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. 2021 Dec;39(12):1141-1148.
doi: 10.1007/s11604-021-01161-1. Epub 2021 Jul 7.

Assessment of squamous cell carcinoma of the floor of the mouth with magnetic resonance imaging

Akira Baba  1   2 , Kazuhiko Hashimoto  3 , Hirofumi Kuno  4 , Koichi Masuda  5 , Satoshi Matsushima  6 , Hideomi Yamauchi  6 , Koshi Ikeda  5 , Masae Yamazaki  7 , Suzuki Taiki  7 , Satoru Ogane  7 , Ryo Kurokawa  8   9 , Yoshiaki Ota  8 , Takeshi Nomura  7 , Hiroya Ojiri  6
Affiliations

Assessment of squamous cell carcinoma of the floor of the mouth with magnetic resonance imaging

Akira Baba et al. Jpn J Radiol. 2021 Dec.

Abstract

Purpose: We aimed to use magnetic resonance imaging (MRI) to determine the relationship between the pathological depth of invasion (DOI), undetectability, and tumor thickness of squamous cell carcinoma of the floor of the mouth.

Materials and methods: We retrospectively evaluated the relationship between pathological DOI and MRI detectability, as well as the relationship between pathological DOI and tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging or coronal T2-weighted imaging.

Results: We analyzed 30 patients with squamous cell carcinoma of the floor of the mouth; MRI revealed that the pathological DOI of the 11 undetectable lesions (median 2 mm) was smaller than that of the 19 detectable lesions (median 14 mm) (p < 0.001), and the cut-off value was 3 mm (sensitivity, 0.84; specificity, 0.91; area under the curve, 0.89). Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was assessed in all 19 detectable lesions; however, tumor thickness on coronal T2-weighted imaging could not be assessed in eight cases. Tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging was found to be significantly associated with the pathological DOI.

Conclusions: Undetectability on MRI indicates superficial lesions with a pathological DOI value that is less than 3 mm. In detectable lesions, tumor thickness on coronal fat-suppressed contrast-enhanced T1-weighted imaging is associated with pathological DOI.

Keywords: Carcinoma; Magnetic resonance imaging; Mouth floor; Neoplasm invasiveness; Squamous cell.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Estimation of tumor thickness on CET1WI, tumor thickness on T2WI, and pathological DOI. A 57-year-old female with a right-sided squamous cell carcinoma of the floor of the mouth. Coronal fat-suppressed contrast-enhanced T1-weighted image (a) and coronal T2-weighted image (b) reveal a right-sided carcinoma in the floor of the mouth. Tumor thickness on CET1WI and tumor thickness on T2WI (two-directional arrow) are measured from the surface to the deepest aspect of the tumor. An image of a hematoxylin and eosin-stained pathological specimen (c) shows a lesion with pathological DOI (two-directional dotted arrow) measured from the horizontal reference line (solid line), connecting the basement membrane of the adjacent normal squamous mucosa, to the deepest aspect of the tumor. Tumor thickness on CET1WI is 13.7 mm, tumor thickness on T2WI is 13 mm, and pathological DOI is 14 mm. Note—DOI, depth of invasion; CET1WI, contrast-enhanced T1-weighted imaging; T2WI, T2-weighted imaging
Fig. 2
Fig. 2
Estimation of tumor thickness on CET1WI, tumor thickness on T2WI, and pathological DOI. An 83-year-old male with a left-sided squamous cell carcinoma of the floor of the mouth. Coronal fat-suppressed contrast-enhanced T1-weighted image (a) reveals a left-sided carcinoma in the floor of the mouth. Tumor thickness on CET1WI (two-directional arrow) is measured. Coronal T2-weighted image (b) shows abnormal lesion as a faint low signal intensity structure (within circle), however, an obvious mass lesion in the left oral floor region is not observed. Tumor thickness on T2WI is not able to be evaluated due to absence of clear contrast between the tumor and adjacent tissue. An image of a hematoxylin and eosin-stained pathological specimen (c) shows a lesion with pathological DOI (two-directional dotted arrow). Tumor thickness on CET1WI is 12.1 mm, and pathological DOI is 11 mm. Note—DOI, depth of invasion; CET1WI, contrast-enhanced T1-weighted imaging; T2WI, T2-weighted imaging
Fig. 3
Fig. 3
Undetectability of floor of the mouth cancer on MRI. An 88-year-old female with a right-sided squamous cell carcinoma of the floor of mouth. Both coronal fat-suppressed contrast-enhanced T1-weighted image (a) and coronal T2-weighted image (b) do not reveal any lesion (undetectable lesion) on the right floor of the mouth (within the circle) with clinically and pathologically proven right-sided squamous cell carcinoma of the floor of mouth
Fig. 4
Fig. 4
Box-and-whisker plots of pathological DOI in all lesions (undetectable and detectable). Note—DOI, depth of invasion
Fig. 5
Fig. 5
ROC curve of the cut-off of pathological DOI between the undetectable and detectable lesions. Note—ROC, receiver operating characteristic; DOI, depth of invasion; AUC, area under curve
Fig. 6
Fig. 6
The Bland Altman plot between tumor thickness on CET1WI and pathological DOI (a), and between tumor thickness on T2WI and pathological DOI (b) after log transformation. Note—DOI, depth of invasion; LoA, limit of agreement; CET1WI, contrast-enhanced T1-weighted imaging; T2WI, T2-weighted imaging
Fig. 7
Fig. 7
Box-and-whisker plots of the median difference between tumor thickness on CET1WI and pathological DOI, and that between tumor thickness on T2WI and pathological DOI. Note—DOI, depth of invasion; CET1WI, contrast-enhanced T1-weighted imaging; T2WI, T2-weighted imaging
Fig. 8
Fig. 8
Relationship between tumor thickness and the DOI in different types of lesions. Note—DOI, depth of invasion; TT, tumor thickness
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