Pathological Depth Of Invasion Research Articles

Subtraction iodine imaging with area detector CT to improve tumor delineation and measurability of tumor size and depth of invasion in tongue squamous cell carcinoma

PurposeTumor size and depth of invasion (DOI) are mandatory assessments for tumor classification in tongue cancer but are often non-assessable on CT due to dental artifacts. This study investigated whether subtraction iodine imaging (SII) would improve tumor delineation and measurability.Materials and methodsFifty-seven consecutive patients with tongue cancer, who underwent scanning with a 320-row area detector CT with contrast administration and were treated with surgical resection, were retrospectively evaluated. CT was reconstructed with single-energy projection-based metallic artifact reduction (sCT). SII was generated by subtracting the pre-contrast volume scans from the post-contrast volume scans using a high-resolution deformable registration algorithm. MRI scans were also evaluated for comparing the ability of measurements. Two radiologists visually graded the tumor delineation using a 5-point scale. Tumor size and DOI were measured wherever possible. The tumor delineation score was compared using the Wilcoxon signed-rank method. Spearman’s correlations between imaging and pathological measurements were calculated. Intraclass correlation coefficients of measurements between readers were estimated.ResultsThe tumor delineation score was greater on sCT-plus-SII than on sCT alone (medians: 3 and 1, respectively; p < 0.001), with higher number of detectable cases observed with sCT-plus-SII (36/57 [63.2%]) than sCT alone (21/57 [36.8%]). Tumor size and DOI measurability were higher with sCT-plus-SII (29/57 [50.9%]) than with sCT alone (17/57 [29.8%]). MRI had the highest detectability (52/57 [91.2%]) and measurability (46/57 [80.7%]). Correlation coefficients between radiological and pathological tumor size and DOI were similar for sCT (0.83–0.88), sCT-plus-SII (0.78–0.84), and MRI (0.78–0.90). Intraclass correlation coefficients were higher than 0.95 for each modality.ConclusionsSII improves detectability and measurability of tumor size and DOI in patients with oral tongue squamous cell carcinoma, thus increasing the diagnostic potential. SII may also be beneficial for cases unevaluable on MRI due to artifacts or for patients with contraindications to MRI.

Assessment of tumor depth in oral tongue squamous cell carcinoma with multiparametric MRI: correlation with pathology

ObjectivesTo compare the correlation of depth of invasion (DOI) measured on multiple magnetic resonance imaging (MRI) sequences and pathological DOI, in order to determine the optimal MRI sequence for measurement.MethodsA total of 122 oral tongue squamous cell carcinoma (OTSCC) patients were retrospectively analyzed, who had received preoperative MRI and surgical resection. DOIs measured on fat-suppressed T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), dynamic enhanced-T1 high-resolution insotropic volume examination (e-THRIVE), and contrast-enhanced fat-suppressed T1WI (CE-T1WI) were respectively compared to those measured in pathologic specimens. The cutoff value of the best correlated MRI sequence was determined, and the T staging accuracy of MRI-derived DOI was evaluated.ResultsDOI derived from e-THRIVE showed the best correlation (r = 0.936, p < 0.001) with pathological DOI. The area under the curve values of MRI-derived DOI distinguishing T1 stage from T2 stage and distinguishing T2 stage from T3 stage were 0.969 and 0.974, respectively. The T staging criteria of MRI-derived DOI were 6.2 mm and 11.4 mm, with a staging accuracy of 86.9% compared to pathological DOI criteria of 5 mm and 10 mm.ConclusionE-THRIVE was the optimal MR sequence to measure the MR-derived DOI, and DOI derived from e-THRIVE could serve as a potential cut-off value as a clinical T staging indicator of OTSCC.Key Points• Multiparametric MRI helps radiologists to assess the neoplasm invasion in patients with oral tongue squamous cell carcinoma.• Retrospective study indicated that measurement was most accurate on enhanced-T1 high-resolution insotropic volume examination dynamic contrast enhancement images.• T staging of oral tongue squamous cell carcinoma was accurate according to the dynamic contrast enhancement MRI-derived depth of invasion.

