Intraoral Ultrasonography Research Articles

Preoperative ultrasonography for tumor thickness evaluation in guiding management in patients with early oral tongue squamous cell carcinoma.

Objectives:(1) To assess the statistical correlation between the tumor thickness (TT) by ultrasonography (USG) and microscopic measurement in cases of early oral tongue squamous cell carcinoma (OTSCC). (2) To assess the predictive capacity of TT by ultrasound in detecting nodal metastasis.Materials and Methods:Prospective analysis was performed in 24 patients for a period of 2 years from 2012 to 2013. Nodal status and TT measurement was done preoperatively by neck and intraoral USG respectively in cases of early (pT1 & T2, clinically N0) OTSCC. As per the institution protocol after histopathological confirmation of malignancy, all patients underwent resection of primary lesion and ipsilateral elective neck dissection (Level - I to IV). Measurement of TT was obtained intraoperatively from fresh glossectomy specimen and postoperatively from histopathological paraffin section examination. The statistical correlation between TT measured by USG and histopathology was assessed by Pearson's correlation coefficient. Chi-square test was used to find the association of pathological T stage, TT with pathological nodal status.Results:Significant statistical correlation was seen between TT by USG and microscopic measures. Between the two, TT measurements were within 1 mm in 37.5% (9/24) of cases, within 2 mm in 29.16% (7/24), and was greater than 2 mm in 8 cases. The Pearson's correlation r is 0.678 (P < 0.001) and ICC (interclass correlation coefficient) is 0.808. The average difference between microscopic and US thickness (Bias) is -0.14637 and the limits of agreement is (4.717, -4.863) with 95% limits of agreement. The rate of occult nodal metastasis was 16.6% and TT of <4 mm had no incidence of nodal metastasis.Conclusion:Ultrasonographic evaluation is reliable and cost-effective tool to measure the TT preoperatively, which will be of help in deciding the management in early OTSCC. TT of 4 mm and above was predictor of occult cervical nodal metastasis.

Strain elastography of tongue carcinoma using intraoral ultrasonography: A preliminary study to characterize normal tissues and lesions.

PurposeThe aim of this study was to evaluate the quantitative strain elastography of tongue carcinoma using intraoral ultrasonography.Materials and MethodsTwo patients with squamous cell carcinoma (SCC) who underwent quantitative strain elastography for the diagnosis of tongue lesions using intraoral ultrasonography were included in this prospective study. Strain elastography was performed using a linear 14 MHz transducer (Aplio 300; Canon Medical Systems, Otawara, Japan). Manual light compression and decompression of the tongue by the transducer was performed to achieve optimal and consistent color coding. The variation in tissue strain over time caused by the compression exerted using the probe was displayed as a strain graph. The integrated strain elastography software allowed the operator to place circular regions of interest (ROIs) of various diameters within the elastography window, and automatically displayed quantitative strain (%) for each ROI. Quantitative indices of the strain (%) were measured for normal tissues and lesions in the tongue.ResultsThe average strain of normal tissue and tongue SCC in a 50-year-old man was 1.468% and 0.000%, respectively. The average strain of normal tissue and tongue SCC in a 59-year-old man was 1.007% and 0.000%, respectively.ConclusionWe investigated the quantitative strain elastography of tongue carcinoma using intraoral ultrasonography. Strain elastography using intraoral ultrasonography is a promising technique for characterizing and differentiating normal tissues and SCC in the tongue.

The role of intraoral ultrasonography in staging of mucosal malignancies

The role of intraoral ultrasonography in staging of mucosal malignancies

High-Resolution Ultrasonic Imaging of Dento-Periodontal Tissues Using a Multi-Element Phased Array System.

Intraoral ultrasonography uses high-frequency mechanical waves to study dento-periodontium. Besides the advantages of portability and cost-effectiveness, ultrasound technique has no ionizing radiation. Previous studies employed a single transducer or an array of transducer elements, and focused on enamel thickness and distance measurement. This study used a phased array system with a 128-element array transducer to image dento-periodontal tissues. We studied two porcine lower incisors from a 6-month-old piglet using 20-MHz ultrasound. The high-resolution ultrasonographs clearly showed the cross-sectional morphological images of the hard and soft tissues. The investigation used an integration of waveform analysis, travel-time calculation, and wavefield simulation to reveal the nature of the ultrasound data, which makes the study novel. With the assistance of time-distance radio-frequency records, we robustly justified the enamel-dentin interface, dentin-pulp interface, and the cemento-enamel junction. The alveolar crest level, the location of cemento-enamel junction, and the thickness of alveolar crest were measured from the images and compared favorably with those from the cone beam computed tomography with less than 10% difference. This preliminary and fundamental study has reinforced the conclusions from previous studies, that ultrasonography has great potential to become a non-invasive diagnostic imaging tool for quantitative assessment of periodontal structures and better delivery of oral care.

