MRI测量和评估口腔黏膜鳞状细胞癌临床分期指标的准确性分析

doi:10.19438/j.cjoms.2023.04.012

中国口腔颌面外科杂志 ›› 2023, Vol. 21 ›› Issue (4): 390-396.doi: 10.19438/j.cjoms.2023.04.012

MRI测量和评估口腔黏膜鳞状细胞癌临床分期指标的准确性分析

司呈云¹, 刘梦秋², 翁海燕³, 章礼玉⁴, 安星妃¹, 周瑜^1,4

1.蚌埠医学院口腔医学院,安徽蚌埠 233030;
2.中国科学技术大学附属第一医院（安徽省立医院）影像科,3.病理科,4.口腔颌面外科,安徽合肥 230002

收稿日期:2022-12-05 修回日期:2023-01-12 出版日期:2023-07-20 发布日期:2023-08-16
通讯作者: 周瑜,E-mail: zyugj@sina.com
作者简介:司呈云（1994-）,女,硕士,E-mail: 1556068113@qq.com

Accuracy of MRI to measure and evaluate clinical staging of oral squamous cell carcinoma

SI Cheng-yun¹, LIU Meng-qiu², WENG Hai-yan³, ZHANG Li-yu⁴, AN Xing-fei¹, ZHOU Yu^1,4

1. School of Stomatology, Bengbu Medical University. Bengbu 233030;
2. Imaging Department, 3. Department of Pathology, 4. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital). Hefei 230002, Anhui Province, China

Received:2022-12-05 Revised:2023-01-12 Online:2023-07-20 Published:2023-08-16

摘要/Abstract

摘要： 目的：研究磁共振成像（MRI）测量和评估口腔黏膜鳞状细胞癌（oral squamous cell carcinoma,OSCC）临床分期指标的准确性。方法：纳入2020年2月—2022年9月就诊于中国科学技术大学附属第一医院的OSCC患者71例,记录MRI测量的肿瘤最大直径（maximum tumor diameter,MTD）、浸润深度（depth of invasive,DOI）以及最大值截面,按相应截面制作病理切片,测量病理MTD和DOI值并进行统计分析,将MRI图像评估的患者颈淋巴结状态与术后病理证实的淋巴结状态进行比较,分析术前MRI测量和评估临床分期的准确性。采用SPSS 26.0软件包对数据进行统计学分析。结果：MRI Gd-T1WI序列测量的DOI平均较病理结果高出2.54 mm（95%CI: 3.56~1.53,P<0.05）,相关系数r为0.984;T2WI序列测量的DOI平均较病理结果高出3.09 mm(95%CI: 4.88~1.29,P<0.05),相关性系数r为0.953。Bland-Altman散点图显示,Gd-T1WI序列的测量结果与病理DOI值一致性更高。临床测量的MTD较病理结果高出0.85 cm（95%CI: 0.78~0.91,P<0.05）,相关性系数r为0.958;MRI测量的MTD较病理结果高出0.21 cm（95%CI:0.10~0.32,P<0.05）,相关性系数r为0.878。MRI测量肿瘤的MTD值较临床目测的结果误差显著降低。通过MRI术前评估患者颈淋巴结状态,真阳性率为69.6%,真阴性率为89.6%。结论：MRI在测量OSCC患者临床分期指标DOI和MTD的准确性较高,可作为评估患者临床分期的一种可靠的参考方法。