Assessment of squamous cell carcinoma of the floor of the mouth with magnetic resonance imaging

PurposeWe aimed to use magnetic resonance imaging (MRI) to determine the relationship between the pathological depth of invasion (DOI), undetectability, and tumor thickness of squamous cell carcinoma of the floor of the mouth.Materials and methodsWe retrospectively evaluated the relationship between pathological DOI and MRI detectability, as well as the relationship between pathological DOI and tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging or coronal T2-weighted imaging.ResultsWe analyzed 30 patients with squamous cell carcinoma of the floor of the mouth; MRI revealed that the pathological DOI of the 11 undetectable lesions (median 2 mm) was smaller than that of the 19 detectable lesions (median 14 mm) (p < 0.001), and the cut-off value was 3 mm (sensitivity, 0.84; specificity, 0.91; area under the curve, 0.89). Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was assessed in all 19 detectable lesions; however, tumor thickness on coronal T2-weighted imaging could not be assessed in eight cases. Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was found to be significantly associated with the pathological DOI.ConclusionsUndetectability on MRI indicates superficial lesions with a pathological DOI value that is less than 3 mm. In detectable lesions, tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging is associated with pathological DOI.

Feasibility of Use of the 8th Edition of the American Joint Committee on Cancer Staging for Head and Neck Cancers in Indian Scenario: An Evaluative Study.

Introduction:Inclusion of depth of invasion (DOI) and a separate classification for human papillomavirus (HPV)-associated Oropharyngeal Cancers (OPCs) are two of the many major changes in the 8th edition of the American Joint Committee on Cancer staging system. After more than 2 years of implementation, the authors found the need to evaluate if the Indian clinicians found it feasible to apply the system in their practice and if the same has influenced their decision-making.Methods:The survey was done in the form of a questionnaire which was distributed personally and via the internet to 100 clinicians. Seventy-two clinicians responded to the questionnaire. The results were analyzed and frequency distribution was computed.Results:Eighty-three percent of the clinicians experienced that palpation of the tumour was not a reliable method to determine the DOI. The common issues stated by the clinicians were difficulty in assessing DOI in certain subsites of the oral cavity (most commonly retromolar trigone–83%), inability to determine DOI in patients with trismus, and inability to correlate pathological and clinical DOI. Thirteen percent of the clinicians did not rely on radiological tools for measuring the DOI. Seventy percent of the clinicians did not perform a P16 assay for patients with oropharyngeal cancers. Fifty percent of the clinicians preferred chemoradiotherapy for early HPV positive oropharyngeal cancers.Discussion:Based on the results of the survey, the authors recommend a need for more interpretative guidelines and methods for determining the DOI. The authors also emphasize the need for determining HPV status for all oropharyngeal carcinomas.

Assessing the magnetic resonance imaging in determining the depth of invasion of tongue cancer.

To assess the magnetic resonance imaging (MRI) in predicting tumour's depth of invasion (DOI) of tongue cancer by comparing to pathology and to determine the cut-off value of MRI-derived DOI for lymph node metastasis. In a retrospective analysis, 156 patients with newly diagnosed tongue cancer were included. Tumour's DOI was compared between MRI measurement and pathology by Pearson correlation coefficient and paired t test. The accuracy of MRI-derived DOI was compared to the pathological DOI. The relationship between MRI-derived DOI and cervical lymph node metastasis was calculated by receiver operating characteristic curve. Tumour's DOI was well correlated between MRI measurement and pathology with correlation coefficients of 0.77. MRI-derived DOI was 3.4mm (28%) larger than pathology. The accuracy of MRI in deciding pathological DOI was 67.9%. The cut-off value of MRI-derived DOI was 10.5mm for lymph node metastasis of tongue cancer. Magnetic resonance imaging can be used as a reference to determine tumour's DOI of tongue cancer. Tumour with MRI-derived DOI larger than 10.5mm deserves simultaneous neck dissection at initial surgery.

Relationship between the microvascular patterns observed by magnifying endoscopy with narrow-band imaging and the depth of invasion in superficial pharyngeal squamous cell carcinoma.

