Tongue Cancer Detection: Can Ultrasound Elastography Make a Difference?
"A new study explores how intraoral ultrasonography combined with strain elastography could offer a less invasive way to characterize tongue lesions."
Detecting tongue cancer early is crucial for successful treatment, but distinguishing between benign lesions and early-stage cancer can be challenging. Traditional methods, including visual exams and palpation, have limitations, highlighting the need for more advanced diagnostic tools.
Ultrasonography is often the first imaging method used to investigate oral and maxillofacial lesions. While conventional ultrasonography provides valuable information, strain elastography is a newer technique that assesses the stiffness of tissues, potentially offering additional insights into the nature of tongue lesions.
This article explores a recent study that investigates the use of intraoral ultrasonography combined with strain elastography for characterizing tongue carcinoma. This preliminary research aims to determine if this combined approach can differentiate between normal tissues and cancerous lesions in the tongue, potentially leading to earlier and more accurate diagnoses.
Tongue Cancer and Imaging
The National Cancer Institute’s SEER Cancer Stat Facts page provides tongue cancer statistics by sex, race, calendar year, and age, and for selected cases by stage and histology. The supplied source material does not include specific incidence, survival, or mortality figures, so none can be stated here. A 2024 scoping review describes tongue cancer as associated with debilitating disease and poor prognostic outcomes. It notes that ultrasound is being considered as an aid to clinical management, while a 2018 study reports that intraoral ultrasound can help determine tumor thickness, a factor relevant to surgical planning.
Ultrasound’s Role in Management
A 2022 study evaluated the advantages and disadvantages of transoral ultrasound in 165 patients with tongue cancer, ages 15 to 85. A 2024 scoping review says ultrasound may assist clinicopathological management, but its reliability remains debatable. The review source also describes a retrospective evaluation of 52 Japanese patients who underwent ultrasound between 2007 and 2012, with tumor depth measured at its deepest portion. Together, these sources describe clinical use and ongoing evaluation, rather than establishing ultrasound as a definitive standalone method.
From Surgical Access to Ultrasound Evaluation
A historical account reports that V. P. Blair of St. Louis advocated surgery as the best management for oral cancers in 1928. It also credits Billroth with advancing access to the tongue and oropharynx by removing part of the mandibular body. Later research turned to imaging early tongue cancer: a 2018 study evaluated ultrasound and compared its findings with postoperative histopathology. The supplied ultrasound-history overview notes that sonography technology continues to evolve and contribute to diagnosis and treatment.
How Does Strain Elastography Work?
Strain elastography is based on the principle that cancerous tissues are generally stiffer than normal tissues. The technique involves applying slight pressure to the tissue using an ultrasound probe and measuring the tissue's deformation. This information is then used to create a visual representation of tissue stiffness.
- Applying gentle compression and decompression to the tongue using the ultrasound probe.
- Monitoring tissue strain over time using a strain graph.
- Using integrated software to measure quantitative strain (%) within regions of interest (ROIs).
- Comparing strain measurements between normal tissues and lesions.
Elastography for Tongue Lesions
A review of oral cancer screening and diagnosis reports that studies of intraoral strain elastography found clear discrimination between non-malignant lesions and early-stage tongue carcinoma. Another review states that strain elastography of the tongue has been found effective for differentiating healthy tissue from squamous cell carcinoma. Shear wave elastography is described as using push pulses to stress tissue and ultrafast ultrasound imaging to detect the resulting shear waves. The 2024 scoping review examines ultrasound’s role in the clinicopathological management of tongue cancer using searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar.
Reliability Remains an Open Question
A 2024 scoping review states that ultrasound’s reliability in tongue cancer management remains debatable. The supplied material does not provide accuracy estimates or establish how often ultrasound findings fail in tongue cancer. A preliminary study focuses on strain elastography of tongue carcinoma and characterization of normal tissues and lesions, while its supplied snippet discusses prior work on elastography of cervical lymph nodes. Those lymph-node findings do not establish performance for tongue tumors, underscoring the limits of drawing conclusions from the excerpt alone.
Comparisons and Evidence Limits
One thyroid-nodule analysis reports an accuracy of 90.95% for real-time ultrasound elastography in distinguishing benign from malignant nodules, compared with 62.93% for conventional ultrasound; the reported difference was statistically significant. These figures concern thyroid nodules, not tongue cancer, so they cannot establish comparative accuracy for tongue elastography. A 2020 source identifies a comparison of MRI and intraoral ultrasound against histopathological tumor thickness in oral tongue squamous cell carcinoma, but the supplied excerpt does not provide its results. The 2024 scoping-review excerpt likewise offers no comparative performance figures.
The Future of Tongue Cancer Diagnosis
This preliminary study suggests that strain elastography using intraoral ultrasonography is a promising technique for characterizing and differentiating normal tissues and SCC in the tongue. While the study involved only two patients, the results warrant further investigation with larger sample sizes.
Evidence for Surgical Benefit Is Still Needed
A 2024 article describes intraoral ultrasound as having been evaluated for accuracy in assessing invasion depth, while noting that the technique has limitations. It says further research is needed to support a role for intraoral ultrasonography in oral cancer surgery. The proposed potential benefit is improved tumor-free surgical excision margins. The supplied source does not quantify that benefit or establish that ultrasound achieves it.
Ultrasound Across Oral and Maxillofacial Care
B-mode Doppler ultrasound can provide vascular information alongside the morphology of soft tissues. The source describes ultrasound imaging as important in confirming diagnoses across oral and maxillofacial regions, including the tongue, lymph nodes, salivary glands, and masticatory muscles. This broader clinical use provides context for tongue imaging, but the excerpt does not address access, cost, or other health-system challenges.
A Case Involving Declined Surgery
A case report describes advanced tongue cancer in a patient who declined surgical treatment. The patient was managed with ultrasound-guided microwave ablation, followed by radiotherapy and chemotherapy. The report discusses these treatments as an effort to optimize therapeutic outcomes in that individual case. A single case report does not establish how effective this approach is for other patients.
The potential benefits of this approach include:
<ul><li>Non-invasive: It does not require surgical biopsies.</li><li>Relatively inexpensive: It utilizes existing ultrasound technology with specialized software.</li><li>Easy to use: The procedure can be performed by trained clinicians.</li><li>Early detection: It may help identify cancerous lesions at an earlier stage.</li></ul>