Intraoral ultrasonography of tongue mass lesions.

To demonstrate the usefulness of intraoral ultrasonography (IOUS) for tongue mass lesions, we analyzed surgery cases excluding squamous-cell carcinoma and leukoplakia and compared IOUS and pathological findings. We used the hospital information system and Radiology Information System to evaluate the IOUS and pathological findings of patients who underwent surgeries for tongue masses in the past 11 years. Surgeries for the tongues were performed in 268 cases. Imaging examinations were carried out in 52 (19.4%) cases including 42 (15.7%) cases by IOUS. The pathological results of the surgeries were as follows: 36 cases were inflammatory lesions, 74 cases were tumours, 131 cases were hyperplasia, 8 cases were cystic lesions and 19 cases were other miscellaneous lesions. On the other hand, the number of patients who received IOUS in the same period was 87, and 42 of them had surgeries. In 32 out of the 42 (76.2%) cases, pre-operative IOUS features matched with pathological results. Most of the haemangiomas and lipomas could be diagnosed by IOUS alone. IOUS of the tongue revealed the nature of the lesions including the border, size, location, depth, the presence or absence of a capsule and the internal structure including vascularity of the mass. The ultrasonographic findings well reflected the histological findings. IOUS is a simple and useful technique that provides additional information beyond inspection, clarifying the internal structure, blood flow and relationships with the adjacent tissues. In this article, we indicated 11 representative cases (fibrous polyp, haemangioma, pyogenic granuloma, lipoma, liposarcoma, chondroma, lymphangioma, schwannoma, neurofibroma, pleomorphic adenoma and amyloidosis) to show the usefulness of IOUS.

Vascularity as assessed by Doppler intraoral ultrasound around the invasion front of tongue cancer is a predictor of pathological grade of malignancy and cervical lymph node metastasis.

To quantitatively evaluate the relationship of vascularity of tongue cancer as demonstrated on intraoral ultrasonography images and tumour thickness with pathological grade of malignancy and the presence of cervical lymph node metastases. 18 patients with tongue cancer were enrolled in this retrospective study. Using Doppler ultrasonography images of the invasion front of the cancers along the length of their tumour boundaries, three vascular indexes were analysed quantitatively, namely ratio of blood flow signal area within the cancer to whole tumour area (BAR), blood flow signal number ratio (BNR) and blood flow signal width ratio (BWR). The associations between these three indexes and occurrence of cervical lymph node metastasis and pathological grade of malignancy [Yamamoto-Kohama (YK) classification] were assessed. Furthermore, the relationship between tumour thickness and occurrence of cervical lymph node metastasis was evaluated on B-mode intraoral ultrasonography images. There was no significant association between BAR and tumour thickness or occurrence of cervical lymph node metastasis. The BNRs and BWRs of patients with cervical lymph node metastasis were significantly higher than those of patients without nodal involvement. The BWRs of patients with high-grade malignancy (YK-4C) were significantly higher than those of patients with low-grade malignancy (YK-2 or 3). BNR and BWR on the invasion front of the tongue cancer are predictors of pathological grade of malignancy and cervical lymph node metastasis.

The Intraoral Ultrasonography in Dentistry.

Ultrasonography (USG) is a diagnostic method that the ultrasonic image is created by ultrahigh-frequency sound waves, which have an acoustic frequency above the threshold of human hearing. Compared to other medical imaging methods, USG has several advantages of being real time, portable, inexpensive, radiation free, and noninvasive. In the medicine, most of the USG applications are transcutaneous. However, intraoral USG has been a relatively rare application, it has recently been drawing more interest. Intraoral USG is also used in dentistry for examining the salivary glands and ducts, as well as the mouth floor, the buccal, labial, and palatal mucosa, the tongue, periodontal tissues, and periapical lesions. The main purpose of this review is to provide detailed information about intraoral USG applications in dentistry.