Prediction of the invasive depth is the objective of endoscopic observation for digestive cancer. In superficial esophageal cancer, a close relationship between microvascular patterns observed by magnifying endoscopy with narrow-band imaging (M-NBI) and pathological depth of invasion is well known. The ability of M-NBI to predict the invasion depth in superficial pharyngeal squamous cell carcinoma (SPSCC) has been seldom evaluated. This study aimed to clarify the relationship between the microvasculature patterns and pathological depth in SPSCC. SPSCC lesions evaluated with M-NBI followed by endoscopic resection were analyzed between April 2010 and March 2017. Endoscopic images were classified as microvasculature tumor types B1, B2, and B3 according to the Japan Esophageal Society classification. The pathological depth of invasion was described as either squamous cell carcinoma in situ (Tis) or invasive subepithelial cancer, and the tumor thickness of all lesions was examined. Data were analyzed using the unpaired t, χ2, or Mann-Whitney U test. Type B1 and type B2/B3 (35/3) microvessels were found in 180 lesions (82%) and 39 (18%), respectively. Of the flat lesions, 115 (83%) were classified as Tis and 23 (17%) as subepithelial cancer. Positive and negative predictive values of the B1 vessels were 77% and 82%, respectively. Additional analysis showed that the positive predictive value of the B1 vessels for the flat-type lesions was 87%; the negative predictive value for the elevated lesions was 93%. Microvascular patterns observed by M-NBI are an important factor in predicting the pathological depth of invasion.

Radiological approach for the newly incorporated T staging factor, depth of invasion(DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection.

The 8th edition of American Joint Committee on Cancer's (AJCC) Cancer Staging Manual was modified by incorporating depth of invasion (DOI) in the T categorization of oral cavity cancer. This is because DOI is strongly associated with cervical lymph node metastasis, which is the most important negative prognostic factor of oral cavity cancer. This major change in the AJCC Cancer Staging Manual caused re-staging of T category in several cases. Although, the DOI on MRI and CT (radiological DOI; r-DOI) strongly correlated with pathological DOI (p-DOI), it is often 2-3mm larger than p-DOI. Due to this variance, estimation of p-DOI based on r-DOI may not be accurate. However, when a lesion is undetectable on MRI, p-DOI was often smaller than 4mm. On the other hand, when MRI depicts lesions with styloglossus and hyoglossus muscle invasion, p-DOI was always larger than 4mm. These correlations between MRI findings and p-DOI are important when assessing the need for elective neck dissection, as the National Comprehensive Cancer Network (NCCN) recommends elective neck dissection in cases with DOI greater than 4mm.

Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI.

There is currently no standardized approach for assessing the depth of invasion (DOI) of oral tongue squamous cell carcinoma via diagnostic imaging. We investigated the usefulness of contrast-enhanced computed tomography (CECT) for estimating the pathological DOI of oral tongue squamous cell carcinoma by evaluating the correlation of pathological DOI with the DOIs on CECT and magnetic resonance imaging (MRI). We retrospectively reviewed 21 of 139 patients who underwent radical surgery for primary oral tongue squamous cell carcinoma between 2009 and 2018. The 21 cases were evaluable, without dental artifacts on CECT. DOIs on CECT and MRI, and pathological DOI were measured. The median pathological DOI was 9mm, that on CECT was 10.9mm, that on T2-weighted MRI was 14.2mm, and that on contrast-enhanced T1-weighted MRI was 13.1mm. The DOIs on CECT and on MRI were larger than the pathological DOI (p = 0.003 to < 0.001). The absolute value of the difference between pathological DOI and DOI on CECT was smaller than that between pathological DOI and DOI on MRI (p = 0.01 and 0.003). DOIs on CECT and on MRI correlated with pathological DOI (r = 0.74-0.66, all p < 0.001). Spearman's correlation coefficient between DOI on CECT and pathological DOI was greater than that between DOI on MRI and pathological DOI. Compared to the DOI determined on an MRI scan, the DOI determined on a CECT scan correlated with and better approximated pathological DOI. Therefore, CECT can be useful for preoperative staging of patients with oral tongue squamous cell carcinoma.

