title: CT Accuracy of Extrinsic Tongue Muscle Invasion in Oral Cavity Cancer.
abstract: Extrinsic tongue muscle invasion in oral cavity cancer upstages the primary tumor to a T4a. Despite this American Joint Committee on Cancer staging criterion, no studies have investigated the accuracy or prognostic importance of radiologic extrinsic tongue muscle invasion, the feasibility of standardizing extrinsic tongue muscle invasion reporting, or the degree of agreement across different disciplines: radiology, surgery, and pathology. The purpose of this study was to assess the agreement among radiology, surgery, and pathology for extrinsic tongue muscle invasion and to determine the imaging features most predictive of extrinsic tongue muscle invasion with surgical/pathologic confirmation.
  
  
  
  Thirty-three patients with untreated primary oral cavity cancer were included. Two head and neck radiologists, 3 otolaryngologists, and 1 pathologist prospectively evaluated extrinsic tongue muscle invasion.
  
  
  
  Fourteen of 33 patients had radiologic extrinsic tongue muscle invasion; however, only 8 extrinsic tongue muscle invasions were confirmed intraoperatively. Pathologists were unable to determine extrinsic tongue muscle invasion in post-formalin-fixed samples. Radiologic extrinsic tongue muscle invasion had 100% sensitivity, 76% specificity, 57% positive predictive value, and 100% negative predictive value with concurrent surgical-pathologic evaluation of extrinsic tongue muscle invasion as the criterion standard. On further evaluation, the imaging characteristic most consistent with surgical-pathologic evaluation positive for extrinsic tongue muscle invasion was masslike enhancement.
  
  
  
  Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.
authors.affiliation: From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.).
authors.forename: J C
authors.identifier: 0000-0002-8264-4883
authors.initials: JC
authors.lastname: Junn
authors.affiliation: From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.).
authors.forename: K L
authors.identifier: 0000-0003-3917-4641
authors.initials: KL
authors.lastname: Baugnon
authors.affiliation: Department of Radiology (E.A.L.), Georgetown University, Washington, DC.
authors.forename: E A
authors.identifier: 0000-0001-9148-6285
authors.initials: EA
authors.lastname: Lacayo
authors.affiliation: From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.).
authors.forename: P A
authors.identifier: 0000-0001-8816-4744
authors.initials: PA
authors.lastname: Hudgins
authors.affiliation: Otolaryngology (M.R.P., M.E.-D., J.T.W.).
authors.forename: M R
authors.identifier: 0000-0001-6477-9728
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Pathology (K.R.M.).
authors.forename: K R
authors.identifier: 0000-0002-3520-9694
authors.initials: KR
authors.lastname: Magliocca
authors.affiliation: From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.).
authors.forename: A S
authors.identifier: 0000-0001-7498-2543
authors.initials: AS
authors.lastname: Corey
authors.affiliation: Otolaryngology (M.R.P., M.E.-D., J.T.W.).
authors.forename: M
authors.identifier: 0000-0003-2355-472X
authors.initials: M
authors.lastname: El-Deiry
authors.affiliation: Otolaryngology (M.R.P., M.E.-D., J.T.W.).
authors.forename: J T
authors.identifier: 0000-0001-9519-5776
authors.initials: JT
authors.lastname: Wadsworth
authors.affiliation: Radiation Oncology (J.J.B.).
authors.forename: J J
authors.identifier: 0000-0002-1519-2071
authors.initials: JJ
authors.lastname: Beitler
authors.affiliation: Hematology Oncology (N.F.S.).
authors.forename: N F
authors.identifier: 0000-0003-4972-1477
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Statistics (Y.L.), Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Y
authors.identifier: 0000-0001-8926-3058
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.) Ashley.aiken@emoryhealthcare.org.
authors.forename: A H
authors.identifier: 0000-0003-1096-3540
authors.initials: AH
authors.lastname: Aiken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000000981:diagnostic imaging* / Q000601:surgery; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000000981:diagnostic imaging* / Q000601:surgery