Assessment Of Mandibular Invasion Research Articles

Accuracy of cone-beam computed tomography for the evaluation of mandible invasion by oral squamous cell carcinoma

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.

Digital volume tomography in the assessment of mandibular invasion in patients with squamous cell carcinoma of the oral cavity – A prospective study

Cancers in the upper part of aero digestive tract comprises 5% of all the malignancies, most common among them is the squamous cell carcinoma (Acton et al., 2000). The incidence and prevalence of oral squamous cell carcinoma (OSCC) in Indian subcontinent is relatively high because of prevalent habits like chewing tobacco, betel quid and areca-nut which increases the risk of developing OSCC (Feller and Lemmer, 2012). Tumor adjacent to the mandible can invade bone, either by direct extension (Huntley et al., 1996) or by the perineural infiltration (Carter and Pittam, 1980). There are no clear guidance to state the amount of bone resection required beyond the tumor, and in majority of the cases soft tissue extension of the tumor determines the amount of resection (Brown et al., 1994). The decision to maintain the continuity of the mandible demands thorough understanding of the anatomy as well as proper assessment of tumor extension (Huntley et al., 1996). Preoperatively it is difficult to assess the degree of mandibular bone involvement, because there is no single imaging tool available to evaluate the extent of bone invasion 100% accurately (Singh, 2008). Different modalities including clinical examination, plain radiographs, conventional computed tomography (dentascan), magnetic resonance imaging (MRI) and nuclear medicine studies have been studied (Ziegler et al., 2002). Conventional radiographs in the form of orthopantomograph (OPG) provides a decent survey of the mandible, but bone mineral loss should be 30–50% before any change is seen (Huntley et al., 1996, Van Cann et al., 2008) Radionuclide bone scintigraphy utilizing radio-active labeled phosphate compounds along with OPG improves diagnosis in the preoperative evaluation. But this high sensitivity is escorted with very low specificity. Periodontal diseases, infections, infarctions and soft tissue involvement in and around the mandible will show a false positive result (Huntley et al., 1996). MRI is less useful in evaluating the cervical bone involvement due to the absence of signal from cortical bone because of less number of mobile hydrogen ions (Huntley et al., 1996, Boeddinghaus and Whyte, 2008). Digital volume tomography (DVT) is a recent imaging technology. DVT is capable of higher special resolution than dentascan (Genden et al., 2005). So the purpose of this study is to evaluate the diagnostic accuracy of DVT in contrast with OPG, dentascan and histological study in assessing the invasion of mandible of patients with OSCC, clinically adjacent or fixed to the mandible.

Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course

Preoperative evaluation of the bone for invasion by oral cavity squamous cell carcinoma remains challenging. The aim of our study was to compare the accuracy of MRI and CT in detecting mandibular invasion by oral squamous cell carcinoma of the oral cavity, with histologic results as the reference standard, and to assess the influence on surgical management and post-operative course. Patients who were clinically suspected of having bone invasion from oral cavity carcinoma were retrospectively included. A single senior radiologist reviewed MRI images and CT-scans, independently, for the presence or absence of mandibular invasion. The different surgical procedures were compared in terms of length of hospital stay and occurrence of surgical complications. Histological mandibular invasion occurred in 9 of 35patients (25.7%). None of the preoperative imaging tests failed to detect bone invasion which resulted in a sensitivity of 100% for both MRI and CT. CT had slightly higher specificity than MRI (61.9% and 57.1% respectively) in predicting bone invasion, but no statistically significant difference was found (P=0.32). Specificity of CT and MRI was higher in the edentulous group (75% and 625% respectively) than in the dentate group (53.8% both), although no statistically significant difference was found. The length of hospital stay was increased in the segmental resection group (25±14.5days) compared to the marginal resection group (13±4.6days; P=0.004) and to the hemimandibulectomy group (15±7.2days; P=0.014). Occurrence of post-operative complications, across all categories, was increased in the segmental resection group (70%, n=7/10; P=0.006) compared to the marginal resection group (8.3%, n=1/12) and to the hemimandibulectomy group (23.1%, n=3/13; P=0.04). MRI and CT being equivalent in detecting mandibular invasion, we suggest MRI as single imaging technique in the preoperative assessment of oral cavity SCC. Specificity could be increased if combined with PET/CT, in order to reduce the number of unnecessary mandibular interruptions.

Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study

This preliminary retrospective study evaluates the diagnostic value of cone-beam computed tomography (CBCT), as a potential standard preoperative procedure, in assessing mandibular invasion by oral squamous cell carcinoma (OSCC) compared with conventional preoperative panoramic radiography (PR), magnetic resonance imaging (MRI) and histological examination of the resection specimen (the golden standard). Between September 2006 and September 2009, 23 patients with histology proven primary OSCC, adjacent to or fixed to the mandible were included. The tumours were classified into four groups, ranging from no bone invasion to evident bone invasion. Sensitivity and specificity for PR were 55% (95% CI [0.350;0.619]) and 92% (95% CI 0.737;0.984]), respectively, both were significantly lower than the 91% (95% CI [0.740;0.909]) and 100% (95% CI [0.845;1]), respectively, for CBCT. MRI showed 82% sensitivity (95% CI [0.608;0.941]) and 67% specificity (95% CI [0.474;0.779]). CBCT has the potential to become a new diagnostic tool in the OSCC screening procedure to predict mandibular invasion or erosion, but its value may be limited by its relatively low sensitivity. A prospective study will start on 64 patients (alpha=0.05; power 0.8; effect size 0.5) to improve these results statistically.

Assessment of mandibular invasion of squamous cell carcinoma by various modes of imaging: constructing a diagnostic algorithm

Assessment of mandibular invasion of squamous cell carcinoma by various modes of imaging: constructing a diagnostic algorithm

Correlation of Three-Dimensional Computed Tomographic (3D-CT) Scan With Panorex in the Assessment of Mandibular Invasion in Oral Cancer

(Deo SVS; Thulkar S; Shukla NK; Gupta SD; Kumar S)

Quantitative analysis of dynamic contrast-enhanced MRI for the assessment of mandibular invasion in oral and oropharyngeal squamous cell carcinomas

Quantitative analysis of dynamic contrast-enhanced MRI for the assessment of mandibular invasion in oral and oropharyngeal squamous cell carcinomas

Single photon emission tomography: Scintigraphy in the assessment of mandibular invasion by head and neck cancer

Background This study was performed to determine the effectiveness of single photon emission tomography (SPET) in contributing to the initial staging of patients with cancers of the head and neck because information about osseous infiltration of head and neck cancer is of major importance for staging and planning of treatment. Methods A retrospective analysis of 89 cases with probable tumor infiltration of the mandible by oral/pharyngeal cancer was undertaken by comparing the preoperative SPET as well as CT-scans, if available, with clinical and postoperative histological examinations. Results For SPET examinations, a sensitivity of 95% and a specificity of 48% were calculated. The positive predictive value was 65%, and the negative predictive value was 93%. CT scans showed a sensitivity of 75% and a specificity of 78%. The positive predictive value was 65%, and the negative predictive value was 93%. Conclusions SPET is a powerful method to detect infiltration of carcinomas into the head and neck skeleton. Its sensitivity is high and superior to CT scans, although the specificity is small due to a high number of false positive results. © 2001 John Wiley & Sons, Inc. Head Neck 23: 979–984, 2001.

Single photon emission tomography: scintigraphy in the assessment of mandibular invasion by head and neck cancer.

