Evidence for imaging the mandible in the management of oral squamouscell carcinoma: a review

doi:10.1054/bjom.2001.0717

British Journal of Oral and Maxillofacial Surgery

Volume 39, Issue 6, December 2001, Pages 411-418

https://doi.org/10.1054/bjom.2001.0717 Get rights and content

Abstract

The accuracy of clinical examination, peroperative periosteal stripping and imaging techniques in predicting tumour invasion of the mandible in oral cancer so far reported have been compared according to their specificity and sensitivity. Clinical examination alone was not shown to be accurate, but periosteal stripping at the time of resection was extremely accurate although so far only one study has investigated it. No single imaging technique will accurately predict the invasion of tumour into the mandible, but a combination of an orthopantomogram and bone scintigraphy is recommended in early invasion. Magnetic resonance imaging is more sensitive than computed tomography and therefore may be more useful if mandibular invasion requires consideration. The decision to resect the mandible as part of the management of oral cancer should be taken on the evidence of clinical examination, periosteal stripping and at least two imaging techniques that complement each other in terms of specificity and sensitivity.

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Cited by (61)

Accuracy of preoperative clinical examination and imaging for mandibular resection in oral cancer: a systematic review of diagnostic test accuracy studies
2023, British Journal of Oral and Maxillofacial Surgery
The aim of this systematic review is not only to analyse the accuracy of clinical examination and radiological preoperative assessment of mandibular invasion reported in isolation, but to highlight those reports that have combined them. A total of 1636 titles and abstracts published between 1995 – 2000 were screened following a literature search in PubMed. Keywords were “mandible” and “squamous cell carcinoma”. A total of 90 full manuscripts were reviewed with 24 meeting defined inclusion/exclusion criteria and yielding the data reported. The most sensitive test was single photon emission tomography with eight out of the 10 studies reporting sensitivity higher than 95%. Magnetic resonance imaging (MRI) demonstrated superior sensitivity but was less specific than computed tomography (CT). A single report attempted to report the combined CT and MRI scans with a separate expert reporting but did not result in more reliable detection. Periosteal stripping was not reported, and there was insufficient data to establish the value of new technologies. This review confirms that, to our knowledge, there are no reliable data on the results of combining imaging techniques with or without clinical examination. It emphasises the lack of data for the combination of preoperative techniques to enhance safe oncological resection of the mandible. Based on the evidence gathered in this review an algorithm of assessment of possible mandibular invasion is proposed. With new technologies available and 3-dimensional models to help plan the mandibular resection and reconstruction, the potential of combining preoperative investigations should be fully realised through prospective research.
Diagnostic efficacy of PET-CT, CT, and MRI in preoperative assessment of mandibular invasion caused by head and neck cancer: A systematic review and meta-analysis
2021, Oral Oncology
This study aims to conduct a systematic review and meta-analysis of the performance of PET-CT, CT, and MRI in diagnosing mandible invasion induced by head and neck cancer (HNC).
The MEDLINE, Embase, Science Direct, CNKI and CQVIP databases were searched from inception until August 1, 2020. Then, a meta-analysis was conducted to calculate the combined diagnostic values with the corresponding 95% CIs. Two independent researchers completed the full text screening, data abstraction, and risk assessment.
This meta-analysis included 53 studies (N = 2 946 participants). For the pooled sensitivity (SEN), MRI (SEN: 0.88, 95% CI: 0.81–0.93) was found to have a significantly higher SEN (P = 0.0045), when compared to CT (SEN: 0.77, 95% CI: 0.71–0.82), while compared with PET-CT (SEN: 0.88, 95% CI: 0.64–0.97), the SEN was approximately equal (P > 0.05). The analysis revealed that the combined specificity (SPE) of MRI (SPE: 0.83, 95% CI: 0.74–0.89) and PET-CT (SPE: 0.81, 95% CI: 0.57–0.93) was lower than that of CT (SPE: 0.87, 95% CI: 0.83–0.90), but there was no statistical significance among these (P > 0.05). The comparison of the area under curve (AUC) reflected that PET-CT, CT and MRI have approximately equal summary diagnostic power in detecting mandibular invasion (P > 0.05).
The findings suggest that compared with CT, MRI is significantly superior for higher SEN in diagnosing mandibular invasion. The SEN of MRI and PET-CT were approximately equal. For the summary of diagnostic power, more prospective clinical trials that directly compare these three methods are needed in the future.
Does SPECT Provide Incremental Value to CT or MRI in Assessing Mandibular Invasion by Oral Squamous Cell Carcinoma?
2020, Journal of Oral and Maxillofacial Surgery
Single photon emission computed tomography (SPECT) has been commonly used as an additional method to assess mandibular bone invasion in patients with oral squamous cell carcinoma (OSCC). In the present study, we measured the diagnostic validity of SPECT findings compared with the histologic findings.
We implemented a retrospective cross-sectional study and enrolled a sample of patients with OSCC adjacent to the mandible. The staging examinations included magnetic resonance imaging (MRI) and/or computed tomography (CT) and additional SPECT. The patients' medical records and imaging data were reviewed by 2 readers, and bone invasion was classified as positive or negative for each diagnostic method. The predictor was bone invasion found on CT and/or MRI compared with the combination of CT and/or MRI with either positive or negative SPECT results. The primary outcome variable was histologic bone invasion. Other variables of interest were clinicopathologic data, type of mandibular resection, and resection margin status. Bivariate tests were used to compare the diagnostic specificity, sensitivity, and accuracy of each imaging modality.