Erratum to “Relationship between appearance of tongue carcinoma on intraoral ultrasonography and histopathologic findings” [Oral Surg Oral Med Oral Pathol Oral Radiol 2014, vol 117, pp 634-639

Erratum to “Relationship between appearance of tongue carcinoma on intraoral ultrasonography and histopathologic findings” [Oral Surg Oral Med Oral Pathol Oral Radiol 2014, vol 117, pp 634-639] Yasuhisa Shinozaki, DDS, Yoshinori Jinbu, DDS, PhD, Hiroto Ito, DDS, PhD, Tadahide Noguchi, DDS, PhD, Mikio Kusama, DDS, PhD, Naoyuki Matsumoto, DDS, PhD, Kazuo Komiyama, DDS, PhD, and Nobuyuki Taniguchi, MD, PhD

The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers

Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor. Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US. 10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n=7) or tonsil (n=3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls. Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.

Relationship between appearance of tongue carcinoma on intraoral ultrasonography and histopathologic findings.

To clarify whether intraoral ultrasonography (I-US) is effective for predicting metastasis of tongue cancer to the cervical lymph nodes. Participants comprised 29 patients with tongue carcinoma classified as T1-T4 using the TNM staging system. All patients underwent I-US preoperatively. Postoperatively, resected specimens were evaluated histopathologically. I-US found that cases with invasive depth ≥3 mm had higher potential for cervical lymph node metastasis than those with invasive depth <3 mm (P < .05). No other significant relationships were identified between observations on I-US and cervical lymph node metastasis. Cases with histopathologic blood vessel infiltration or lymph duct infiltration had a significant difference in risk of cervical lymph node metastasis. I-US is useful for preoperatively assessing the invasive depth of tongue carcinoma. Furthermore, observations from I-US and invasive depth of the tumor allowed presumptive diagnosis with regard to cervical lymph node metastasis.

Tongue Ultrasonography in the Diagnosis of a Submucosal Tongue Infection Mimicking a Neoplasm: a Case Report

A 44-year-old-man presented with submucosal tongue swelling with a duration of one week. Upon physical examination, a submucosal mass lesion on the right side of the tongue was detected. An initial magnetic resonance imaging (MRI) study showed a tongue mass thought to be a tongue neoplasm. Before a biopsy, intraoral tongue ultrasonography (USG) was performed and edema formation within the tongue muscle fibres was detected without any mass or abscess formation. After empirical antibiotic treatment, a subsequent MRI showed complete resolution of the lesion. In the diagnostic work-up of a suspicious submucosal tongue lesion, USG imaging is helpful and should be considered. (Gazi Med J 2012; 23: 65-8)

Application of ultrasonography in dentistry

Summary Recent development of the ultrasonography (US) equipments enables the visualization of fine detail of the surface structure of the face and neck soft tissue. In this article, some studies referring to the clinical usefulness of the US in dentistry in the diagnosis of lymph node metastases, tongue carcinomas, periapical lesions and temporomandibular joint disorders are reviewed. For the early detection of lymph node metastases, follow-up US is recommended at an interval of no more than 1 month if a wait-and-see policy is adopted. US-elastography has a potential to be a promising method offering complementary information to conventional US. In order to determine the appropriate treatment planning of tongue carcinoma (including the prediction of subsequent lymph node metastases), intraoral US should be routinely used as one of the standard technique for the evaluation of the depth of tumor invasion. In the diagnosis of periapical lesions, US can provide useful information about the extent of the lesions and the location of the tooth root apices once the surface cortical bone around the lesion is eroded. Moreover, US is reported to be useful as an alternative imaging technique for visualization of disk position, joint effusion and bone abnormalities for the evaluation of temporomandibular joint disorders.

Intraoral ultrasonography: development of a specific high-frequency probe and clinical pilot study

Although ultrasonography is a non-invasive, inexpensive and painless diagnostic tool for soft tissue imaging, this technique is not currently used for oral exploration. Therefore, we developed a 25-MHz high-frequency ultrasound probe, specially designed for intraoral applications. This paper aims to present clinical intraoral ultrasound images actually interpretable, in order to identify the relevant applications of this novel tool and to design future oral studies. Two independent radiologists performed ultrasound examinations on three healthy volunteers. All the teeth were explored on the lingual and buccal sides (162 samples) to evaluate the ergonomics of the system and the visualisation of anatomic structures. Osseointegrated dental implants and a mucocele were also scanned. At the gingivodental junction of the maxillary and mandibular teeth, the device clearly identifies the tooth surfaces, the alveolar bone reflection with its surrounding subepithelial connective tissue of the gingiva and the gingival epithelia. The bone level and the thickness of soft tissue around the implant are measurable on the buccal and lingual sides. Therefore, intraoral ultrasonography provides additional morphological information that is not accessible by conventional dental x-rays. We propose a novel diagnostic tool that explores the biological width and is able to define the thin or thick nature of the gums. Moreover, intraoral ultrasonography may help to monitor precancerous lesions. This promising device requires large-scale clinical studies to determine whether it should remain a research tool or be used as a diagnostic tool for daily dental practice.