An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer

Background: In stage-I/stage-II oral tongue cancer, the cutoff value of depth of invasion (DOI) for prophylactic neck dissection is controversial.Objectives: To examine the relationship between the DOI and the rate of occult lymph node metastasis. In addition, to examine the relationship between the DOI evaluated by magnetic resonance imaging (MRI) and pathological DOI.Materials and methods: In this retrospective study, 95 patients with clinical T1-2/N0M0 oral tongue cancer were enrolled. The rate of occult lymph node metastasis per DOI between 2 and 11 mm was calculated from the total pathological lymph node metastasis and delayed neck metastasis cases. We measured DOI using MRI and compared DOI obtained from pathology.Results: The total rate of occult lymph node metastasis was 23.9%. In the rate of occult lymph node metastasis per DOI, there were two peaks at point of 5 to 6 mm and 9 to 10 mm. And there was a significant correlation between the DOI evaluated by MRI and the pathological DOI (Pearson’s correlation coefficient was 0.87).Conclusions and significance: There was no consistent increase in the rate of occult lymph node metastasis per DOI. MRI was a useful modality to measure the DOI.

Analysis of tongue squamous cell carcinoma with Doppler sonography and strain elastography using intraoral ultrasonography

Background: Depth of invasion (DOI) in oral carcinoma has been integrated into the primary tumor categories in the current tumor-node metastasis staging, and intraoral ultrasonography provides sufficient accuracy for the measurement of tumor DOI in oral tongue carcinoma. Aims: The objectives of this study were to analyze the tongue squamous cell carcinoma (SCC) with Doppler sonography and strain elastography using intraoral ultrasonography. Materials and Methods: Six patients with tongue SCC who underwent Doppler sonography and strain elastography using intraoral ultrasonography were prospectively included. Doppler sonography and strain elastography using intraoral ultrasonography were obtained with a linear 14 MHz transducer using our protocol. The tumor thickness using ultrasonography and tumor with/without vascular signals were evaluated by the Mann–Whitney U-test. The relationship between tumor thickness using ultrasonography and pathological tumor thickness and DOI was assessed by the Pearson's rank correlation test. P values lower than 0.05 indicate statistically significant differences. Results: The tumor thickness using ultrasonography in the vascular signal's presence group (5.8 ± 1.4 mm) was larger than that of the absence group (3.1 ± 1.5 mm, P = 0.050). The strain values of tumor and control in the tongue SCC were 0% and 0.534% ± 0.236%, respectively. Tumor thickness using ultrasonography was correlated with pathological tumor thickness (r = 0.811, P = 0.050) and pathological DOI (r = 0.599, P = 0.209), respectively. Conclusions: Doppler sonography and strain elastography using intraoral ultrasonography are useful for the analysis of tongue SCC.

The role of MRI-derived depth of invasion in staging oral tongue squamous cell carcinoma: inter-reader and radiological-pathological agreement.

Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radiological–histopathological correlations for the depth of invasion were evaluated with Bland–Altman plots, the intraclass correlation coefficients (ICC), and the paired samples test; agreements for T staging were assessed using the Kappa coefficient. Results Inter-reader reliability was excellent for the MRI-derived depth of invasion (ICC = 0.91), very good between MRI-derived depth of invasion and pathological depth of invasion (ICC = 0.89 for the experienced reader, 0.86 for the inexperienced reader). Both readers reached a good agreement regarding T staging (kappa value = 0.70). Furthermore, the agreement between radiological and pathological T staging was good (kappa value = 0.74 for the experienced reader, 0.60 for the inexperienced reader). Conclusion MRI-derived depth of invasion should be measured in the pretreatment assessment of oral tongue squamous cell carcinoma as it has an excellent inter-reader reliability and nearly excellent radiological–pathological correlation.

Preoperative indicators of misdiagnosis in invasion depth staging of esophageal cancer: Pitfalls of magnifying endoscopy with narrow-band imaging.