关键词: 磁共振成像, 口腔黏膜鳞状细胞癌, 病理检查, 浸润深度, 肿瘤最大直径, 淋巴结转移

Abstract: PURPOSE: To investigate the accuracy of magnetic resonance imaging (MRI) for measuring and assessing the clinical staging of oral squamous cell carcinoma (OSCC). METHODS: A total of 71 patients with OSCC in The First Affiliated Hospital of University of Science and Technology of China from February 2020 to September 2022 were enrolled. The MRI measurements of maximum tumor diameter(MTD), depth of invasion(DOI), and maximum cut sections were recorded, pathological sections were made on the sections, the pathological MTD and DOI were measured and statistically analyzed, and the cervical lymph node status assessed by MRI was compared with the postoperative pathological lymph node status to analyze the accuracy of preoperative MRI measurements and clinical staging. SPSS 26.0 software package was used for data analysis. RESULTS: The mean DOI measured on the MRI was 2.54 mm(95%CI: 3.56-1.53, P<0.05), higher for Gd-T1WI sequence, with correlation coefficient r=0.984; the mean DOI measured on T2WI sequence was 3.09 mm(95%CI: 4.88-1.29, P<0.05) higher, with correlation coefficient r=0.953. Bland-Altman dot plots showed that the measurements of Gd-T1WI sequence were more consistent with pathological DOI values. At the same time, the clinical measurements of MTD were 0.85 cm (95%CI: 0.78-0.91, P<0.05), higher than the histologic findings, with correlation coefficient r of 0.958; the MRI measurements of MTD were 0.21 cm(95%CI: 0.10-0.32, P<0.05), higher than the histologic findings, with correlation coefficient r of 0.878. The MTD measured by MRI was significantly lower than that measured by clinical visualization. The preoperative assessment of cervical lymph node status by MRI was true-positive in 69.6% and true-negative in 89.6% of patients. CONCLUSIONS: MRI has a high accuracy in measuring clinical stage in patients with OSCC and can be used as a reliable reference method for assessing clinical stage.

Key words: Magnetic resonance imaging, Oral squamous cell carcinoma, Pathologic examination, Depth of invasive, Maximum tumor diameter, Lymphatic metastasis

中图分类号:

R739.8

司呈云, 刘梦秋, 翁海燕, 章礼玉, 安星妃, 周瑜. MRI测量和评估口腔黏膜鳞状细胞癌临床分期指标的准确性分析[J]. 中国口腔颌面外科杂志, 2023, 21(4): 390-396.

SI Cheng-yun, LIU Meng-qiu, WENG Hai-yan, ZHANG Li-yu, AN Xing-fei, ZHOU Yu. Accuracy of MRI to measure and evaluate clinical staging of oral squamous cell carcinoma[J]. China J Oral Maxillofac Surg, 2023, 21(4): 390-396.

参考文献

[1] Marur S, Forastiere AA.Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment[J]. Mayo Clin Proc, 2016, 91(3): 386-396.
[2] Wunschel M, Neumeier M, Utpatel K, et al.Staging more important than grading? evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma[J]. Clin Oral Investig, 2021, 25(3): 1169-1182.
[3] Faisal M, Abu Bakar M, Sarwar A, et al.Depth of invasion (DOI) as a predictor of cervical nodal metastasis and local recurrence in early stage squamous cell carcinoma of oral tongue (ESSCOT)[J]. PLoS One, 2018, 13(8): e0202632.
[4] Bulbul MG, Zenga J, Puram SV, et al.Understanding approaches to measurement and impact of depth of invasion of oral cavity cancers: a survey of American Head and Neck Society Membership[J]. Oral Oncol, 2019, 99:104461.
[5] Amin M, Edge S, Greene F, et al.AJCC cancer staging manual[M]. 8th Ed. New York: Springer, 2017.
[6] 周凯, 李恒勇, 齐晓杰,等. 口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响[J]. 中国口腔颌面外科杂志, 2021, 19(2): 138-145.
Zhou K, Li HY, Qi XJ, et al.Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation[J]. China Journal of Oral and Maxillofacial Surgery, 2021,19(2):138-145.
[7] Smiley N, Anzai Y, Foster S, et al.Is ultrasound a useful adjunct in the management of oral squamous cell carcinoma?[J]. J Oral Maxillofac Surg, 2019, 77(1): 204-217.
[8] Noorlag R, Nulent T, Delwel V, et al.Assessment of tumour depth in early tongue cancer: accuracy of MRI and intraoral ultrasound[J]. Oral Oncol, 2020, 110: 104895.
[9] Baba A, Ojiri H, Ogane S, et al.Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI[J]. Oral Radiol, 2021, 37(1): 86-94.
[10] Takamura M, Kobayashi T, Nikkuni Y, et al.A comparative study between CT, MRI, and intraoral US for the evaluation of the depth of invasion in early stage (T1/T2) tongue squamous cell carcinoma[J]. Oral Radiol, 2021, 38(1): 114-125.
[11] Tang W, Wang Y, Yuan Y, et al.Assessment of tumor depth in oral tongue squamous cell carcinoma with multiparametric MRI: correlation with pathology[J]. Eur Radiol, 2022, 32(1): 254-261.
[12] Li M, Yuan Z, Tang Z.The accuracy of magnetic resonance imaging to measure the depth of invasion in oral tongue cancer: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Surg, 2022, 51(4): 431-440.
[13] Mascitti M, Rubini C, De Michele F, et al.American Joint Committee on Cancer staging system 7th edition versus 8th edition: any improvement for patients with squamous cell carcinoma of the tongue?[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2018, 126(5): 415-423.
[14] D'Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer[J]. N Engl J Med, 2015, 373(6): 521-529.
[15] Xu C, Yuan J, Kang L, et al.Significance of depth of invasion determined by MRI in cT1N0 tongue squamous cell carcinoma[J]. Sci Rep, 2020, 10(1): 4695-4701.
[16] Donners R, Krieg AH, Baumhoer D, et al.Quantitative signal intensity ratios to distinguish between subfascial lipoma and atypical lipomatous tumor/well-differentiated liposarcoma using short-tau inversion recovery (STIR) MRI[J]. Diagn Interv Imaging, 2020,101(6): 383-390.
[17] Chang WC,Chang CF, Li YH, et al.A histopathological evaluation and potential prognostic implications of oral squamous cell carcinoma with adverse features[J]. Oral Oncol, 2019, 95: 65-73.
[18] Minamitake A, Murakami R, Sakamoto F, et al.Can MRI-derived depth of invasion predict nodal recurrence in oral tongue cancer?[J]. Oral Radiol, 2021, 37(4): 641-646.
[19] Fu JY, Zhu L, Li J, et al.Assessing the magnetic resonance imaging in determining the depth of invasion of tongue cancer[J]. Oral Dis, 2021, 27(3): 457-463.
[20] Baba A, Hashimoto K, Kayama R, et al.Radiological approach for the newly incorporated T staging factor, depth of invasion, 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[J]. Jpn J Radiol, 2020, 38(9): 821-832.
[21] Choi KY, Park SC, Kim JH, et al.The occult nodal metastasis rate of early tongue cancer (T1-T2): a protocol for a systematic review and meta-analysis[J]. Medicine (Baltimore), 2021, 100(3): e24327.
[22] Vuity D, McMahon J, Hislop S, et al. Sentinel lymph node biopsy for early oral cancer- accuracy and considerations in patient selection[J]. Br J Oral Maxillofac Surg, 2022, 60(6): 830-836.
[23] Ren J, Yuan Y, Tao X, et al.Histogram analysis of diffusion-weighted imaging and dynamic contrast-enhanced MRI for predicting occult lymph node metastasis in early-stage oral tongue squamous cell carcinoma[J]. Eur Radiol, 2022, 32(4): 2739-2747.

