Klijs J de Koning1, Sjors A Koppes2, Remco de Bree3, Jan Willem Dankbaar4, Stefan M Willems5, Robert J J van Es1, Rob Noorlag6. 1. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. 4. Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. 5. Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands. 6. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: r.noorlag@umcutrecht.nl.
Abstract
OBJECTIVES: Squamous cell carcinoma of the tongue (SCCT) is preferably treated by surgery. Free resection margins (≥5 mm) provide local control and disease-free survival. However, close (1-5 mm) and positive margins (<1 mm) are frequently encountered. We present our first experience of in-vivo ultrasound (US) guided SCCT resections followed by ex-vivo US control on the resection specimen to obtain free margins. We compare the results with those from a hisorical cohort of 91 conventionally treated SCCT patients. MATERIALS AND METHODS: Ten patients with SCCT were included in a consecutive US-cohort. We aimed for a 5-10 mm margin during surgery, while we visualized the resection plane on US. Ex-vivo US measurements on the resection specimen determined whether there was any need for an immediate re-resection. US measurements were then compared with histopathology. Histopathological margins were compared with a consecutive cohort of 91 patients who had undergone conventional surgery for a SCCT. RESULTS: In the US cohort, 70% of the margins were free. In the conventional cohort, this figure was 17% (P = 0.005). US predicted minimal histopathological margin distance with a mean ± SD error of 1.9 ± 1.8 mm. The mean ± SD of the histopathological overall submucosal/deep margin distance was 7.9 ± 2.1 mm in the US cohort and 7.0 ± 2.2 mm in the conventional cohort (P = 0.188). Ex-vivo examination through use of US indicated an immediate re-resection, which prevented local adjuvant treatment. CONCLUSION: Use of US-guided SCCT resection is feasible and improves margin control.
OBJECTIVES: Squamous cell carcinoma of the tongue (SCCT) is preferably treated by surgery. Free resection margins (≥5 mm) provide local control and disease-free survival. However, close (1-5 mm) and positive margins (<1 mm) are frequently encountered. We present our first experience of in-vivo ultrasound (US) guided SCCT resections followed by ex-vivo US control on the resection specimen to obtain free margins. We compare the results with those from a hisorical cohort of 91 conventionally treated SCCT patients. MATERIALS AND METHODS: Ten patients with SCCT were included in a consecutive US-cohort. We aimed for a 5-10 mm margin during surgery, while we visualized the resection plane on US. Ex-vivo US measurements on the resection specimen determined whether there was any need for an immediate re-resection. US measurements were then compared with histopathology. Histopathological margins were compared with a consecutive cohort of 91 patients who had undergone conventional surgery for a SCCT. RESULTS: In the US cohort, 70% of the margins were free. In the conventional cohort, this figure was 17% (P = 0.005). US predicted minimal histopathological margin distance with a mean ± SD error of 1.9 ± 1.8 mm. The mean ± SD of the histopathological overall submucosal/deep margin distance was 7.9 ± 2.1 mm in the US cohort and 7.0 ± 2.2 mm in the conventional cohort (P = 0.188). Ex-vivo examination through use of US indicated an immediate re-resection, which prevented local adjuvant treatment. CONCLUSION: Use of US-guided SCCT resection is feasible and improves margin control.
Authors: Caterina Giannitto; Giuseppe Mercante; Luca Disconzi; Riccardo Boroni; Elena Casiraghi; Federica Canzano; Michele Cerasuolo; Francesca Gaino; Armando De Virgilio; Barbara Fiamengo; Fabio Ferreli; Andrea Alessandro Esposito; Paolo Oliva; Flavio Ronzoni; Luigi Terracciano; Giuseppe Spriano; Luca Balzarini Journal: Front Oncol Date: 2021-12-09 Impact factor: 6.244