This study was performed to determine the effectiveness of single photon emission tomography (SPET) in contributing to the initial staging of patients with cancers of the head and neck because information about osseous infiltration of head and neck cancer is of major importance for staging and planning of treatment. A retrospective analysis of 89 cases with probable tumor infiltration of the mandible by oral/pharyngeal cancer was undertaken by comparing the preoperative SPET as well as CT-scans, if available, with clinical and postoperative histological examinations. For SPET examinations, a sensitivity of 95% and a specificity of 48% were calculated. The positive predictive value was 65%, and the negative predictive value was 93%. CT scans showed a sensitivity of 75% and a specificity of 78%. The positive predictive value was 65%, and the negative predictive value was 93%. SPET is a powerful method to detect infiltration of carcinomas into the head and neck skeleton. Its sensitivity is high and superior to CT scans, although the specificity is small due to a high number of false positive results.

Computer-aided 3-D99mTc-DPD-SPECT reconstruction to assess mandibular invasion by intraoral squamous cell carcinoma: diagnostic improvement or not?

Objective: A prospective study was designed to compare computer-aided 3-D99mTc-DPD-SPECT (Technetium-Dicarboxy propan-single photon emission CT) reconstruction with clinical examination, panoramic radiography, CT scan and conventional99mTc-DPD-SPECT investigation in the assessment of mandibular bone invasion by squamous cell carcinoma. Patients and Methods: Between October 1997 and December 1999, 88 patients with intraoral squamous cell carcinoma of the regions adjacent to the mandible were enrolled in this study. In 50 cases, mandibular resection (segmental or marginal) was performed based on the pre-treatment diagnostic results. Imaging studies were read independently by four experienced observers. Results: No differences could be found between presurgical 3-D99mTc-DPD-SPECT reconstruction and conventional99mTc-DPD-SPECT investigation. Both techniques revealed a sensitivity of 100% whereas CT scan showed the greatest specificity (93.8%). SPECT investigation had a specificity of 91.6% and the greatest efficiency (95.4%). The greatest predictive positive value was found for CT scan (92.3%). Clinical examination and panoramic radiography displayed the lowest sensitivity, 82.5% vs. 85.0%, and specificity, 79.2% vs. 89.5% respectively. Conclusion: This investigation does not provide evidence that 3-D99mTc-DPD-SPECT reconstruction has any advantages when compared to conventional99mTc-DPD-ECT investigation in the assessment of mandibular invasion by squamous cell carcinoma. Despite a sensitivity of 100% the specificity is still in need of improvement. Until newer methods or techniques become available the combination of CT scanning and conventional99mTc-DPD-SPECT investigation appears to be the best means of detecting tumour invasion preoperatively and is thus helpful in directing appropriate surgical procedure.

Use of computed tomography in the assessment of mandibular invasion in carcinoma of the retromolar trigone

Carcinomas originating in the retromolar trigone (RMT) are uncommon and characterized by early spread. Determination of mandibular invasion is significant for planning therapy and determining prognosis. For oral cavity cancers in general, CT is reasonably accurate in assessing bone invasion. However, there is a paucity of information specifically addressing the value of CT in the RMT. In this study, the records of patients with biopsy-proven RMT carcinomas treated between 1984 and 1998 were reviewed with attention to preoperative CT scans and histopathologic findings during surgery. Half of the patients who were treated with primary resection had mandibular invasion. Bone invasion was not identified radiographically in 27% of patients with preoperative CT scans. The sensitivity of CT for bone involvement in RMT cancers was 50%, with a negative predictive value of 61.1%. The positive predictive value was 91.1%. These findings suggest that CT is a useful, but potentially inaccurate, predictor of bone invasion in the RMT. (Otolaryngol Head Neck Surg 2000;122:673-7.)

Use of computed tomography in the assessment of mandibular invasion in carcinoma of the retromolar trigone

Carcinomas originating in the retromolar trigone (RMT) are uncommon and characterized by early spread. Determination of mandibular invasion is significant for planning therapy and determining prognosis. For oral cavity cancers in general, CT is reasonably accurate in assessing bone invasion. However, there is a paucity of information specifically addressing the value of CT in the RMT. In this study, the records of patients with biopsy‐proven RMT carcinomas treated between 1984 and 1998 were reviewed with attention to preoperative CT scans and histopathologic findings during surgery. Half of the patients who were treated with primary resection had mandibular invasion. Bone invasion was not identified radiographically in 27% of patients with preoperative CT scans. The sensitivity of CT for bone involvement in RMT cancers was 50%, with a negative predictive value of 61.1%. The positive predictive value was 91.1%. These findings suggest that CT is a useful, but potentially inaccurate, predictor of bone invasion in the RMT.

