Intraoperative Ultrasound for the Management of Oral Tongue Cancer: a Systematic Review and Meta-Analysis

Overview

Journal OTO Open

Specialty Otorhinolaryngology

Date 2024 Jun 7

PMID 38846015

Authors

Ryland N Spence

Vivienne H Au

Yan Zhao

Allen L Feng

Amy F Juliano

Deborah Goss

Mark A Varvares

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate for correlation between intraoperative ultrasound (IOUS)-measured tumor thickness (TT) (uTT) and histopathological TT (hTT), and to compare IOUS-assisted resection with conventional resection in patients with oral tongue cancers.

Data Sources: Ovid MEDLINE (1946-2023), Embase.com (1947-2023), and Web of Science (All Databases 1900-2023).

Review Methods: Inclusion criteria were the use of IOUS for the management of oral tongue cancer. Studies that did not report quantitative data were excluded. Additionally, studies that were not contributory to meta-analysis, or a narrative analysis of pooled results were excluded. Selection was carried out by 2 reviewers. A total of 2417 studies were initially identified, with 12 ultimately being included in this review, and 7 included in the meta-analysis. Data were extracted by 2 investigators and were pooled using a random-effects model.

Results: Our meta-analysis reveals a pooled correlation coefficient of 0.92 (95% confidence interval: 0.80-0.96) for studies comparing uTT to hTT. Studies comparing IOUS-assisted resection to conventional resection found IOUS-assisted resection yielded wider nearest margins in all studies reporting this outcome.

Conclusion: IOUS reliably measures TT, similarly to that of histopathology measurement. IOUS-assisted resection, which allows the surgeon to view the deep extent of tumor invasion, may increase closest radial margin distance compared to conventional resection. IOUS-assisted resection may represent a more reliable approach to achieving clear margins than conventional resection.

References

DCruz A, Dhar H, Vaish R, Hawaldar R, Gupta S, Pantvaidya G . Depth of invasion in early oral cancers- is it an independent prognostic factor?. Eur J Surg Oncol. 2021; 47(8):1940-1946. DOI: 10.1016/j.ejso.2021.03.243. View

Du E, Ow T, Lo Y, Gersten A, Schiff B, Tassler A . Refining the utility and role of Frozen section in head and neck squamous cell carcinoma resection. Laryngoscope. 2016; 126(8):1768-75. DOI: 10.1002/lary.25899. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Brouwer de Koning S, Karakullukcu M, Lange C, Schreuder W, Karssemakers L, Ruers T . Ultrasound aids in intraoperative assessment of deep resection margins of squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg. 2020; 58(3):285-290. DOI: 10.1016/j.bjoms.2019.11.013. View

Patel V, Galloway T, Liu J . The impact of positive margin on survival in oral cavity squamous cell carcinoma. Oral Oncol. 2021; 122:105499. DOI: 10.1016/j.oraloncology.2021.105499. View

Maxwell J, Thompson L, Brandwein-Gensler M, Weiss B, Canis M, Purgina B . Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control. JAMA Otolaryngol Head Neck Surg. 2015; 141(12):1104-10. PMC: 5242089. DOI: 10.1001/jamaoto.2015.1351. View

Long S, Mclean T, Valero Mayor C, Fitzgerald C, Feit N, Katabi N . Use of Intraoperative Frozen Section to Assess Final Tumor Margin Status in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. 2022; 148(10):911-917. PMC: 9353701. DOI: 10.1001/jamaoto.2022.2131. View

Sproll K, Leydag S, Holtmann H, Schorn L, Aissa J, Kropil P . Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients?. J Cancer Res Clin Oncol. 2021; 147(8):2421-2433. DOI: 10.1007/s00432-021-03523-8. View

Tarabichi O, Bulbul M, Kanumuri V, Faquin W, Juliano A, Cunnane M . Utility of intraoral ultrasound in managing oral tongue squamous cell carcinoma: Systematic review. Laryngoscope. 2018; 129(3):662-670. DOI: 10.1002/lary.27403. View

10.

Yoon B, Bulbul M, Sadow P, Faquin W, Curtin H, Varvares M . Comparison of Intraoperative Sonography and Histopathologic Evaluation of Tumor Thickness and Depth of Invasion in Oral Tongue Cancer: A Pilot Study. AJNR Am J Neuroradiol. 2020; 41(7):1245-1250. PMC: 7357662. DOI: 10.3174/ajnr.A6625. View

11.

Nentwig K, Unterhuber T, Wolff K, Ritschl L, Nieberler M . The impact of intraoperative frozen section analysis on final resection margin status, recurrence, and patient outcome with oral squamous cell carcinoma. Clin Oral Investig. 2021; 25(12):6769-6777. PMC: 8602179. DOI: 10.1007/s00784-021-03964-y. View

12.

de Koning K, Koppes S, de Bree R, Dankbaar J, Willems S, van Es R . Feasibility study of ultrasound-guided resection of tongue cancer with immediate specimen examination to improve margin control - Comparison with conventional treatment. Oral Oncol. 2021; 116:105249. DOI: 10.1016/j.oraloncology.2021.105249. View

13.

Helbig M, Flechtenmacher C, Hansmann J, Dietz A, Tasman A . Intraoperative B-mode endosonography of tongue carcinoma. Head Neck. 2001; 23(3):233-7. DOI: 10.1002/1097-0347(200103)23:3<233::aid-hed1024>3.0.co;2-p. View

14.

Kerawala C, Ong T . Relocating the site of frozen sections--is there room for improvement?. Head Neck. 2001; 23(3):230-2. DOI: 10.1002/1097-0347(200103)23:3<230::aid-hed1023>3.0.co;2-v. View

15.

Helbig M, Helmke B, Flechtenmacher C, Hansmann J, Dietz A, Tasman A . [Intraoperative endosonographic guided resection of tongue carcinoma]. HNO. 2004; 53(7):631-6. DOI: 10.1007/s00106-004-1174-1. View

16.

Bulbul M, Tarabichi O, Parikh A, Yoon B, Juliano A, Sadow P . The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections. Oral Oncol. 2021; 122:105512. PMC: 9375962. DOI: 10.1016/j.oraloncology.2021.105512. View

17.

Mair M, Nair D, Nair S, Dutta S, Garg A, Malik A . Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 123(5):544-549. DOI: 10.1016/j.oooo.2016.11.018. View

18.

Bulbul M, Zenga J, Tarabichi O, Parikh A, Sethi R, Robbins K . Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members. Laryngoscope. 2020; 131(4):782-787. DOI: 10.1002/lary.28976. View

19.

Kodama M, Khanal A, Habu M, Iwanaga K, Yoshioka I, Tanaka T . Ultrasonography for intraoperative determination of tumor thickness and resection margin in tongue carcinomas. J Oral Maxillofac Surg. 2009; 68(8):1746-52. DOI: 10.1016/j.joms.2009.07.110. View

20.

Nilsson O, Knutsson J, Landstrom F, Magnuson A, Von Beckerath M . Ultrasound-assisted resection of oral tongue cancer. Acta Otolaryngol. 2022; 142(9-12):743-748. DOI: 10.1080/00016489.2022.2153916. View