|Year : 2022 | Volume
| Issue : 4 | Page : 248-251
Clinical practice guidelines for radiographic assessment in management of oral cancer
LM Abhinaya, Arvind Muthukrishnan
Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
|Date of Submission||18-Apr-2022|
|Date of Decision||03-Jun-2022|
|Date of Acceptance||04-Jun-2022|
|Date of Web Publication||10-Oct-2022|
Dr. Arvind Muthukrishnan
Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
In recent years, oral cancer has become a huge solicitude in oncology with its accelerating incidence and has accounted for nearly 50% of cancers seen in India. Screening of patients and lack of awareness among people about the early signs and symptoms are the major factors for a late diagnosis. Although examination of the lesion clinically and diagnosis has a paramount role in early detection, different imaging techniques are required to accurately gauge the extent to local regions. Imaging plays a pivotal role in deciding the apt treatment strategy, assessing the resectability of the tumor, and gauging exact margins for resection. Thus, this study aims to describe a new clinical guideline using various available imaging systems and their importance in oral cancer management.
Keywords: Computed tomography, imaging, magnetic resonance imaging, oral cancer, panoramic radiographs
|How to cite this article:|
Abhinaya L M, Muthukrishnan A. Clinical practice guidelines for radiographic assessment in management of oral cancer. J Adv Pharm Technol Res 2022;13:248-51
|How to cite this URL:|
Abhinaya L M, Muthukrishnan A. Clinical practice guidelines for radiographic assessment in management of oral cancer. J Adv Pharm Technol Res [serial online] 2022 [cited 2023 Feb 2];13:248-51. Available from: https://www.japtr.org/text.asp?2022/13/4/248/358208
| Introduction|| |
More than 378,500 new cases of oral cancer are being diagnosed worldwide and oral cancer is placed at an 8th position. Oral cancer also constitutes more than 50% of all cancers; with a higher male predominance. The common risk factors for developing oral cancer are deleterious habits such as smoking and smokeless tobacco chewing, alcohol consumption along with low-socioeconomic status, deficient diet and hygiene, viral infections such as Herpes simplex virus (HSV), continuous irritation from dentures, or sharp cuspal tips. Ninety-five percent of cancer in the oral cavity is oral squamous cell carcinoma. Commonly affected intraoral sites include gingiva, buccal mucosa, retromolar pad, and hard and soft palate. In comparison with the west, India has about 70% of advanced stages of oral cancer being reported (American Joint Committee on Cancer, Stage III-IV). Early diagnosed patients are found to have comparatively better long-term survival ranging from 60% to 90% and diagnosis of oral cancer has a better survival rate when compared to an advanced stage diagnosis (20%–50%) and is <5% for palliative care patients. The clinical examination followed by proper imaging and histopathological examination is used routinely to detect oral cancer. Our research and knowledge have resulted in high-quality publications from our team.,,,,,,,,,,,,,,
Hence, the early detection of cancer combined with appropriate imaging techniques for proper staging is highly required and crucial.
| Imaging Methods in Oral Cancer|| |
The early stages of oral cancer are quite a challenge to be identified and detected through imaging. The subsequent imaging methods that are used include – orthopantomogram, cone-beam computed tomography (CBCT), diffusion-weighted magnetic resonance imaging (DW-MRI), perfusion computed tomography (CT), single-photon emission computed tomography (SPECT), hybrid methods (positron emission tomography [PET]/CT, PET/MRI, and SPECT/CT), and ultrasound.
| Panoramic Radiographs|| |
Panoramic radiographs are the initial imaging modalities used in diagnosis. Plain radiographs depict malignant lesions with loss of cortical lamina, and radiolucency depicting the lesion is significant only when there is 30% or more involvement in the loss of osseous tissue. These radiographs fail to assess the soft tissues, involvement of facial bones, and primary lesions.
