RELIABILITY OF MRI IN MEASURING TONGUE TUMOUR THICKNESS: A 1.5T STUDY
AbstractBackground: 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
A B B
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
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
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
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
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.
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
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