Abstract
BackgroundFor patients with oral squamous cell carcinoma (OSCC), accurate evaluation of mandible invasion and resection with appropriate boundaries are important for preserving the structure and function of the mandible and preventing local recurrence. Although cone-beam computed tomography (CBCT), which has high spatial resolution, is now widely used in the diagnosis of oral and maxillofacial bone lesions, no studies have systematically evaluated the accuracy of CBCT for evaluating the presence of bone invasion, the boundaries of bone invasion and the presence of nerve invasion. Therefore, this study aimed to systemically explore the accuracy of CBCT in the preoperative assessment of mandibular invasion by OSCC.MethodsThirty mandibular specimens from OSCC patients were collected in this study. The samples were marked and subjected to CBCT examination. Hematoxylin–eosin staining was used for histopathological assessment sed as the gold standard. The evaluation included the presence of bone invasion, the boundaries of bone invasion and the presence of nerve invasion. The CBCT and histopathological boundaries of bone invasion were delineated and merged to compare and calculate the deviation of CBCT in boundary evaluation.ResultsThe accuracy of CBCT in evaluating the presence of mandible invasion was 100%, and the accuracy of CBCT in evaluating the presence of nerve invasion was 69.2%. A mean deviation of 2.97 mm was found for assessment of the boundary of bone invasion using CBCT compared with the histopathological standard. The interexaminer agreement and intraexaminer agreement were perfect for the detection of bone invasion and nerve invasion (κ > 0.8). The intraclass correlation coefficient was 0.923 for the consistency test of boundary delineation on CBCT images.ConclusionCBCT is quite reliable in determining the presence or absence of mandible invasion but not as reliable for nerve invasion. The deviation in bone invasion boundary estimation should be considered in osteotomy for OSCC.
Highlights
For patients with oral squamous cell carcinoma (OSCC), accurate evaluation of mandible invasion and resection with appropriate boundaries are important for preserving the structure and function of the mandible and preventing local recurrence
The present study aimed to explore the accuracy of using cone-beam computed tomography (CBCT) to evaluate mandible invasion by OSCC, with histopathological examination as the gold standard
Of the 15 segmental mandibulectomy specimens, 13 (87%) specimens presented with mandible invasion, and 6 specimens presented with nerve invasion (Table 1)
Summary
For patients with oral squamous cell carcinoma (OSCC), accurate evaluation of mandible invasion and resection with appropriate boundaries are important for preserving the structure and function of the mandible and preventing local recurrence. Cone-beam computed tomography (CBCT), which has high spatial resolution, is widely used in the diagnosis of oral and maxillofacial bone lesions, no studies have systematically evaluated the accuracy of CBCT for evaluating the presence of bone invasion, the boundaries of bone invasion and the presence of nerve invasion. Given the benefits of achieving complete resection with clear margins while achieving maximum preservation of the unaffected tissue, an accurate preoperative assessment of mandibular invasion by OSCC is crucial for optimizing treatment and preventing local recurrence. Cone-beam computed tomography (CBCT), which has high spatial resolution and a low cost, is currently widely used in the diagnosis of oral and maxillofacial bone lesions. No studies have investigated the accuracy of this modality for predicting the extent of invasion
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