Transcervical Ultrasonography Is Feasible to Visualize and Evaluate Base of Tongue Cancers

Ray Gervacio F Blanco,Jia Liu,Jeremy Richmon,Carole Fakhry,John Saunders,Patrick K Ha,Joseph Califano,Geoffrey Neuner,Harry Quon,Sheila Sheth,Barbara Messing,Maura Gillison,Joseph Najbauer

doi:10.1371/journal.pone.0087565

Ray Gervacio F Blanco, Jia Liu + Show 11 more

Open Access

https://doi.org/10.1371/journal.pone.0087565

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Abstract

BackgroundBase of tongue (BOT) is a difficult subsite to examine clinically and radiographically. Yet, anatomic delineation of the primary tumor site, its extension to adjacent sites or across midline, and endophytic vs. exophytic extent are important characteristics for staging and treatment planning. We hypothesized that ultrasound could be used to visualize and describe BOT tumors.MethodsTranscervical ultrasound was performed using a standardized protocol in cases and controls. Cases had suspected or confirmed BOT malignancy. Controls were healthy individuals without known malignancy.Results100% of BOT tumors were visualized. On ultrasound BOT tumors were hypoechoic (90.9%) with irregular margins (95.5%). Ultrasound could be used to characterize adjacent site involvement, midline extent, and endophytic extent, and visualize the lingual artery. No tumors were suspected for controls.ConclusionsUltrasonography can be used to transcervically visualize BOT tumors and provides clinically relevant characteristics that may not otherwise be appreciable.

Highlights

The incidence of oropharyngeal squamous cell cancer (OPSCC) is rapidly rising in the United States and is expected to increase by 225% in the decade [1]
The Base of tongue (BOT) is obscured by the oral tongue, ‘‘falls vertically away from the view of an examiner,’’ and even with ‘‘a laryngeal mirror or fiberoptic laryngoscope...is still viewed tangentially, making thorough inspection difficult [3].’’ Examination can further be complicated by a physiologic gag reflex
Twenty-two cases with known or suspected base of tongue cancers and 18 controls were enrolled in this study

Summary

Introduction

The incidence of oropharyngeal squamous cell cancer (OPSCC) is rapidly rising in the United States and is expected to increase by 225% in the decade [1]. An evolution of the OPSCC treatment paradigm from a primary radiation-based strategy to a primary surgical approach is being considered [2]. The epidemiology of this disease has changed and the treatment paradigm is rigorously being evaluated in clinical trials, the diagnostic evaluation of OPSCCs has not been re-examined. The base of tongue (BOT) is a challenging anatomic subsite of the oropharynx to examine. Clinical examination (intraoral visualization, mirror laryngoscopy and fiberoptic laryngoscopy) can demonstrate the mucosal or exophytic portion of a tumor, suggest an endophytic component (asymmetry) and local tumor extension. Base of tongue (BOT) is a difficult subsite to examine clinically and radiographically. Anatomic delineation of the primary tumor site, its extension to adjacent sites or across midline, and endophytic vs exophytic extent are important characteristics for staging and treatment planning. We hypothesized that ultrasound could be used to visualize and describe BOT tumors

Methods

Results

Conclusion