The Japan Esophageal Society classification has been widely applied for predicting the invasion depth of superficial esophageal squamous cell carcinomas (SESCCs). Although Type B2 of the classification clinically corresponds to SESCCs with muscularis mucosa or slight submucosal invasion (MM/SM1), diagnostic yield based on Type B2 is insufficient. This study aimed to investigate risk factors for misdiagnosis in preoperative invasion depth staging. We included a total of 104 SESCCs in which Type B2 was observed by magnifying endoscopy. SESCCs were classified as either correct diagnosis (pMM/SM1, 39 lesions), overdiagnosis (epithelium or the lamina propria [pEP/LPM], 34 lesions), or underdiagnosis (deep invasion into the submucosa [pSM2-3], 31 lesions) based on pathological depth of invasion. The association between misdiagnosis and endoscopic features, including distinct features, was evaluated using logistic regression analysis. Distinct features were defined as nodular protrusion, thickness, and/or clearly depressed area. The diameter of type B2 area was endoscopically measured, and the cut-off value was determined using a receiver operating characteristic curve. Type B2 area <6mm (area under the curve, 0.776) and Type B2 vessels around erosion were significantly associated with overdiagnosis (odds ratio, 16.6 and 11.0, respectively), while distinct features were significantly associated with underdiagnosis (odds ratio, 8.7). Adjusted by these misdiagnosis factors, positive predictive value of Type B2 significantly improved from 38% to 65% (P<0.01). Lesions with a small Type B2 area (<6mm) and/or Type B2 vessels around erosion should be diagnosed as EP/LPM and lesions with distinct features as SM2-3.

Magnetic resonance imaging findings of styloglossus and hyoglossus muscle invasion: Relationship to depth of invasion and clinical significance as a predictor of advisability of elective neck dissection in node negative oral tongue cancer

PurposeBy comparing styloglossus and hyoglossus muscle invasion (SHMI) of oral tongue squamous cell cancer (OTSCC) on MR imaging to pathological depth of invasion (DOI) and prognosis, we aimed to evaluate the clinical significance of MR imaging findings of SHMI. MethodForty-five, early stages and clinically N0 OTSCCs were retrospectively reviewed. Data included pathological DOI, DOI on MR imagings, two-year potential cervical lymph node positive, locoregional control, disease-free survival, and overall survival. Data were statistically compared between the groups with MR evidence of SHMI (SHMI+) and without MR evidence of SHMI (SHMI-). ResultsThere were 17 SHMI + and 28 SHMI-. Elective neck dissections performed on 13 cases revealed five node positive cases, all of which were SHMI + . Pathological DOI in SHMI + was significantly larger than SHMI- (average 9.0 vs 4.6 mm, p < 0.001). All SHMI + revealed pathological DOI larger than 4 mm. The two-year potential cervical lymph node positive rate of SHMI + was significantly higher than SHMI- (p = 0.01). Locoregional control rate and disease-free survival of SHMI+ were significantly lower than in SHMI- (p = 0.02). There was no significant difference in overall survival. Interobserver agreement in evaluation of SHMI on MR imaging was good (kappa value = 0.72, p < 0.001). ConclusionsPathological DOIs of SHMI + were all larger than 4 mm, which is the cut-off point that National Comprehensive Cancer Network recommends for neck dissection, and SHMI + had a worse prognosis than SHMI-. SHMI + can be used as a criterion for elective neck dissection.

Undetectability of oral tongue cancer on magnetic resonance imaging; clinical significance as a predictor to avoid unnecessary elective neck dissection in node negative patients.

We retrospectively reviewed early stage oral tongue cancer patients treated with radical surgery with clinically N0, between May 2009 and February 2016. Collected data include age, sex, pathological DOI, DOI on MRI, locoregional control rate, disease-free survival rate, and overall survival rate. These data were statistically compared between the detectable lesion (DL) group and undetectable lesion (UL) group on MRI. Interobserver agreement in evaluation of detectability of the oral tongue cancer was assessed by k statistics. Total of 53 patients were studied, and 28 were DLs and 25 ULs. Pathological DOI in UL was significantly smaller than that of DL (average 1.7 vs 4.6 mm, p < 0.001). Cut-off value between UL group and DL group was 3.5 mm (sensitivity 96 %, specificity 75 %). 96 % of ULs had pathological DOI smaller than 4 mm, the recommended cut-off value for neck dissection. There was no significant difference in locoregional control rate (p = 0.24), disease-free survival rate (p = 0.24) or overall survival rate (p = 0.92). Interobserver agreement in evaluation of detectability on MRI was very good ( k-value = 0.89, p < 0.001). When oral tongue cancer is not detected on MRI, it indicates pathological DOI being smaller than 4 mm, which may imply that elective neck dissection is unnecessary.

