Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience

SIMPLE SUMMARY: Oral cavity squamous cell carcinoma (OSCC) is a significant cancer burden worldwide. The current staging system for OSCC lacks accuracy in risk assessment: still, one-third of patients affected by stage I and II OSCC can develop locoregional recurrences following adequate treatment. Researchers explored the use of high-frequency intraoral ultrasonography (IOUS) to predict histological risk factors in OSCC. The results demonstrated that IOUS accurately measured the depth of invasion (DOI) and showed a strong correlation with adverse histopathological features (APFs). This promising new imaging technique could improve risk stratification for OSCC patients, potentially leading to better treatment outcomes. ABSTRACT: Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins’ appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.