Comparison of magnetic resonance imaging and high frequency ultrasonography in carcinoma of tongue and its clinicopathological correlation: a prospective study


  • Javed A. Mir Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
  • Sanober M. Masoodi Department of Radiodiagnosis, Royale Kalindi Hospital, New Delhi, India
  • Tajamul Rashid Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
  • Suhail M. Masoodi Department of Anaesthesiology, Hamdard Institute of Medical Sciences and Research, New Delhi, India



Carcinoma tongue, MRI, Ultrasonography, Tumour thickness


Background: Carcinoma of oral tongue has a high propensity for cervical node metastasis. The thicker the tumour, the higher would be the risk of nodal metastasis and locoregional recurrence. Ultrasonography is used for evaluation of carcinoma tongue and tumour thickness and has a high correlation with histopathological findings.

Methods: Our study is a comparative prospective study conducted on 30 patients of carcinoma tongue. All patients underwent magnetic resonance imaging (MRI) scan and ultrasonography. The findings of MRI and ultrasound were correlated with clinical and pathological findings.

Results: MRI had a better correlation with histopathology for primary tumour characteristics and nodal assessment than ultrasonography. Ultrasound with a Pearson correlation coefficient of 0.809 correlated better than MRI for tumour thickness. Tumour thickness of >5 mm was associated with 27.2% nodal positivity rate whereas no patient with primary tumour thickness <5 mm had node positive disease.

Conclusions: Ultrasonography has a high correlation with histopathological thickness. Ultrasound thus seems to be an optimal technique in early stage, node negative tongue cancer for evaluation of tumour thickness and predict nodal status. 


Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K, et al. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.

Alter BP. Cancer in Fanconi Anemia 1927-2001. Cancer. 2003;97:425-40.

Demarosi F, Soligo D, Lodi G, Moneghini L, Sardella A, Carrassi A. Squamous cell carcinoma of the oral cavity associated with graft versus host disease: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):63-9.

Koch WM, Lango M, Sewell D, Zahurak M, Sidransky D. Head and neck cancer in nonsmokers: a distinct clinical and molecular entity. Laryngoscope. 1999;109:1544-51.

Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92:709-20.

Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Relation of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg. 1986;152(4):351-3.

Wallwork BD, Anderson SR, Coman WB. Squamous cell carcinoma of the floor of the mouth: tumour thickness and the rate of cervical metastasis. ANZ J Surg. 2007;77(9):761-4.

Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152(4):345-50.

Lodder WL, Teertstra HJ, Tan IB, Pameijer FA, Smeele LE, van Velthuysen MF, et al. Tumour thickness in oral cancer using an intra-oral ultrasound probe. Eur Radiol. 2011;21(1):98-106.

Franceschi D, Gupta R, Spiro RH, Shah JP. Improved survival in the treatment of squamous carcinomas of the oral tongue. Am J Surg.1993;166:360-5.

Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH, et al. Can we detect or predict the presence of occult nodal metastasis in patients with squamous carcinoma of the oral tongue? Head Neck. 1998;20:138-44.

Shah JP, Medina JE, Shaha AR, Schantz SP, Marti JR. Cervical lymph node metastasis. Curr Probl Surg. 1993;30:277-335.

Taniguchi Y, Okura M. Prognostic significance of perioperative blood transfusion in oral cavity squamous cell carcinoma. Head Neck. 2003;25:931-6.

Okura M. Lymph node metastasis. In: Pandali SG, ed. Recent research developments in cancer. Trivandrum, India: Transworld research Network; 2002: 331-337.

Rasgon B, Cruz R, Hilsinger R, Sawicki JE. Relation of lymph node metastasis to histopathological appearance in oral cavity and oropharyngeal carcinoma. A case series and literature review. Laryngoscope. 1989;99(11):1103-10.

Shintani S, Matsura H, Hasegawa Y, Nakayama B, Fujimoto Y. The relationship of shape of tumour invasion to depth of invasion and cervical node metastasis in squamous cell carcinoma of the tongue. Oncology. 1997;54:463.

Shah JP, Patel SG. Head and Neck surgery and oncology. 3rd ed. London: Mosby; 1990.

