The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections

Mustafa G Bulbul; Osama Tarabichi; Anuraag S Parikh; Byung C Yoon; Amy Juliano; Peter M Sadow; William Faquin; Matthew Gropler; Ronald Walker; Sidharth V Puram; Mark A Varvares

doi:10.1016/j.oraloncology.2021.105512

The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections

Oral Oncol. 2021 Nov:122:105512. doi: 10.1016/j.oraloncology.2021.105512. Epub 2021 Sep 23.

Authors

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
² Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, IA, USA.
³ Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
⁴ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
⁶ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA.
⁸ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
⁹ Department of Otolaryngology - Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: sidpuram@wustl.edu.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address: mark_varvares@meei.harvard.edu.

Abstract

Objectives: To investigate the potential utility of intra-oral ultrasound (IOUS) in guiding deep margin clearance and measuring depth of invasion (DOI) of oral tongue carcinomas (OTC).

Materials and methods: Retrospective chart review of consecutive patients with T1-T3 OTC who underwent intraoperative ultrasound-guided resection and a comparator group that had undergone resection without the use of IOUS both by a single surgeon. Data was extracted from operative, pathology and radiology reports. Deep margins and DOI were reviewed by a dedicated head and neck pathologist. Correlation between histologic and ultrasound DOI was assessed using Pearson correlation.

Results: A total of 23 patients were included in the study cohort with a comparator group of 21 patients in the control group. None of the patients in the study cohort had a positive (cut-through) deep margin and the mean deep margin clearance was 8.5 ± 4.9 and 6.7 ± 3.8 for the IOUS and non-IOUS groups respectively (p-value 0.18) showing a non-significant improvement in the IOUS group. As a secondary outcome, there was a strong correlation between histologic and ultrasound DOI (0.9449).

Conclusion: Ultrasound appears to be a potentially effective tool in guiding OTC resections. In this small series, IOUS facilitated deep margin clearance and resulted in a non-statistically significant increase in deep margin clearance. Intraoral ultrasound can accurately measure lesional DOI.

Keywords: Deep margin; Depth of invasion; Intra-oral ultrasound; Intraoperative ultrasound; Oral tongue cancer; Oral tongue squamous cell carcinoma; Ultrasound.

MeSH terms

Glossectomy
Humans
Margins of Excision*
Retrospective Studies
Tongue
Tongue Neoplasms* / diagnostic imaging
Tongue Neoplasms* / surgery
Ultrasonography*

Grants and funding

P01 CA240239/CA/NCI NIH HHS/United States