INTRA-OPERATIVE ULTRASOUND IN ORAL TONGUE CANCER RESECTION: FEASIBILITY STUDY AND EARLY OUTCOMES

Presentation: B092
Topic: Oral Cavity
Type: Poster
Date:
Session:
Authors: Osama Tarabichi, Vivek V Kanumuri, Amy F Juliano, Mary E Cunnane, William C Faquin, Mark A Varvares
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Institution(s): Massachusetts eye and ear infirmary
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Introduction: Oral tongue cancer poses a serious public health issue with the American Cancer Society estimating that 16,100 individuals will be afflicted by this malignancy in 2016.  Surgical resection is the mainstay of early stage oral tongue cancer management. The infiltrating nature of these tumors into the complex muscular framework of the tongue and the lack of an accurate objective method for determining the location of the deep margin often leads to incomplete resections with close (<5mm) or positive margins. The superiority of ultrasound over manual palpation at delineating dimensions of oral tongue malignancies is well established. In an attempt to optimize local control of these tumors at the time of initial surgery, we are employing ultrasound intra-operatively to achieve a complete resection of the deep margin.  Herein, we relay a description of our technique and preliminary data that points to the safety and feasibility of this method.

Methods: A retrospective chart review of a single surgeon’s experience with this technique was carried out. The technique is as follows. After general anesthetic induction and sterile preparation and exposure of the operative site, the peripheral margins of resection are marked with a surgical marker allowing for 1.0-1.5 cm of gross clearance. Following this, a broadband compact linear array transducer (L15-7io, Phillips) enclosed in a sterile plastic cover is introduced to the surgical field and placed on the surface of the target lesion. The deep margin is identified and a sonographic measure of the tumor thickness is attained. Resection is planned based on the images obtained allowing for at least 1.0 cm of deep clearance. The deep resection margin is evaluated using the ultrasound probe at various points during the procedure to be certain that an adequate depth (> 5mm) is maintained. At the conclusion of the procedure, the probe is used to interrogate the resected specimen held in the surgeon’s hand to verify (or confirm) that an adequate deep margin is obtained; these images are captured for documentation. The specimen is then sent to the frozen section lab to verify the distance of all margins including the deep margin. Permanent sections of the resected specimen are also obtained.

Results/conclusion: Six patients with T1-T2 primary squamous cell carcinoma of the oral tongue were included in our preliminary study. Successful sonographic visualization of the deep margin was achieved in all cases. No intra- or post-operative complications related to the use of the ultrasound probe were noted. The average distance from deep margin to resection margin was 7.1+/-2 mm in our study group.

Conclusions: This preliminary study demonstrates that intraoral ultrasound is safe and feasible as an adjunct to trans-oral resection of early tongue cancer. In addition, our early results indicate that it may improve the reliability of obtaining adequate clearance of the deep margin. A longer term study with a greater number of patients with clinical follow up is required to determine if integration of this technique into oral tongue resections translates into better local control and improvement in disease-specific survival.

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