The study enrolled 122 patients, with a mean age of 67 years (55% male; study period, January 2010 to December 2017). In 60 patients (49%), segmental mandibular resection was performed. The sensitivity and specificity for bone invasion were 100% and 39% for SPECT and 84% and 75% for CT and/or MRI. The negative results for bone invasion using SPECT did not match the false-positive CT and/or MRI results in 5% (n = 6 of 122). Positive SPECT findings, in addition to positive CT and/or MRI findings increased the sensitivity to 100% but decreased the specificity to 29% (P < .001). Considering only negative SPECT findings increased the specificity to 85% (P = .03), sensitivity remaining unaffected. The accuracy of CT and/or MRI alone was 80% and was 84% when combining CT and/or MRI and negative SPECT findings (P = .03).
In oncologic staging with CT and/or MRI, the addition of SPECT provided only small benefits. Only negative SPECT results allowed for greater specificity and accuracy. The use of SPECT could be considered to rule out bone invasion in cases of radiologic uncertainty of positive CT or MRI findings.
Can radiological examination of mandibular bone invasion accurately predict the need for mandibular resection in oral squamous cell carcinoma?
2019, International Journal of Oral and Maxillofacial Surgery
Bone invasion by oral squamous cell carcinoma necessitates jaw resection, with preoperative imaging ideally able to guide the resection. A retrospective review of 109 patients with oral squamous cell carcinoma who underwent mandibular resection was performed. Eighty-three had preoperative computed tomography (CT) imaging and 72 underwent magnetic resonance imaging (MRI). The presence of bone invasion on imaging was compared to histopathology. Bone invasion was detected in 44 of 109 resection specimens (40.4%) and was identified on CT in 31 of 83 cases (37.4%) and on MRI in 35 of 72 cases (48.6%). The sensitivity and specificity of CT for detecting bone invasion was 69.0% and 79.6%, respectively, while for MRI was 87.1% and 80.5%, respectively. Histological detection of bone invasion was associated with greater disease-specific mortality (P = 0.002), as was MRI detection of bone invasion (P = 0.027). CT detection was not significant (P = 0.240). Negative prediction of bone invasion was 95% accurate for both modalities in clinically non-invaded mandibles. Survival was reduced in patients who underwent marginal mandibular resection when bone invasion was detected histologically (33.3% vs. 70.5%, P = 0.277) and with CT, although this was not statistically significant. More data are required to determine whether more aggressive resection is warranted when bone invasion is detected preoperatively.
Invasion of the mandible in gingivobuccal complex cancers: Histopathological analysis of routes of tumour entry and correlation with preoperative assessment
2018, Oral Oncology
Citation Excerpt :
The sensitivity of SPECT in our cohort was excellent (100%) corroborating with published literature. This is due to the advantage of a radiolabelled particle (99 mTc MDP) which makes it a functional imaging modality resulting in high sensitivity [21]. The drawback however is the high false positivity mainly due to coexisting odontogenic infection particularly in those with poor oral hygiene encountered commonly in oral cancers.
To determine the most accurate imaging modality predicting mandibular invasion in gingivobuccal (GB) complex cancers. To determine patterns of invasion and routes of tumour entry into the mandible by detailed histopathologic analysis.
Prospective observational study of GB Complex cancers juxtaposed with the mandible clinically necessitating some form of mandibular resection. Orthopantomogram (OPG), Multi Detector Computed Tomography (MDCT), DENTA scan and Single Photon Emission Computed Tomography scan (SPECT) were performed after which the patient was subjected to surgery. Histopathological assessment was systematically performed with serial cuts of the mandibular segment.
Of 70 patients, MDCT was the most accurate with area under curve (AUC) of 0.833. OPG, DENTA and SPECT had AUC of 0.714, 0.786 and 0.738 respectively. Mean calculated difference of involved height was −0.025 cm by MDCT (p value 0.87), −0.2 cm by OPG (p value 0.09) and 0.12 by DENTA scan (p value 0.41). Mean difference of involved length was −0.51 cm (p value 0.08) and −1.02 cm (p value 0.04) for MDCT and OPG respectively. 50% of tumour invasion was through the occlusal route while large tumours demonstrated multiple routes of entry.
-Gingivobuccal complex cancers are homogenous with respect to mandibular invasion, preferred route of tumour entry being the occlusal surface.
-Multidetector CT scan is fairly accurate in detecting mandibular involvement and predicting extent of involvement.
-Oncological safety can be achieved by positioning the bone cuts corresponding to the adjacent soft tissue margins in segmental mandibulectomy.
Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis
2018, Oral Oncology
To assess diagnostic efficacy of imaging techniques for mandibular invasion by head and neck cancer.
Thirteen databases were searched. Study inclusion, data-extraction and quality assessment were performed independently. STATA 14.0 were mainly used for meta-analysis.
Forty-nine studies were included. For mandibular invasion (cortex and marrow), CBCT, SPECT, CT, MRI, orthopantomography, PET-CT and bone-scintigraphy showed pooled sensitivities of 90%, 97%, 73%, 88%, 75%, 90%, 92%, specificities of 85%, 69% 91%, 90%, 83%, 89%, 79%, AUC of 0.9461, 0.9434, 0.8995, 0.9296, 0.8761, 0.9290, 0.9207, respectively. The combined SROC curves indicated CBCT and SPECT were superior to other techniques. For mandibular medullary invasion (marrow), CT and MRI showed pooled sensitivities of 85% and 93%, specificities of 86% and 84%.
CBCT was top-priority choice for bone invasion diagnosis. SPECT was recommended for exclusion, CT and MRI were suitable for conformation. Further investigations are needed for mandibular medullary involvement.

