CT Accuracy of Extrinsic Tongue Muscle Invasion in Oral Cavity Cancer

• Published in: American journal of neuroradiology : AJNR Vol. 38; no. 2; pp. 364 - 370
• Main Authors: Junn, J C, Baugnon, K L, Lacayo, E A, Hudgins, P A, Patel, M R, Magliocca, K R, Corey, A S, El-Deiry, M, Wadsworth, J T, Beitler, J J, Saba, N F, Liu, Y, Aiken, A H
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.02.2017
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Computed tomography; Criteria; Dental materials; Evaluation; Feasibility studies; Female; Head & Neck; Head & neck cancer; Humans; Image Processing, Computer-Assisted; Imaging; Male; Medical personnel; Middle Aged; Mouth - diagnostic imaging; Mouth - surgery; Mouth Neoplasms - diagnostic imaging; Mouth Neoplasms - surgery; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - surgery; Muscles; Neoplasm Staging; Oral cavity; Pathology; Patients; Predictive Value of Tests; Radiology; Reproducibility of Results; Retrospective Studies; Surgery; Surgical equipment; Tomography, X-Ray Computed; Tongue; Tongue - diagnostic imaging; Tongue - surgery
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a4993

Extrinsic tongue muscle invasion in oral cavity cancer upstages the primary tumor to a T4a. Despite this American Joint Committee on Cancer staging criterion, no studies have investigated the accuracy or prognostic importance of radiologic extrinsic tongue muscle invasion, the feasibility of standardizing extrinsic tongue muscle invasion reporting, or the degree of agreement across different disciplines: radiology, surgery, and pathology. The purpose of this study was to assess the agreement among radiology, surgery, and pathology for extrinsic tongue muscle invasion and to determine the imaging features most predictive of extrinsic tongue muscle invasion with surgical/pathologic confirmation. Thirty-three patients with untreated primary oral cavity cancer were included. Two head and neck radiologists, 3 otolaryngologists, and 1 pathologist prospectively evaluated extrinsic tongue muscle invasion. Fourteen of 33 patients had radiologic extrinsic tongue muscle invasion; however, only 8 extrinsic tongue muscle invasions were confirmed intraoperatively. Pathologists were unable to determine extrinsic tongue muscle invasion in post-formalin-fixed samples. Radiologic extrinsic tongue muscle invasion had 100% sensitivity, 76% specificity, 57% positive predictive value, and 100% negative predictive value with concurrent surgical-pathologic evaluation of extrinsic tongue muscle invasion as the criterion standard. On further evaluation, the imaging characteristic most consistent with surgical-pathologic evaluation positive for extrinsic tongue muscle invasion was masslike enhancement. Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.