Free three-dimensional image software in local extension assessment of oral squamous cell carcinoma: a pilot study

Abstract Objective: Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. Methods: Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. Results: OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICC = 0.82; 95% CI 0.59–0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICC = 0.51; 95% CI 0.09–0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor’s longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. Conclusion: Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. Level of evidence: Laboratory study.

研究目的：口腔鳞状细胞癌（Oral Squamous Cell Carcinoma, OSCC）常规治疗方式为手术切除，手术切缘阳性会显著增加局部复发风险并降低患者生存率。本研究旨在评估口腔鳞状细胞癌的三维分割（Three-Dimensional Segmentation, 3DS）图像相较于计算机断层扫描（computed tomography scan, CT）多平面重建（Multiplanar Reconstruction, MPR）图像，在肿瘤切除手术规划中的应用优势。
研究方法：纳入26例局部晚期口腔鳞状细胞癌患者，分别通过多平面重建图像、三维分割图像及手术病理标本（Surgical Pathology Specimen, SPS）分析（金标准）对肿瘤形态与尺寸进行评估。本研究仅采用多平面重建图像制定手术方案，行根治性口腔鳞状细胞癌切除手术。
研究结果：三维分割图像对口腔鳞状细胞癌形态的评估准确性高于多平面重建图像。多平面重建图像、三维分割图像与手术病理标本测量所得的肿瘤体积及尺寸结果相近。但三维分割图像测量的肿瘤最长径与手术病理标本分析结果呈强相关性（组内相关系数ICC=0.82；95%置信区间CI：0.59–0.92），而多平面重建图像测量的肿瘤最长径与手术病理标本分析结果仅呈中等程度相关（ICC=0.51；95%CI：0.09–0.78）。仅针对切缘阳性的手术病理标本进行分析时，11例病例中有8例（72.7%）的多平面重建图像、5例（45.5%）的三维分割图像低估了肿瘤最长径。
研究结论：本研究数据初步证实，三维分割模型可作为口腔鳞状细胞癌切除手术规划的有效工具，但仍需在更大规模的患者队列中开展验证研究。
证据等级：实验室研究。