Article Figures & Data
Figures
- FIG 1.
Gray-scale sonographic images of the normal oral tongue (A–C). Normal muscle striations can be seen in the paramedian oral tongue (A, sagittal) and in the midline dorsum of the tongue (B, transverse). Note that in the midline, the median fibrous septum is discernable as an echogenic line (arrow in B). At the lateral edge of the oral tongue, the parenchyma is mildly heterogeneous and hyperechoic (C, sagittal). D, Doppler sonography image of the lateral oral tongue shows fairly even distribution of blood flow throughout the parenchyma.
- FIG 2.
A, Axial contrast-enhanced CT image through the oral tongue is degraded by streak artifacts from metallic dental amalgam; the known right lateral oral tongue cancer cannot be appreciated. B, Re-angled contrast-enhanced CT image scanned at a tilted angle to avoid streak artifacts shows an area of subtle heterogeneous enhancement (arrow), likely representing the tumor. C, Coronal reformatted CT image shows the area (arrow) appearing relatively subtle and ill-defined. D, Intraoperative gray-scale sonography image shows an area of lobulated hypoechogenicity representing the tumor (arrows). The sonography probe was sheathed in a sterile probe cover (arrowhead), with sonography gel on either side of it (asterisks). Note how the probe was suspended lightly on the gel against the tongue to avoid distorting the natural contour of the tumor. E, Intraoperative gray-scale sonography image shows an endophytic ulcerated area of the tumor (marked by calipers). Sonography gel (arrow) coats the tongue in a thick layer, enabling visualization of the natural contour of the tumor.
- FIG 3.
Axial (A) and coronal (B) contrast-enhanced CT images show the enhancing right lateral tongue tumor (arrows in A and B). However, it is difficult to appreciate on these images whether there may be exophytic or endophytic components that may render DOI different from TT. C, Intraoperative gray-scale sonography image obtained at the edge of the tumor demonstrates the exophytic nature of the tumor at that site. Rulers show measurements taken for uDOI (on the left) and uTT (on the right). D, The arrows denote the deep margin of the tumor. E, Intraoperative sonography image obtained during resection but before complete extirpation. Air can be seen at the resected interface as an echogenic line (arrow). Calipers show the margin of clearance between tumor and resection plane. F, Intraoperative sonography image obtained following complete extirpation of tumor. Air is seen throughout the resected edge (arrows). Calipers demarcate the tumor. Special attention was paid to ensure that the resection margins were free of tumor.
- FIG 4.
A, Schematic representation of tumor thickness and depth of invasion. B, Representative, intraoperative sonography image of a tongue squamous cell carcinoma. The lesion is seen as a circumscribed, hypoechoic mass (asterisk). Scale bar = 1cm.
- FIG 5.
A, Correlation between sonography and histologic tumor thickness measurements (r = Pearson coefficient; n = 20). B, Correlation between sonography and histologic depth of invasion measurements (r = Pearson coefficient; n = 20).
Tables
Patient characteristics
Patient No. Age (yr) Sex uTT (mm) hTT (mm) uDOI (mm) hDOI (mm) Lymphovascular Invasion Perineural Invasion Nodal Metastasis 1 75 F 5 5 5 5 No No No 2 70 F 9 9 9 9 No Yes No 3 44 M 4 5 4 3 No No No 4 81 M 7 5 7 5 No No No 5 66 M 4 2.5 3 2.5 No No NA 6 29 F 6.5 4 6.5 4 No No NA 7 53 F 7 6 3 2 No Yes No 8 27 M 8 9 8 9 Indeterminate Yes No 9 75 F 3 2 3 1 No No NA 10 61 M 5 4 3 4 No No No 11 61 M 10 10 9 7 No No No 12 46 M 15 13 10 13 No Yes No 13 46 M 8.5 10 8.5 9 No Yes Yes 14 65 M 8 7 8 7 No Yes No 15 57 M 14 15 14 15 No No Yes 16 65 M 3 2 3 1.5 No No No 17 76 F 8 8 6 8 No No No 18 78 M 13 16 13 16 Yes Yes No 19 82 M 7 5 6 5 No Yes No 20 50 F 4 3 3 2.5 No No NA Note:—hTT indicates histologic tumor thickness; hDOI, histologic depth of invasion; NA, not applicable.
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