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^f1: Correspondence and requests for offprints to: Mr J. S. Brown, Consultant Oral and Maxillofacial Surgeon, Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. Tel: +44 (0) 151 529 5283; Fax: +44 (0) 151 529 5288 E-mail: [email protected]

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Regular ArticleEvidence for imaging the mandible in the management of oral squamouscell carcinoma: a review

Abstract

Br J Oral Maxillofac Surg

J Craniomaxillofac Surg

Int J Oral Maxillofac Surg

J Craniomaxillofac Surg

J Craniomaxillofac Surg

J Oral Maxillofac Surg

J Maxillofac Surg

Oral Surg Oral Med Oral Path Oral Radiol Endod

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

DentaScan: a newdiagnostic method for evaluating mandibular and maxillary pathology

Laryngoscope

DentaScan imaging of the mandible and maxilla

Head Neck

DentaCT for evaluating mandibular and maxillary invasion in cancer of the oral cavity

Ann Otol Rhinol Laryngol

Facial bonescintigraphy. VII. Diagnosis of malignant lesions in the mandible [New possibilities in the diagnosis and documentation using 3D power doppler ultrasound with carcinoma of the floor of the mouth as illustration] [in German]

Acta Radiol Diagn (Stockh)

Mandibular involvement by oral squamous cell carcinoma

Laryngoscope

Assessment of mandibular invasion by carcinoma[published erratum appears in Cancer 1986; 57: 1449]

Cancer

Regular Article
Evidence for imaging the mandible in the management of oral squamouscell carcinoma: a review