| Cone-Beam Computed Tomography|| |
Isovolumetric imaging is intensely and increasingly used by dentists as a diagnostic tool. CBCT is more accurate and has an upper hand to panoramic radiography but less sensitivity and specificity when compared to CT and MRI. CBCT is advantageous as a tool used for the detection of oral cancers but again has poor assessment for soft tissues.
| Ultrasonography|| |
Diagnosis of superficial lesions, lymph nodes- and core needle-guided biopsy, and fine-needle aspiration biopsies are evaluated using ultrasonography (USG). Chaukar et al.'s study revealed that USG is inadequate as the sole imaging modality in diagnosing cervical lymph nodes. Color-Doppler coupled with USG is commonly used for the assessment of lymph node involvement post a surgical resection with or without radiation. Studies done by Filauro et al. and Noorlag et al. infer that intraoral USG being noninvasive can be used as a diagnostic tool for preoperative workup in intermediate anterior oral squamous cell carcinoma cases.,
| Computed Tomography|| |
CT is a three-dimensional imaging modality useful in assessing primary tumors and associated local bone infiltration along with contrast-enhanced determination for lymph node metastasis. CT scan is the gold standard for the identification of tumors in the head-and-neck region due to its increasing accessibility but fails in diagnosing the early stages of cancer. Minor early-stage lesions are preceded with contrast-enhanced CT. The specificity of CT is 82%–100% and sensitivity is 41%–82%. The bone invasion has a sensitivity of 63%–80% and specificity of 81%–100%. Differentiation between recurrent tumors, surgical scars, and postradiation therapy reaction is a huge disadvantage in CT imaging. Boundaries of a tumor are well-detected and -determined by multidetector CT (MDCT). Studies done by Arya et al. and Vidiri et al. showed that specificity and sensitivity can be increased with the use of puffed cheek MDCT along with the involvement of the inferior alveolar nerve.
| Magnetic Resonance Imaging|| |
The sequence of undergoing an MRI study includes the following – T1, T2, Short T1 Inversion Recovery (STIR), Turbo inversion recovery magnitude (TIRM), diffusion-weighted imaging (DWI), and perfusion with and without a contrast agent. MRI gives best soft tissue differentiation and helps in assessing the extent of locoregional and distant lymph node metastases as it has a gadolinium contrast and multiplanar reconstruction views can assist in planning surgical resection followed by reconstruction, graft placement, and variation between recurrence and scars posttreatment. The origin, surface area, and margins of the lesions along with assisting as an adjuvant technique to biopsy for screening are a huge advantage of MRI, DWI-MRI can help in assessing the response of the tumor cells postchemotherapy. The disadvantages of using this imaging are the presence of ferromagnetic materials, claustrophobic patients, and patients with the use of pacemakers.
| Positron Emission Tomography|| |
PET with 18F-fluorodeoxyglucose (radioactive compound) administered orally or intravenously evaluates tissue metabolic activity and has been used to determine the metastasis of tumor cells. Other uses of a PET scan include planning for an adjuvant treatment, estimating for risk of recurrence, and identifying the initial tumor site in cases of early metastases (carcinoma of unknown primary). A recent study by Breik et al. reported that PET-CT is preferred for follow-up imaging post 6 months than imaging at 3 months in comparison with MRI.
| Single-Photon Emission Computed Tomography|| |
SPECT uses gamma radiation for mapping the metabolic activity of the tumor. In starting stages, sentinel lymph node biopsy plays a major role as it decides and excludes the presence of lymphatic metastases with high probability. SPECT is the main choice of imaging in the case of sentinel nodes.
| Conclusion|| |
Knowledge and correct use of the various imaging modalities help in analyzing the extent of the lesion, deciding the course of treatment, plan surgical resection of bone and soft tissue followed by reconstruction procedure for preserving the form and function of the patient. Interpretation of cancer through imaging must go hand in hand with knowledge of the patient's clinical examination of the tumor and its provisional diagnosis. Imaging plays a pivotal role in assessing posttreatment responses and detecting recurrence further distinguishing it from postsurgical changes.