Relationship between the appearance of tongue carcinoma on intraoral ultrasonography and neck metastasis

Objective To evaluate the usefulness of intraoral ultrasonography (IOUS) as a tool for predicting neck metastasis.

Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography

Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography

Usefulness of intra‐oral ultrasonography to predict neck metastasis in patients with tongue carcinoma

To assess tissue characterization relating with neck metastasis of invasive tongue cancer, we investigate the usefulness of intra-oral ultrasonography (US). The patients with squamous cell carcinoma of the tongue (n = 110) were preoperatively evaluated with intra-oral US. The US images were compared with histological sections. The histological and ultrasonographic parameters were evaluated for their correlation with neck metastasis. High-quality ultrasonic images were obtained, and all lesions over 1 mm thickness by histology were detected. There was a significant correlation (P < 0.0001) between measurements of tumor thickness by US and histology. Univariate analysis showed that the histological parameters influencing neck metastasis were mode of invasion (P = 0.0006), muscular invasion (P < 0.0001), stromal reaction (P = 0.0002), and tumor thickness (P = 0.0004). Of the ultrasonographic parameters, shape of margin (P = 0.019), pattern of margin (P = 0.033), internal echo signal (P = 0.035), and tumor thickness (P < 0.0001) showed a significant correlation with neck metastasis. Ultrasound images of oral tongue cancer reflected the histological structures. Tumors with diffuse invasive mode shows an irregular and unclear tumor margins on US image. Thickness of 8 mm by ultrasound is useful as a cut-off point of predicting risk of neck metastasis of tongue cancer. Intra-oral US is a reliable tool in objectively predicting subclinical neck metastasis in tongue cancer.

Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography

Tumor thickness of oral tongue carcinoma is an important independent prognostic factor for local recurrence, subclinical nodal metastasis, and survival. An accurate preoperative assessment of tumor thickness is therefore essential in optimizing treatment algorithm. The present study aims at evaluating the accuracy of intraoral ultrasonography in preoperative measurement of tumor thickness. Forty-five patients with oral tongue carcinoma had intraoral ultrasonography to document tumor thickness using a 7.5 MHz right angle probe. The ultrasonic tumor thickness was correlated with the fresh unpreserved surgical specimen pathologic tumor thickness. Ultrasonic tumor thickness had significant correlation with pathologic tumor thickness. The accuracies of ultrasonic measurement of tumor thickness in staging of tumor thickness at cutoff values between 3 and 15 mm were above 91%. Intraoral ultrasonography had satisfactory accuracy in the measurement of tumor thickness and is a useful adjunct in assisting pretreatment staging and prognosis evaluation of oral tongue carcinoma.

P79 Intraoral ultrasonography assisted resection of T1-2 tongue cancer for the adequate deep resection margins

P79 Intraoral ultrasonography assisted resection of T1-2 tongue cancer for the adequate deep resection margins

Intraoral Ultrasound in the Diagnosis and Treatment of Suspected Peritonsillar Abscess in the Emergency Department

Intraoral Ultrasound in the Diagnosis and Treatment of Suspected Peritonsillar Abscess in the Emergency Department

Noninvasive quantitative assessment of oral tongue cancer by intraoral ultrasonography

To assess tissue characterization of oral tongue cancer and prediction of subclinical cervical lymph node metastasis, we investigated whether intraoral ultrasonography could be used in conjunction with a computer-aided diagnosis (CAD) system. The study population comprised 109 patients with presurgical, clinical T1N0 or T2N0 oral tongue squamous cell carcinoma who underwent partial glossectomy. All the patients were examined by preoperative intraoral and postoperative ex vivo ultrasonography. To evaluate the ultrasonic images quantitatively, ultrasonographic parameters from tumor contour features were computed by using the proposed CAD system. The imaging results were correlated with histopathologic findings. Oral tongue cancer was clearly identified in all patients by intraoral ultrasonography. Ultrasonic images of oral tongue cancer reflected the histopathologic structures. Subclinical cervical lymph node metastasis was predicted by intraoral ultrasonography. In a logistic regression analysis using the proposed CAD system, the diagnostic sensitivity, specificity, and accuracy for prediction of subclinical lymph node metastasis were 87.2%, 84.3%, and 85.3%, respectively. Intraoral ultrasonography in conjunction with the proposed CAD system allows tissue characterization and prediction of subclinical cervical lymph node metastasis.