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Objectives This study aimed to clarify the accuracy of intraoral ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in preoperative image depth of invasion (DOI) measurement of T1/T2 tongue cancer through comparison with histopathological measurements. Methods Imaging of the primary lesions was performed at our hospital; the lesions were classified into T1 and T2 based on the 8th edition of the AJCC/UICC, and surgery performed. There was histopathological confirmation of lesions as squamous cell carcinoma in 48 patients with tongue cancer. T3 and T4 cases, cases in which preoperative chemotherapy and radiation therapy were performed, and cases where biopsy was performed before imaging were excluded. The radiological DOI in US, CT, and MRI and the histopathological DOI as base were comparatively investigated and statistical analyses were performed by Bland–Altman analysis and Spearman's rank correlation coefficient. Results Bland–Altman analysis showed that the US radiological DOI was overestimated by an average of 0.2 mm compared to the histopathological DOI, while CT and MRI radiological DOI were overestimated by an average of 2–3 mm. The comparison of CT and MRI revealed that the difference between the MRI and histopathological DOI, as well as the 95% limit of agreement, were smaller than those of the CT radiological DOI. Conclusions US is the most accurate preoperative diagnostic tool for T1 and T2 squamous cell carcinoma; CT and MRI tend to have an overestimation of about 2–3 mm and so caution is required.

The aim of this study was to estimate the clinical significance of using intraoral strain elastography to establish an early diagnosis of tongue carcinoma. A total of 17 patients (11 men, 6 women; median age 67 years; age range 38–85 years) with a tumorous lesion of the tongue suggesting that early stage tongue carcinoma were enrolled in the study. Intraoral strain elastography was performed with a small hockey stick-shaped intraoperative probe and acoustic coupling polymer gel. The elasticity of the lesions was classified into four grades, with a score of 1 indicating a very soft tissue and a score of 4 indicating a very hard tissue. The patients were divided into two groups based on the histopathologically verified malignancy: carcinoma group (n = 15) and non-malignancy group (n = 2). All patients underwent surgical resection and histopathological examination of the surgical specimen. The pathology in the carcinoma group included 12 cases of squamous cell carcinoma and three cases of carcinoma in situ. The pathology in the non-malignancy group included one case of viral stomatitis and one case of pyogenic granuloma. The elasticity score was limited to 3 or 4 in the carcinoma group and 1 or 2 in the non-malignancy group. There was no significant difference in the elasticity scores between squamous cell carcinoma and carcinoma in situ. Although limited by the small number of subjects, the present results suggest that intraoral strain elastography could be an alternative noninvasive method for diagnosing tongue carcinoma.

To evaluate the usefulness of intraoral ultrasonography (IOUS) as a tool for predicting neck metastasis. Squamous cell carcinoma (SCC) of the tongue is aggressive and has a great propensity to metastasize to cervical lymph nodes. SCC of the oral cavity has a worse prognosis when associated with metastatic cervical nodes. Therefore, the metastatic potential of tongue carcinoma should be graded preoperatively to help determine the requirement for neck dissection. Nineteen patients (11 men, 8 women) between 36 and 79 years of age (mean age 60) with T1 to T4a TNM-stage tongue carcinomas were evaluated preoperatively with IOUS. Clinical and pathological TNM classifications were performed. The average tumor thicknesses measured using histological sections were significantly (p

In order to assess the usefulness of repeated sonography in detecting cervical lymph node metastases at the earliest stage during a follow-up period in patients with stage I/II carcinoma 20 consecutive patients with stage I/II squamous cell carcinoma of the tongue were studied. Each patient was examined repeatedly with sonography during the follow-up period. Nine metastatic nodes in 9 of the 20 patients (45%) met our criteria, and were detected by repeated sonography. Histopathological examination revealed that 14 nodes had metastatic foci. Although the sensitivity, per node, of sonography was originally only 64%, follow-up sonography detected all of the subclinical subsequent lymph node metastases among the patients in this study. In conclusion, repeated sonography was useful in the detection of lymph node metastases during follow-up care of patients with stage I/II tongue carcinoma, provided that the follow-up examination was performed at maximum interval of one month, if possible, sonography should be performed in such cases at two-week intervals for at least one and a half year.

To evaluate the predictive value of preoperative neck computed tomography (CT) in combination with histologic grading as a prognostic factor for patients with tongue carcinoma. Fifty-five patients with squamous cell carcinoma of the tongue were examined by CT prior to radical neck dissection. The locoregional failure and survival rates of these patients were analyzed in relation to their clinical characteristics, histologic grading (World Health Organization, WHO) based on tongue biopsy, and imaging diagnoses prior to surgery. Logistic multivariate regression analysis showed that both histologic grading and number of metastic lymph nodes on CT were significant and independent prognostic factors in locoregional failure (p=0.009 and p=0.009, respectively). When the number of metastatic lymph nodes detected on preoperative neck CT were combined with the histologic grading for the evaluation, the five-year overall survival rates of A group (0 node with any Grade, or 1 node with GradeI–II) and B group (1 node with GradeIII, or 2 or more nodes with any Grade) were 74.5% and 37.5%, respectively (p=0.001). The difference was more significant than histologic grading alone or the number of metastatic lymph nodes seen on CT alone. The combination of preoperative neck CT with histologic grading of the primary tumor is useful as a prognostic indicator for patients with tongue carcinoma.

Four hundred and seventy-four patients with squamous cell carcinomas of the tongue were treated with radiation therapy at the Department of Radiology, Osaka University Hospital between 1978 and 1987. Brachytherapy was mainly employed for the majority of the patients with T1 and T2 lesions, whereas the combination of external irradiation and brachytherapy was the treatment of choice for the patients with infiltrative T2 and more advanced lesions. Patients treated with brachytherapy alone were given an estimated tumor dose of about 70Gy within a week. Patients treated with the combined therapy received an estimated tumor dose of about 30Gy to 50Gy within 3 to 5 weeks from external irradiation, followed by 50Gy to 60Gy within a week from brachytherapy. The treatments used in this study improved the survival. The 2-year local control rates were 85% in T1, 77% in T2, 60% in T3 and 33% in T4 lesions. The 5-year actuarial survival rates according to the T stage were 78% in T1, 64% in T2, 50% in T3 and 40% in T4 lesions. One hundred and four patients(28%) of three hundred and sixty nine patients who had negative lymph nodes clinically had cervical lymph node metastases subsequently. Whereas twenty six patients(25%) of one hundred and five patients who had positive lymph nodes clinically proved to be false positive. The incidence of osteoradionecrosis was 6.0% in patients treated with the combination of external irradiation(30Gy) and brachytherapy(60Gy), while it was 1.7% in patients treated with brachtherapy alone(70Gy). Brachytherapy is a fairly good therapeutic technique for the majority of the patients with tongue cancers. The multicombined treatment modality could provide the chance for cure of advanced lesions.

A new system for the histological grading of malignancy was ultilized in 91 cases of squamous cell carcinomas of the anterior 2/3 of the tongue which were treated initially by radiotherapy at Osaka University Hospital from 1967 to 1980. Three different morphological parameters were evaluated with respect to the tumor, cell population estimated in terms of a four-point scale. A correlation was found between the degree of histological malignancy and the incidence of neck node metastasis. Furthermore, a statistical significance was valid on the survival rates between the group according to the histological grading. At present, prophylactic neck dissection is encouraged, especially for the highly malignant cases.