The authors would like to thank the Department of Oral and Maxillofacial Radiology at Saveetha Dental College and Hospital, Chennai, for their support and for helping us to complete the study.
Financial support and sponsorship
- Saveetha Institute of Medical and Technical Science
- Saveetha Dental College and Hospitals
- Saveetha University
- Roshan Granites and Marbles, Chennai.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mahajan A, Ahuja A, Sable N, Stambuk HE. Corrigendum to “Imaging in oral cancers: A comprehensive review” [Oral Oncol. 104 (2020) 104658]. Oral Oncol 2020;111:104956.
Pałasz P, Adamski Ł, Górska-Chrząstek M, Starzyńska A, Studniarek M. Contemporary diagnostic imaging of oral squamous cell carcinoma – A review of literature. Pol J Radiol 2017;82:193-202.
Veluthattil AC, Sudha SP, Kandasamy S, Chakkalakkoombil SV. Effect of hypofractionated, palliative radiotherapy on quality of life in late-stage oral cavity cancer: A prospective clinical trial. Indian J Palliat Care 2019;25:383-90.
] [Full text]
Kumar SP, Girija ASS, Priyadharsini JV. Targeting NM23-H1-mediated inhibition of tumour metastasis in viral hepatitis with bioactive compounds from Ganoderma lucidum: A computational study. pharmaceutical-sciences [Internet]. 2020;82(2).
Manickam A, Devarasan E, Manogaran G, Priyan MK, Varatharajan R, Hsu CH, et al.
Score level based latent fingerprint enhancement and matching using SIFT feature. Multimed Tools Appl 2019;78:3065-85.
Ravindiran M, Praveenkumar C. Status review and the future prospects of CZTS based solar cell – A novel approach on the device structure and material modeling for CZTS based photovoltaic device. Renew Sustain Energy Rev 2018;94:317-29.
Vadivel JK, Govindarajan M, Somasundaram E, Muthukrishnan A. Mast cell expression in oral lichen planus: A systematic review. J Investig Clin Dent 2019;10:e12457.
Ma Y, Karunakaran T, Veeraraghavan VP, Mohan SK, Li S. Sesame inhibits cell proliferation and induces apoptosis through inhibition of STAT-3 translocation in thyroid cancer cell lines (FTC-133). Biotechnol Bioprocess Eng 2019;24:646-52.
Mathivadani V, Smiline AS, Priyadharsini JV. Targeting epstein-barr virus nuclear antigen 1 (EBNA-1) with Murraya Koengii bio-compounds: An in-silico approach. Acta Virol 2020;64:93-9.
Happy A, Soumya M, Venkat Kumar S, Rajeshkumar S, Sheba RD, Lakshmi T, et al
. Phyto-assisted synthesis of zinc oxide nanoparticles using Cassia alata
and its antibacterial activity against Escherichia coli
. Biochem Biophys Rep 2019;17:208-11.
Prathibha KM, Johnson P, Ganesh M, Subhashini AS. Evaluation of salivary profile among adult type 2 diabetes mellitus patients in South India. J Clin Diagn Res 2013;7:1592-5.
Paramasivam A, Vijayashree Priyadharsini J. Novel insights into m6A modification in circular RNA and implications for immunity. Cell Mol Immunol 2020;17:668-9.
Ponnanikajamideen M, Rajeshkumar S, Vanaja M, Annadurai G. In Vivo
type 2 diabetes and wound-healing effects of antioxidant gold nanoparticles synthesized using the insulin plant chamaecostus cuspidatus in albino rats. Can J Diabetes 2019;43:82-9.e6.
Vijayashree Priyadharsini J, Smiline Girija AS, Paramasivam A. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol 2018;94:93-8.
Anita R, Paramasivam A, Priyadharsini JV, Chitra S. The m6A readers YTHDF1
aberrations associated with metastasis and predict poor prognosis in breast cancer patients. Am J Cancer Res 2020;10:2546-54.
