Oral cancer staging established by magnetic resonance imaging

Rogério Ribeiro De Paiva,André Ferreira Leite,Eliete Neves Silva Guerra,Maria Alves Garcia Silva,Paulo Tadeu De Souza Figueiredo

doi:10.1590/s1806-83242011000600007

Rogério Ribeiro De Paiva, André Ferreira Leite + Show 3 more

Open Access

https://doi.org/10.1590/s1806-83242011000600007

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Abstract

The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

Highlights

The prognosis of carcinoma of the maxillofacial region is influenced by a variety of factors, such as the degree of cellular differentiation, size, location, presence of infiltration into the bone tissue, immune response, age, gender, patient’s socio-economic status and the presence of cervical lymph node metastasis, the latter being considered the most significant factor when determining the prognosis.[1,2,3]
Oral cancer is diagnosed after clinical examination, biopsy and anatomic pathology examination of the lesion have been carried out
Observers 1 and 2 were dental specialists holding a Master’s in oral radiology, and Observers 3 and 4 were medical radiologists. These four radiologists established staging based on the magnetic resonance imaging (MRI) scans without any prior knowledge of the clinical staging already established by the head and Primary site – Side

Summary

Introduction

The prognosis of carcinoma of the maxillofacial region is influenced by a variety of factors, such as the degree of cellular differentiation, size, location, presence of infiltration into the bone tissue, immune response, age, gender, patient’s socio-economic status and the presence of cervical lymph node metastasis, the latter being considered the most significant factor when determining the prognosis.[1,2,3] Incidence and mortality rates vary from one country to another and even within countries, because of differences in customs, especially tobacco use and alcohol consumption, environmental factors and the quality of medical care.[4]. After the diagnosis has been established, an assessment is needed of the extent and spread. Staging, which can be defined as the quantification of the clinical parameters of the disease, helps in making therapeutic decisions and in establishing a prognosis for the patient.[1,2,3,5,6] The TNM system classifies the anatomical extent of the disease in any part of the body, by using clinical observation and histological and surgical complementation, or diagnostic imaging methods

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