MRI测量和评估口腔黏膜鳞状细胞癌临床分期指标的准确性分析

Accuracy of MRI to measure and evaluate clinical staging of oral squamous cell carcinoma

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 6

编辑推荐

Metrics

本文评价

[1]	周瑜, 翁海燕, 司呈云, 段贤捷, 安星妃, 章礼玉. 第8版TNM分期修订版对早期口腔黏膜鳞癌患者预后及危险分层作用的临床研究[J]. 中国口腔颌面外科杂志, 2022, 20(6): 571-576.
[2]	王灿, 张春叶, 陶晓峰, 王博成, 朱凌. 29例头颈部炎性肌纤维母细胞肿瘤的CT及MRI影像学特征分析[J]. 中国口腔颌面外科杂志, 2022, 20(5): 494-499.
[3]	陈建荣, 丁水清, 陈亮, 何佳嘉, 祁荣兴. 颞下颌关节紊乱的影像学特征：锥形束CT和MRI效能比较[J]. 中国口腔颌面外科杂志, 2022, 20(3): 273-276.
[4]	瞿俊晨, 贾传海, 丁庆国, 曹锐, 丘佳明. MRI图像纹理分析在腮腺良、恶性肿瘤鉴别诊断中的价值[J]. 中国口腔颌面外科杂志, 2022, 20(2): 173-176.
[5]	王天鸽, 周志捷, 林怡君, 孙仪庭, 陈昱, 孙华, 毛丽霞, 刘加强. 术前正畸对颞下颌关节关节盘及髁突位置和形态的影响[J]. 中国口腔颌面外科杂志, 2021, 19(5): 439-444.
[6]	高倩倩, 冯元勇, 刘世恩, 万升标, 江涛, 尚伟. 颈部淋巴结转移和反应性增生的间质磁共振造影表现[J]. 中国口腔颌面外科杂志, 2016, 14(3): 218-222.