Radionuclide bone imaging for detection of mandibular invasion by squamous cell carcinoma.

The assessment of mandibular invasion is an important part of the pre-operative staging of oropharyngeal squamous cell carcinoma. When bone is surgically resected, histology often shows no direct bone invasion, yet such resections are associated with post-operative complication and morbidity. This prospective study of a large group of patients aims to lay down criteria for bone invasion using radionuclide bone imaging and orthopantomography, and to test their effectiveness when compared with histological analysis. 77 patients with proven squamous cell carcinoma of the oral cavity were investigated pre-operatively by radionuclide bone imaging and orthopantomography. All had bone resected as part of complete resection of the tumour. One patient had systemic bone metastases and was, therefore, excluded. In the remaining 76 patients, there were four false positive assessments for bone invasion radiologically and no false negatives. There were 48 true positive results and 24 true negatives, giving a sensitivity of 100% and specificity of 86%. It is concluded that correct application of the outlined criteria for bone invasion demonstrated that radionuclide bone imaging and orthopantomography are a sensitive test for bone invasion, with an acceptable level of specificity.

Bone scanning in the assessment of mandibular invasion by oral cavity carcinomas

Bone scanning in the assessment of mandibular invasion by oral cavity carcinomas

A comparison of different imaging modalities and direct inspection after periosteal stripping in predicting the invasion of the mandible by oral squamous cell carcinoma

To compare the predictability of orthopantomograms (OPG), bone scans, computerised tomography (CT), magnetic resonance imaging (MRI) and periosteal stripping with direct inspection in predicting both the presence and extent of tumor invasion of the mandible. Prospective study. Queen Elizabeth Hospital, Birmingham; Wordsley Hospital, Stourbridge; North Staffordshire Royal Infirmary, Stroke-on-Trent. 35 consecutive patients requiring a mandibular resection as part of their treatment for oral squamous cell carcinoma. The prediction of the extent of bone invasion for each of the investigations and direct inspection after periosteal stripping. The actual extent of invasion of the mandible from a detailed histological assessment. The OPG underpredicted the width and depth of invasion by on average 13 mm and 2 mm. There were 5 false negative reports. Bone scans overpredicted the width and depth by 14 mm and 15 mm with 1 false negative. CT scans underpredicted the width of invasion by 5 mm and overpredicted depth by 3 mm, but 7 false negatives were returned. MRI scans overpredicted width and depth of invasion by 19 mm and 10 mm with 1 false negative. Direct inspection after periosteal stripping underpredicted the width and depth of invasion by 5 mm and 3 mm with 1 false negative. OPG's and bone scans are useful for the initial assessment of all tumours in the region of the mandible. MRI is a more useful investigation than CT in the assessment of mandibular invasion by oral squamous cell carcinomas. Exploratory periosteal stripping at the time of resection can accurately predict the presence of tumour invading the mandible.

Assessment of mandibular invasion by carcinoma

In this prospective study of 31 patients, the most sensitive assessment of malignant invasion of the mandible was by physical examination. Bone scanning and conventional roentgenographs are useful adjuncts in the staging evaluation of patients when clinical involvement is suspected and to determine the extent of disease in order to aid in treatment planning. However, they are frequently subject to false-positive interpretive errors, especially due to increased osteoblastic activity associated with dental disease and occasional tumor adjacent to the mandible. When appropriate, the radiographs ordered should be those that allow for the most accurate assessment of the particular lesion as determined by its location. Until a more specific and accurate method for detecting and measuring malignant invasion of the mandible is developed, the physical findings and the judgment of the head and neck surgeon remains our most valuable tool.