Amarai TMP, Carvalho DFA, Pinto CA, Kowalski LP. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. Oral Oncol. 2004;40:780.

Byers RM, Bland KI, Borlase B, Luna M. The prognostic and therapeutic value of frozen section determination in the surgical treatment of squamous cell carcinoma of the head and neck. Am J Surg. 1978;136:525.

Oral RA, Aisner S. Accuracy of frozen section in assessing margins in oral cancer resection. J Oral Maxillofac Surg. 1997;55:669.

Scholl P, Byers RM, Batsakis JG, Wolf P, Santini H. Microscopic cut through of cancer in the surgical treatment of squamous carcinoma of the tongue: Prognostic and therapeutic implications. Am J Surg. 1986;152:354.

Shintani S, Yoshihama Y, Ueyama Y, Terakado N, Kamei S, Fijimoto Y, et al. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxillofac Surg. 2001;30:139-43.

Lam P, Au-Yeung KM, Cheng PW, Wei WI, Yuen AP, Trendell-Smith N, et al. Correlation MRI and histologic tumour thickness in the assessment of oral tongue cancer. AJR Am J Roentgenol. 2004;182:803-8.

Iwai H, Kyomoto R, Ha Kawa SK, Lee S, Yamashita T. Magnetic resonance determination of tumour thickness as predictive factor of cervical metastasis in oral tongue carcinoma. Laryngoscope. 2002;112:457-61.

Preda L, Chiesa F, Calabrese L, Latronico A, Bruschini R, Leon ME, et al. Relationship between histologic thickness of tongue carcinoma and tumour estimated from preoperative MRI. Eur Radiol. 2006;16;2242-48.

Ng SH, Yen TC, Liao CT, Chang JT, Chan SC, Ko SF, et al. F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma. A prospective study of 124 patients with histologic correlation. J Nucl Med. 2005;46(7):1136-43.

Shintani S, Nakayama B, Matsura H, Hasegawa Y. Intraoral ultrasonography is useful to evaluate tumour thickness in tongue carcinoma. Am J Surg. 1997;173:345.

Yuen APW, Ng RW, Lam PF, Ho A. Preoperative measurement of tumour thicknes of oral tongue carcinoma with intraoral ultrasonography. Head Neck. 2008;30:230.

Songra AK, Ng SY, Farthing P, Hutchison IL, Bradley PF. Observation of tumour thickness and resection margin at superior excision of primary oral squamous cell carcinoma: assessment by ultrasound. Int J Oral Maxillofac Surg. 2006;35:324.

Yamane M, Ishii J, Izumo T, Nagawawa T, Amagasa T. Non-invasive quantitative assessment of oral tongue cancer by intraoral ultrasonography. Head Neck. 2007;29:307.

Mettler FA, Schultz K, Kelsey CA, Khan K, Sala J, Kligerman M. Grey scale ultrasonography in the evaluation of neoplastic invasion of base of tongue. Radiology. 1979;133(3):781-4.

Taylor SM, Drover C, Maceachern R, Bullock M, Hart R, Psooy B, et al. Is preoperative ultrasound accurate in measuring tumour thickness and predicting the incidence of cervical metastasis in oral cancer. Oral Oncology. 2010;46(1):38-41.

Kaneoya A, Hasegawa S, Tanaka Y, Omura K. Quantitative analysis of invasive front in tongue cancer using ultrasonography. J Oral Maxillofac Surg. 2009;67:40-6.

Park JO, Jung SL, JOO YH, Jung CK, Cho KJ, Kim MS. Diagnostic accuracy of MRI in the assessment of tumour invasion depth in oral /oropharyngeal cancer. Oral Oncology. 2011;47(5):381-6.

Yesuratnam A, Wiesenfeld D, Tsui A, Iseli TA, Hoorn SV, Ang MT, et al. Preoperative evaluation of oral tongue squamous cell carcinoma with intraoral ultrasound and magnetic resonance imaging-comparison with tumour thickness and accuracy in guiding patient management. Int J Oral Maxillofac Surg. 2014;43(7):787-94.

Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski Y. Anterior tongue cancer and the incidence of cervical lymph node metastasis with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients. ANZ J Surg. 2005;75:101-5.






Original Research Articles