Ultrasound aids in intraoperative assessment of deep resection margins of squamous cell carcinoma of the tongue.

We wanted to find out whether ultrasound (US) can be used to assess the deep resection margins after excision of squamous cell carcinoma (SCC) of the tongue, as intraoperative feedback on their condition might help to prevent them being too close. Resected specimens of cancers of the tongue from 31 patients with SCC of the tongue were suspended in US gel and scanned with a small 5-10MHz US probe. The tumour was readily visible and US could differentiate it from muscle tissue. The margin of normal tongue musculature surrounding the tumour was measured on the US images, and the minimal resection margin was noted and compared with that reported by the histopathologist. The mean (SD) deep resection margins measured on the US images differed by 1.1 (0.9) mm from those reported by the histopathologist (Pearson's correlation coefficient: 0.79, p<0.01). The US measurements took a maximum of five minutes. It is feasible to use US to assess resection specimens of SCC of the tongue as an adjunct to existing strategies (such as frozen section analysis) to help achieve the desired deep surgical margins. The method is easy to incorporate into surgical routine as it does not take long.

The oral cavity tumor thickness: Measurement accuracy and consequences for tumor staging.

INTRODUCTION: In the 8th edition of the AJCC/UICC cancer staging system (AJCC8), the depth of invasion (DOI) of the oral cavity tumor is the discriminative factor in tumor staging over the previously used greatest dimension (GD). In order to obtain a complete representation of how accurate we stage oral cavity cancer clinically, we evaluated the accuracy of measurements of the tumor dimensions on ultrasound (US) and magnetic resonance (MR) imaging by comparing this with the histopathology as the "golden standard". Secondly, we compared the pathological tumor staging of these tumors according to the AJCC7 and AJCC8, to evaluate the effect of the incorporation of the DOI in the AJCC8. MATERIALS AND METHODS: In a retrospective analysis, including 85 oral cavity tumors, the GD and tumor thickness (TT) measured on US and MR, were compared to histopathology with a Pearson correlation coefficient (R) and a Bland-Altman plot. The tumors were staged according to both the AJCC7 and AJCC8. RESULTS: TT was more reliably measured with US (R = 0.67, limits of agreement = 10.7 mm), whereas GD was more reliably measured with MR (R = 0.69, limits of agreement = 25.7 mm). The AJCC8 staging resulted into a higher tumor stage in 21% of the cases, compared to the AJCC7. CONCLUSION: For preoperative tumor staging, the TT is best estimated by the use of US. The incorporation of DOI in the AJCC8 can result in a higher tumor stage in more than twenty percent of the patients, with an associated worse prognosis for the patient.

Value of MR and CT Imaging for Assessment of Internal Carotid Artery Encasement in Head and Neck Squamous Cell Carcinoma.

Objective. This study was conducted to assess the value of CT and MR imaging in the preoperative evaluation of ICA encasement. Methods. Based upon three patient groups this study was performed. Retrospective analysis of 260 neck dissection reports from 2001 to 2010 was performed to determine unexpected peroperative-diagnosed encasement. Two experienced head and neck radiologists reviewed 12 scans for encasement. Results. In four out of 260 (1.5%) patients undergoing neck dissection, preoperative imaging was false negative as there was peroperative encasement of the ICA. Of 380 patients undergoing preoperative imaging, the radiologist reported encasement of the ICA in 25 cases. In 342 cases no encasement was described, 125 of these underwent neck dissection, and 2 had encasement peroperatively. The interobserver variation kappa varied from 0.273 to 1 for the different characteristics studied. Conclusion. These retrospectively studied cohorts demonstrate that preoperative assessment of encasement of the ICA using MRI and/or CT was of value in evaluation of ICA encasement and therefore contributively in selecting operable patients (without ICA encasement), since in only 1.5% encasement was missed. However, observer variation affects the reliability of this feature.

Complications of polyalkylimide 4% injections (Bio-Alcamid): a report of 18 cases.

Injectable filler materials can be valuable to aesthetic surgeons. To date, hardly any short-term and no long-term complications of polyalkylimide injections (Bio-Alcamid) have been reported. We present and discuss the history of 18 patients who had such complications. The patients were between 31 and 55 years of age. The time between injection and the onset of complications of polyalkylimide ranged from 1 month to 3 years. Additional invasive therapy at, or near, the site of injections triggered the onset of infection in 10 patients. By use of T2-weighted MRI with fat suppressing spectro-presaturation inversion recovery (SPIR) the filler material can be visualised. Once infection or migration of the permanent filler occurs, the therapeutic options are limited to surgical removal by a direct approach. Polyalkylimide should be handled under strict antiseptic circumstances. This does not only apply at the time of initial injections, but even more during any subsequent invasive treatment such as evacuation of surplus deposits or additional surgical procedures at, or near, the site of injection.