

mouth. Head Neck 1995;17:463–72.

O’Brien CJ, Lauer CS, Fredricks S, Clifford AR, McNeil EB,

Bagia JS, et al. Tumor thickness influences prognosis of T1 and

T2 oral cavity cancer—but what thickness? Head Neck


DiTroia JF. Nodal metastases and prognosis in carcinoma of the

oral cavity. Otolaryngol Clin North Am 1972;5:333–42.

Huang SH, Hwang D, Lockwood G, Goldstein DP, O’Sullivan

B. Predictive value of tumor thickness for cervical lymph-node

involvement in squamous cell carcinoma of the oral cavity: a

meta-analysis of reported studies. Cancer 2009;115:1489–97.

Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in

planning a management strategy for the stage N0 neck. Arch

Otolaryngol Head Neck Surg 1994;120:699–702.

Morton RP, Ferguson CM, Lambie NK, Whitlock RM. Tumor

thickness in early tongue cancer. Arch Otolaryngol Head Neck

Surg 1994;120:717–20.

Tokuda O, Harada Y, Matsunaga N. MRI of Soft-Tissue Tumors:

Fast STIR Sequence as Substitute for T1-Weighted FatSuppressed Contrast-Enhanced Spin-Echo Sequence. Am J

Roentgenol 2009;193:1607–14.

Iwai H, Kyomoto R, Ha-Kawa SK, Lee S, Yamashita T.

Magnetic resonance determination of tumor thickness as

predictive factor of cervical metastasis in oral tongue carcinoma.

Laryngoscope 2002;112:457–61.

Wallwork BD, Anderson SR, Coman WB. Squamous cell

carcinoma of the floor of the mouth: tumour thickness and the

rate of cervical metastasis. ANZ J Surg 2007;77:761–4.

Tetsumura A, Yoshino N, Amagasa T, Nagumo K, Okada N,

Sasaki T. High-resolution magnetic resonance imaging of

squamous cell carcinoma of the tongue: an in vitro study.

Dentomaxillofac Radiol 2001;30(1):14–21.

Ong CK, Chong VFH. Imaging of tongue carcinoma. Cancer

Imaging 2006;6:186–93.

Buettner P, Garbe C, Guggenmoos-Holzmann I. Problems in

defining cutoff points of continuous prognostic factors: Example

of tumor thickness in primary cutaneous melanoma. J Clin

Epidemiol 1997;50:1201–10.



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