Vigneshwaran S, Sundarakannan R, John KM, Joel Johnson RD, Prasath KA, Ajith S, et al
. Recent advancement in the natural fiber polymer composites: A comprehensive review. J Clean Prod 2020;277:124109.
Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: A randomized controlled study. Eur J Phys Rehabil Med 2018;54:880-9.
Mohanavel V, Ashraff Ali KS, Prasath S, Sathish T, Ravichandran M. Microstructural and tribological characteristics of AA6351/Si3N4 composites manufactured by stir casting. J Mater Res Technology 2020;9:14662-72.
Borse V, Konwar AN, Buragohain P. Oral cancer diagnosis and perspectives in India. Sens Int 2020;1:100046.
Chaukar D, Dandekar M, Kane S, Arya S, Purandare N, Rangarajan V, et al
. Relative value of ultrasound, computed tomography and positron emission tomography imaging in the clinically node-negative neck in oral cancer. Asia Pac J Clin Oncol. 2016 Jun;12(2):e332–8.
Filauro M, Missale F, Marchi F, Iandelli A, Carobbio AL, Mazzola F, et al
. Intraoral ultrasonography in the assessment of DOI in oral cavity squamous cell carcinoma: A comparison with magnetic resonance and histopathology. Eur Arch Otorhinolaryngol 2021;278:2943-52.
Linz C, Müller-Richter UD, Buck AK, Mottok A, Ritter C, Schneider P, et al
. Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer. Int J Oral Maxillofac Surg 2015;44:8-15.
Figueiredo PT, Leite AF, Freitas AC, Nascimento LA, Cavalcanti MG, Melo NS, et al
. Comparison between computed tomography and clinical evaluation in tumour/node stage and follow-up of oral cavity and oropharyngeal cancer. Dentomaxillofac Radiol 2010;39:140-8.
Arya S, Rane P, Sable N, Juvekar S, Bal M, Chaukar D. Retromolar trigone squamous cell cancers: A reappraisal of 16 section MDCT for assessing mandibular invasion. Clin Radiol 2013;68:e680-8.
Vidiri A, Guerrisi A, Pellini R, Manciocco V, Covello R, Mattioni O, et al
. Multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the evaluation of the mandibular invasion by squamous cell carcinomas (SCC) of the oral cavity. Correlation with pathological data. J Exp Clin Cancer Res 2010;29:73.
Singh A, Thukral CL, Gupta K, Sood AS, Singla H, Singh K. Role of MRI in evaluation of malignant lesions of tongue and oral cavity. Pol J Radiol 2017;82:92-9.
Bolzoni A, Cappiello J, Piazza C, Peretti G, Maroldi R, Farina D, et al
. Diagnostic accuracy of magnetic resonance imaging in the assessment of mandibular involvement in oral-oropharyngeal squamous cell carcinoma: A prospective study. Arch Otolaryngol Head Neck Surg 2004;130:837-43.
Shah D. Dynamic manoeuvres on MRI in oral cancers – A pictorial essay. Indian J Radiol Imaging 2020;30:334-9. [Full text]
Schimming R, Juengling FD, Lauer G, Altehöfer C, Schmelzeisen R. Computer-aided 3-D 99mTc-DPD-SPECT reconstruction to assess mandibular invasion by intraoral squamous cell carcinoma: Diagnostic improvement or not? J Craniomaxillofac Surg 2000;28:325-30.
Breik O, Kumar A, Birchall J, Mortimore S, Laugharne D, Jones K. Follow up imaging of oral, oropharyngeal and hypopharyngeal cancer patients: Comparison of PET-CT and MRI post treatment. J Craniomaxillofac Surg 2020;48:672-9.
Heuveling DA, van Weert S, Karagozoglu KH, de Bree R. Evaluation of the use of freehand SPECT for sentinel node biopsy in early stage oral carcinoma. Oral Oncol 2015;51:287-90.