Predictors of carcinomatous invasion of the mandible.
The preoperative assessment of mandibular invasion by oral or oropharyngeal squamous cell carcinoma poses a challenge for the head and neck surgeon. A study of 64 composite resection patients was performed to determine which variables in the patient's history, physical exam, and diagnostic workup had a predictive association with carcinomatous mandibular invasion. Four postoperative variables were included in this analysis. Thirty-nine percent of the mandibular specimens demonstrated cancerous involvement. A multivariate recursive partitioning statistical analysis was performed to create a decision tree. Branching was based on the two statistically predictive variables: computed tomographic (CT) scan results and primary tumor location. The guide provides improved predictive accuracy with a 100% negative predictive value (NPV) and a 46% positive predictive value (PPV). This decision guide should help the surgeon provide accurate patient counseling, anticipate reconstructive needs, and maximize surgical oncologic effectiveness.
Tsue
T T
TT
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle 98195.
McCulloch
T M
TM
Girod
D A
DA
Couper
D J
DJ
Weymuller
E A
EA
Glenn
M G
MG
D000328:Adult; D000368:Aged; D000539:Alveolar Process / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy; D003663:Decision Trees; D003817:Dentition; D005157:Facial Pain / Q000473:pathology; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014456:Ulcer / Q000473:pathology