JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: P046
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Hussain A Alsaffar, MBBS, FRCS, Jonathan C Irish, MD, MSc, FRCSC, FACS, Colleen Simpson, Research, Coordinator, David Goldstien, MD, FRCSC, Ralph Gilbert, MD, FRCSC, Patrick J Gullane, MD, FRCSC, FACS, FRA, Dale H Brown, BSc, BCh, FRCSC, MB, Emma Barker, MD
Institution(s): University health network- Princess Margaret Cancer Centre


Neck metastasis is the most important prognostic factor in head and neck squamous cell carcinomas (SCC). Despite the controversy on the exact depth cut off point depth of invasion has been used as a high predictable factor for microscopic neck metastasis. Determining the depth of invasion can be clinical and radiological; however, there is no standard tool in determining the depth of invasion preoperatively. Preoperative assessment of the depth of a lesion is an important step to detect the high-risk group for regional disease, and to lower the likelihood of the necessity of a second surgery or unnecessary neck dissection.
MRI has been used widely in staging in head and neck area; however this has never been compared to clinical evaluation of the thickness.

1. To compare preoperative clinical vs. radiological invasion in oral tongue SCC using the standard pathological depth.
2. To compare clinical and radiological accuracy between superficial (< 5mm) vs. deeply invading cancer (>5mm)
This is a prospective study. All consecutive biopsy proven oral tongue invasive SCC presented at the Princess Margaret Cancer Centre (PMCC) were included. Clinical, radiological and appropriate staging where determined preoperatively. Each surgeon estimated the depth clinically and was asked to give an estimate before reviewing radiology images. Two different experienced head -neck radiologists read the images and were blinded to the clinical, radiology and pathological reports. Two separate readings of the depth and visibility of the tumor were obtained. Standard pathology reports postoperatively were reviewed to determine the depth of invasion from the tumor specimen.
Spearman correlation coefficient was utilized to assess the agreement between measures.

77 patients were included, 72 were available for analysis. We found a strong correlation between clinical and pathological thicknesses and radiological and pathological thicknesses with correlation coefficient 0.780, 0.820, respectively (P < 0. 0001). Interestingly, pathological thickness < 6mm showed weak correlation with radiological measurement with a correlation coefficient 0.135 (P value 0.773). However, strong correlation with clinical thickness was found with correlation coefficient 0.765 (P < 0.0001). Shrinkage factor was 10.5%.

Subgroup analysis will further undertaken.


This is the first study of its kind evaluating the clinical assessment of tumor thickness, and compared to radiological study. There are strong correlations between pathological, radiological and clinical thicknesses. Clinical measurements in a thin tumor <6mm showed superiority to radiological measurements with weak correlation between pathological and radiological thickness.

Key words:
Depth of invasion, oral tongue, MRI, CT scans, clinical examination




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