Tu1177 ENDOSCOPIC RESECTION IS THE APPROPRIATE TREATMENT CHOICE FOR MM INVASIVE ESOPHAGEAL SCC

Recent advances in endoscopic resection (ER) provide us increasing chances for resecting esophageal SCC with muscularis mucosae (MM) invasion. For them, we perform additional therapy such as chemo radiotherapy (CRT) or operation considering the risk of metastasis and patients’ condition. However, there is only a few reports of long term outcome comparing ER and operation, which is the standard treatment for MM invasive esophageal SCC. We retrospectively studied the long-term outcome in 134 cases of esophageal SCC with pathological MM invasion resected by ER (99 cases) and operation (35 cases) from 2003 to 2014 in Cancer Institute Hospital. Median observation period was 62 months for ER cases and 50 months for operation cases. Median age for ER and operation cases were 66 and 64. Median lesion size in ER cases were significantly smaller than that in operation cases (24mm vs 44mm, P<0.01). Lymphovascular invasion were observed 14% in ER cases and 26% in operation cases. It was implicated that operation cases were more advanced cancer, although pathological depth of invasion was both MM. Of 99 cases of ER, 79 cases were observed without additional treatment. One case had recurrence as LN metastasis, received operation and CRT, and survived with no re-recurrence. The rest of 20 cases were recommended additional therapy because of lymphovascular invasion or droplet infiltration and 12 cases were performed additional therapy (operation/CRT/RT 7/4/1). Of 35 cases of operation, one case had recurrence and resected additionally. No one died of Esophageal SCC in both groups. Overall survival rate in 3 year/5 year were 90.8%/89.4% in ER cases and 88.6%/81.2% in operation cases. Cause specific survival rate in 3 year/5 year were 100%/100% in both ER cases and operation cases. The long-term outcome of ER for MM invasive esophageal SCC was good enough with appropriate additional therapy. ER will be a good and appropriate treatment choice for MM invasive esophageal SCC.

Staging of oral cavity cancer in the 8th edition of the TNM classification: the role of computed tomography in the assessment of depth of invasion and extranodal extension

Introduction: In the TNM staging (TNM-8) for oral cavity cancers (OCC), depth of invasion (DOI) and extranodal extension (ENE) were added to the T and N pathological classification, respectively. It has been recognized for decades that the prognosis of OCC worsens when the tumor is thicker, but more recent data suggest that DOI is a better predictive parameter than tumor thickness. Objective: Suggest and validate pre-surgical tomographic evaluation criteria for OCC based on the pathological DOI criteria. Methods: A retrospective cohort study was conducted with 80 patients with tongue and floor of mouth tumors, T1 and T2, followed from 2009 to 2015. Patients were initially classified according to the 7th edition of the TNM (TNM-7) using pathological samples and then reclassified based on the updated 8th edition of the TNM (TNM-8) criteria. The same was done radiologically, using extrapolation and adaptation of the pathological criteria to tomographic evaluation. The results of pathological staging were compared and correlated with the main clinical outcomes. The same was done with the radiological results. To evaluate the pre-surgical accuracy of tomographic staging, radiological and pathological results were compared. Results: Regardless of the criteria (TNM-7 or TNM-8), it was observed that computed tomography (CT) with venous contrast may be used to guide the initial staging. Strong positive correlation was observed between tumor thickness and DOI at both CT and pathology. Considerable upstaging was observed in the sample of assessed patients for both criteria. In the comparison between tomographic and pathological T classifications, moderate correlation was observed in relation to thickness and DOI. Conclusion: Computed tomography can be used to evaluate the depth of preoperative invasion in oral cavity tumors according to the criteria established in the present study.