The use of tumor-to-tongue thickness ratio to predict the need for microvascular flap reconstruction following glossectomy in carcinoma tongue

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Journal of Head & Neck Physicians and Surgeons Pub Date : 2020-01-01 DOI:10.4103/jhnps.jhnps_5_20
A. Anand, D. Balasubramanian, Sandhya C Jayasankaran, K. Milind, Samskruthi P. Murthy, N. Subramaniam, R. Bhaskaran, Jimmy Mathew, Mohit Sharma, Krishnakumar Thankappan, S. Iyer
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Abstract

Background: Microvascular flap reconstruction (MFR) of medium–large tongue defects following ablative surgery is the standard of care. The decision for MFR is often made prior to surgery or intraoperatively depending on the extent of the defect and the volume of remnant tongue. However, there exists no objective technique to predict this requirement preoperatively. This knowledge is crucial for counseling and planning. We aimed to identify an objective magnetic resonance imaging (MRI) measurement tool to predict the need for MFR of tongue tumors. Materials and Methods: This was a retrospective analysis of patients undergoing surgery (with or without reconstruction) for squamous cell carcinoma of the tongue. Patients had a preoperative MRI as part of their assessment. As per our institution protocol, the decision for the requirement of MFR was made by a consensus of two experienced reconstructive surgeons intraoperatively. This decision was correlated with the ratio of tumor volume to the total tongue volume (tv) as observed in the MRI. Results: A total of 47 patients were identified. Twenty-eight patients underwent reconstruction, while 19 did not. The ratio of tumor thickness to tongue thickness (Tt/tt) was calculated, and a cutoff of >0.395 (sensitivity 89.3% and specificity 89.5%) was found to significantly correlate with the decision for MFR (P < 0.001). The volume of a tumor to total tv ratio was calculated from the data of 22 cases, and a cutoff of >4.2 (sensitivity 83.3 and specificity 90) was found to be correlated significantly with the decision for MFR (P < 0.001). Conclusion: Tt/tt ratio is a useful tool to determine the need for MFR of tongue tumor excision defects in the preoperative setting and can help guide counseling.
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利用肿瘤-舌厚比预测癌舌舌切除术后微血管皮瓣重建的需要
背景:微血管皮瓣重建(MFR)是中大舌头消融术后缺损的标准治疗方法。MFR的决定通常在手术前或术中根据缺损的程度和残舌的体积而定。然而,目前还没有客观的技术来预测术前这一需求。这些知识对于咨询和计划是至关重要的。我们的目的是寻找一种客观的磁共振成像(MRI)测量工具来预测舌肿瘤的MFR需求。材料和方法:本研究是对接受舌鳞癌手术(带或不带重建)患者的回顾性分析。患者术前进行MRI检查作为评估的一部分。根据我们的机构协议,MFR的要求是由两位经验丰富的重建外科医生在术中一致决定的。这一决定与MRI观察到的肿瘤体积与舌总体积(tv)的比值有关。结果:共发现47例患者。28名患者接受了重建,19名没有。计算肿瘤厚度与舌部厚度之比(Tt/ Tt),发现截断值>0.395(敏感性89.3%,特异性89.5%)与MFR的判定有显著相关性(P < 0.001)。根据22例病例的数据计算肿瘤体积与总体积之比,发现截断值bbb4.2(敏感性83.3,特异性90)与MFR的判定有显著相关性(P < 0.001)。结论:Tt/ Tt比值是判断舌肿瘤切除缺损术前是否需要行MFR的有效工具,可指导患者的心理咨询。
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来源期刊
Journal of Head & Neck Physicians and Surgeons
Journal of Head & Neck Physicians and Surgeons MEDICINE, GENERAL & INTERNAL-
CiteScore
0.30
自引率
0.00%
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0
审稿时长
15 weeks
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