title: Magnetic resonance imaging and computed tomography in the assessment of mandibular invasion by squamous cell carcinoma of the oral cavity. Influence on surgical management and post-operative course.
abstract: BACKGROUND
  Preoperative evaluation of the bone for invasion by oral cavity squamous cell carcinoma remains challenging. The aim of our study was to compare the accuracy of MRI and CT in detecting mandibular invasion by oral squamous cell carcinoma of the oral cavity, with histologic results as the reference standard, and to assess the influence on surgical management and post-operative course.
  
  
  METHODS
  Patients who were clinically suspected of having bone invasion from oral cavity carcinoma were retrospectively included. A single senior radiologist reviewed MRI images and CT-scans, independently, for the presence or absence of mandibular invasion. The different surgical procedures were compared in terms of length of hospital stay and occurrence of surgical complications.
  
  
  RESULTS
  Histological mandibular invasion occurred in 9 of 35 patients (25.7%). None of the preoperative imaging tests failed to detect bone invasion which resulted in a sensitivity of 100% for both MRI and CT. CT had slightly higher specificity than MRI (61.9% and 57.1% respectively) in predicting bone invasion, but no statistically significant difference was found (P=0.32). Specificity of CT and MRI was higher in the edentulous group (75% and 625% respectively) than in the dentate group (53.8% both), although no statistically significant difference was found. The length of hospital stay was increased in the segmental resection group (25±14.5 days) compared to the marginal resection group (13±4.6 days; P=0.004) and to the hemimandibulectomy group (15±7.2 days; P=0.014). Occurrence of post-operative complications, across all categories, was increased in the segmental resection group (70%, n=7/10; P=0.006) compared to the marginal resection group (8.3%, n=1/12) and to the hemimandibulectomy group (23.1%, n=3/13; P=0.04).
  
  
  CONCLUSIONS
  MRI and CT being equivalent in detecting mandibular invasion, we suggest MRI as single imaging technique in the preoperative assessment of oral cavity SCC. Specificity could be increased if combined with PET/CT, in order to reduce the number of unnecessary mandibular interruptions.
authors.affiliation: Department of oral and maxillofacial surgery, Lille university hospital, avenue du Professeur-Emile-Laine, 59037 Lille cedex, France. Electronic address: farrow.emilie@gmail.com.
authors.forename: E S
authors.initials: ES
authors.lastname: Farrow
authors.affiliation: Department of radiology, oncologic center Oscar-Lambret, Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Boulanger
authors.affiliation: Department of oral and maxillofacial surgery, Lille university hospital, avenue du Professeur-Emile-Laine, 59037 Lille cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Wojcik
authors.affiliation: Department of pathology, oncologic center Oscar-Lambret, Lille, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Lemaire
authors.affiliation: Department of oral and maxillofacial surgery, Lille university hospital, avenue du Professeur-Emile-Laine, 59037 Lille cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Raoul
authors.affiliation: Head and neck department, oncologic center Oscar-Lambret, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Julieron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008339:Mandibular Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D019647:Oral Surgical Procedures / Q000379:methods; D000072078:Positron Emission Tomography Computed Tomography; D011184:Postoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Bone marrow; CT-scan; Carcinome épidermoïde; Cavité orale; IRM; MRI; Mandibular neoplasm; Moelle osseuse; Néoplasme mandibulaire; Oral cavity; Scanner; Squamous cell carcinoma