原文題目

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原文題目(出處)： Relationship between the appearance of tongue carcinoma on intraoral ultrasonography and neck metastasis. Oral Radiol 2011;27:1-7

原文作者姓名： Maria C. Chammas, Tu´ lio A. A. Macedo, Raquel A.

Moyses, Rene´ Gerhard, Marcelo D. Durazzo, Cla´udio R.

Cernea, Giovanni G. Cerri

通訊作者學校： Department of Radiology, Hospital das Clı´nicas da Faculdade de Medicina da Universidade de Sa˜o Paulo, Brazil

報告者姓名(組別)：黃珊珊 Intern F 組

報告日期： 101/2/4

內文：

Introduction

 SCC of the tongue:

1. usually very aggressive

2. great propensity to metastasize to cervical lymph nodes

3. even worse prognosis when associated with metastatic cervical nodes

4. the metastatic potential should be graded preoperatively to help determine the requirement for neck dissection

 One of the most important factors associated with the development of nodal metastases: the thickness of the lesion

1. thickness of SCC directly related to the presence of nodal metastasis

2. procedures routinely performed preoperatively: digital palpation, computed tomography (CT), magnetic resonance imaging (MRI), and biopsies for histopathological examination

3. Ultrasonography is a noninvasive, rapid, easily repeatable, and inexpensive examination.

 Purpose of this study:

1. examing the usefulness of intraoral ultrasonography (IOUS) as a tool for predicting neck metastasis

2. delineating the extent of the tumor based on a comparison with the histopathological findings

Materials and methods

 19 patients (11 men, 8 women) between 36 and 79 years of age (mean age 60 years) with T1 to T4a TNM-stage tongue carcinomas were evaluated preoperatively by IOUS between February 2006 and January 2009

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 Sonographic technique

1. B-mode intraoral scanning was performed using a grayscale US system

2. High-frequency T-type linear array probe with lateral field-of view coated with sterile gel and covered with a rubber sheath

Results

 Intraoral sonography identified all of the tongue lesions.

 Close examination of the findings revealed the sonographic pattern of 1. normal tongue  homogeneous echogenic tissue

2. tumors  hypoechoic

 When an ulcerated area was present, a hyperechoic image was visualized with posterior sonography attenuation due to air interpositioning

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 A significant correlation was observed between the tumor thicknesses measured using US (r) and the pathological findings (q)

 Using the maximum accuracy, the cutoff points for the US and histological tumor thickness for predicting neck metastasis  1.8 and 1.1 cm, respectively

 Of the 19 (42.1%) patients, eight had metastatic lymph nodes

 A tumor with a thickness＞1.8 cm measured by IOUS and 1.1 cm measured in the histological sections had a higher probability of metastatic cervical lymph nodes.

 Among the histopathological parameters: only tumor thickness was a significant predictor of metastasis

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 Muscle invasion, histological grade, inflammatory cell infiltration, and desmoplasia were not correlated with neck metastasis (p＞0.05)

Discussion

 A knowledge of the factors may influence neck metastasis would help to avoid unnecessary surgical intervention for N0 patients

 There is a significant correlation between neck metastasis and tumor thicknesscan help in planning the treatment regimen and indicate the disease prognosis

 US images reflect the actual tumor thickness more precisely than the measurements obtained using histological sections

 The main technical limitation of IOUS was apparent when large or posterior lesions were present, primarily due to:

1. difficulty in accessing the posterior tongue with the probe 2. induction of vomiting

Conclusion

 Intraoral ultrasonography is useful tool for identifying tongue tumors and measuring their thickness

 Thickness measured by IOUS showing a very good correlation with histological measurements

 IOUS provides prognostic information prior to surgical treatment since tumor thickness can predict the chance of recognizing metastatic cervical nodes

題號題目

1 下列關於 Squamous cell carcinoma 的敘述何者錯誤?

(A) Oral SCC has a varied clinical presentation, including: exophytic, endotphytic, leukoplakic, erythroplakic and erythroleukoplakic.

(B) The surface of the lesion is often ulcerated and indurated on palpation

(C) Destruction of underlying bone appears on radiographs as a

“moth-eaten”with ill-defined margins

(D) There is severe pain in the early growth phase

答案(D) 出處：Oral and Maxillary Pathology, third edition. P.412~14

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題號題目

2 下列關於 metastasis of Squamous cell carcinoma 之敘述何者正確?

(A) Metastatic spread of oral SCC is largely through the lympatics to the ipsilateral cervical lymph nodes

(B) Carcinoma of the lower lip and oral floor tends to travel to the submandibular nodes

(C) The most common sites of distant metastasis are the brain, liver and muscles.

(D) In TNM staging, N0 means no evidence of distant metastasis 答案(A) 出處：Oral and Maxillary Pathology, third edition. P.417~8