PDF(Pubmed)
Abstract：
(1) Background: The assessment of resection margins during surgery of oral cavity squamous cell cancer (OCSCC) dramatically impacts the prognosis of the patient as well as the need for adjuvant treatment in the future. Currently there is an unmet need to improve OCSCC surgical margins which appear to be involved in around 45% cases. Intraoperative imaging techniques, magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS), have emerged as promising tools in guiding surgical resection, although the number of studies available on this subject is still low. The aim of this diagnostic test accuracy (DTA) review is to investigate the accuracy of intraoperative imaging in the assessment of OCSCC margins. (2) Methods: By using the Cochrane-supported platform Review Manager version 5.4, a systematic search was performed on the online databases MEDLINE-EMBASE-CENTRAL using the keywords \"oral cavity cancer, squamous cell carcinoma, tongue cancer, surgical margins, magnetic resonance imaging, intraoperative, intra-oral ultrasound\". (3) Results: Ten papers were identified for full-text analysis. The negative predictive value (cutoff < 5 mm) for ioUS ranged from 0.55 to 0.91, that of MRI ranged from 0.5 to 0.91; accuracy analysis performed on four selected studies showed a sensitivity ranging from 0.07 to 0.75 and specificity ranging from 0.81 to 1. Image guidance allowed for a mean improvement in free margin resection of 35%. (4) Conclusions: IoUS shows comparable accuracy to that of ex vivo MRI for the assessment of close and involved surgical margins, and should be preferred as the more affordable and reproducible technique. Both techniques showed higher diagnostic yield if applied to early OCSCC (T1-T2 stages), and when histology is favorable.
摘要：
（1）背景：口腔鳞状细胞癌（OCSCC）手术中切除边缘的评估极大地影响了患者的预后以及未来对辅助治疗的需求。目前，改善OCSCC手术切缘的需求尚未满足，这似乎涉及约45％的病例。术中成像技术,磁共振成像（MRI）和口内超声（ioUS），已经成为指导手术切除的有前途的工具，尽管关于这一主题的研究数量仍然很少。此诊断测试准确性（DTA）审查的目的是研究术中成像在评估OCSCC切缘中的准确性。（2）方法：通过使用Cochrane支持的平台ReviewManager版本5.4，使用关键字\“口腔癌，鳞状细胞癌,舌癌,手术切缘,磁共振成像，术中,口腔内超声检查\“。(3)结果：共确定了10篇论文进行全文分析。ioUS的阴性预测值（截止值<5mm）为0.55至0.91，MRI的阴性预测值为0.5至0.91；对四项选定研究进行的准确性分析显示灵敏度为0.07至0.75，特异性为0.81至1。图像指导可以使自由切缘切除术的平均改善35％。（4）结论：IoUS在评估闭合和受累手术边缘方面显示出与离体MRI相当的准确性，并且应该被首选为更实惠和可重复的技术。如果应用于早期OCSCC（T1-T2阶段），两种技术均显示出更高的诊断产量，当组织学是有利的。
