High Frequency Ultrasound imaging of oral carcinoma of the tongue: a case report
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1
Second University of Naples, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Italy
Aim. This case report aims to suggest an ultrasound characterization of an oral carcinoma as feasibility and experimental model of this non-invasive technique in the oral mucosa compared with its histo-pathological section.
Materials and Methods. This study was approved by the ethics committee of the University of Campania "Luigi Vanvitelli."
The test was performed using a high-frequency ultrasound with a 15” LCD monitor (1024x768). The transducer was a “hockey” probe with an 18 MHz frequency and an axial field of vision from 0,4 mm to 2 cm and the lateral from 0,7 mm to 2 cm. The technique, also, included the utilization of an echographic gel between the transducer and lesional tissue. Excisional biopsy and immune-histological examination have been performed. The ultrasound images were compared with its histological image.
Results. The case of a 73-year-old patient referred to Oral Pathology Division of Multidisciplinary Department of Medical-Surgical and Dental Specialties, the University of Campania “Luigi Vanvitelli” is presented. The patient showed a nodular-vegetative lesion in the right margin of the tongue, not bleeding, with irregular margins; the dimensions are about 2 cm x 1.5 cm. On palpation, it was firm in consistency. The ultrasonography analysis carried out positioning the probe according to the transversal axis of the lesion showed like a hypoechogenic area with undefined margins about 2 cm of length and about 9 mm deep. It is possible to evaluate, firstly, the disruption of the standard tissue architecture followed by the invasion up to the muscular tissue. Inside the lesion, there’s a circular well-delimited anechoic area. This area seems to correlate histologically with the presence of necrosis and leukocytes infiltration area delimited by a thick epithelial layer. The color-doppler analysis highlights generous vascularity surrounding the lesion. The patient underwent surgery at the Maxillofacial Division of Multidisciplinary Department of Medical-Surgical and Dental Specialties, the University of Campania “Luigi Vanvitelli.” Histological images showed a well-differentiated Squamous Cell carcinoma (G1), with the absence of tumor thrombus. There was also a presence of perineural infiltration. The lesion is close to the deep/ medial margin, but where all the tissues appear to be damaged by electrocoagulation phenomena. The others exeresis margins appeared unharmed.
Discussion. This case report allows us to compare an ultrasound image of the surface, high-resolution, obtained in vivo and in real time, with histopathological findings. High res-Ultrasound is already being used successfully in other fields of medicine, for example in dermatology. Introducing the use of this technique in the oral cavity may be used in the early detection of neoplastic and non-neoplastic lesions. Besides, this technique can be helpful in the pre-surgical evaluation of other oral lesions. The technique also allows obtaining detailed macroscopic images of tissues. It is possible to measure with relative specificity the lesions’ dimensions and the vascular index. Moreover, analyzing the size of echo reflection, as well as the presence of eventual eco-graphic artifacts, it is possible to have an initial characterization of the lesion texture. Indeed, the clinical observation can detect only lateral and longitudinal extension of a lesion within a safety margin, but not depth and infiltration of deeper structures. Although an ultrasonographic examination cannot replace a biopsy to make the diagnosis of a lesion, this technique presents many advantages: it could be a valid support in diagnosis as it is a non-invasive, real-time technique that provides data in conformity to the reality; it could be a valid support in pre-surgical evaluation of the lesion; other imaging techniques, such as confocal microscopy and optical coherence tomography, provide high-resolution images but, at the same time, very low penetration (≤0.5 mm); in contrast, sonography, that allows the use of variable-frequency probes, has a reasonable balance between high penetration and resolution without loss of definition when changing the depth; high-frequency ultrasonography is an excellent tool for the diagnosis of different oral mucosa conditions but could presents many critical issues: this method is operator-dependent; it is crucial to understand the normal mucosa eco-graphic structure as well as the correlation between histological and sonographic findings since in literature there is a limited number of studies about intraoral application of this technique. Further investigations are necessary to determine the potential of ultrasonographic images as an aid in the diagnosis of oral lesions.
References
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2. Di Stasio D, Lauritano D, Paparella R, Franco R, Montella M, Serpico R, Lucchese A. Ultrasound imaging of oral fibroma: a case report. J Biol Regul Homeost Agents. 2017 Apr-Jun;31(2 Suppl 1):23-26. PubMed PMID: 28691450.
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Keywords:
ultrasound,
OSCC (oral squamous cell carcinoma),
diagnosis,
Non invasive,
Pre-surgical evaluation
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Fiori
F,
Colella
G,
Lucchese
A,
Montella
M,
Serpico
R and
Di Stasio
D
(2019). High Frequency Ultrasound imaging of oral carcinoma of the tongue: a case report.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00014
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Received:
11 Oct 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Fausto Fiori, Second University of Naples, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Naples, Campania, 80138, Italy, marcomascitti86@hotmail.it