Preoperative Prediction of the Aggressiveness of Oral Tongue Squamous Cell Carcinoma with Quantitative Parameters from Dual-Energy Computed Tomography

Xieqing Yang; Huijun Hu; Fang Zhang; Dongye Li; Zehong Yang; Guangzi Shi; Guoxiong Lu; Yusong Jiang; Lingjie Yang; Yu Wang; Xiaohui Duan; Jun Shen

doi:10.3389/fonc.2022.904471

Preoperative Prediction of the Aggressiveness of Oral Tongue Squamous Cell Carcinoma with Quantitative Parameters from Dual-Energy Computed Tomography

Front Oncol. 2022 Jun 23:12:904471. doi: 10.3389/fonc.2022.904471. eCollection 2022.

Authors

Xieqing Yang¹, Huijun Hu¹, Fang Zhang^{1

2}, Dongye Li¹, Zehong Yang^{1

2}, Guangzi Shi^{1

2}, Guoxiong Lu¹, Yusong Jiang¹, Lingjie Yang¹, Yu Wang¹, Xiaohui Duan^{1

2}, Jun Shen^{1

2}

Affiliations

¹ Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.

Abstract

Objectives: To determine whether quantitative parameters derived from dual-energy computed tomography (DECT) were predictive of the aggressiveness of oral tongue squamous cell carcinoma (OTSCC) including the pathologic stages, histologic differentiation, lymph node status, and perineural invasion (PNI).

Methods: Between August 2019 and March 2021, 93 patients (mean age, 54.6 ± 13.8 years; 66 men) with pathologically diagnosed OTSCC were enrolled in this prospective study. Preoperative DECT was performed and quantitative parameters (e.g., slope of the spectral Hounsfield unit curve [λ_Hu], normalized iodine concentration [nIC], normalized effective atomic number [nZ_eff], and normalized electron density [nRho]) were measured on arterial phase (AP) and venous phase (VP) DECT imaging. Quantitative parameters from DECT were compared between patients with different pathologic stages, histologic differentiation, lymph node statuses, and perineural invasion statuses. Logistic regression analysis was utilized to assess independent parameters and the diagnostic performance was analyzed by the receiver operating characteristic curves (ROC).

Results: λ_Hu and nIC in AP and λ_Hu, nZ_eff, and nIC in VP were significantly lower in stage III-IV lesions than in stage I-II lesions (p < 0.001 to 0.024). λ_Hu in VP was an independent predictor of tumor stage with an odds ratio (OR) of 0.29, and area under the curve (AUC) of 0.80. λ_Hu and nIC were higher in well-differentiated lesions than in poorly differentiated lesions (p < 0.001 to 0.021). The nIC in VP was an independent predictor of histologic differentiation with OR of 0.31, and AUC of 0.78. λ_Hu and nIC in VP were lower in OTSCCs with lymph node metastasis than those without metastasis (p < 0.001 to 0.005). λ_Hu in VP was the independent predictor of lymph node status with OR of 0.42, and AUC of 0.74. No significant difference was found between OTSCCs without PNI and those with PNI in terms of the quantitative DECT parameters.

Conclusion: DECT can be a complementary means for the preoperative prediction of the aggressiveness of OTSCC.

Keywords: Aggressiveness; Dual-energy CT; Oral tongue squamous cell carcinoma; histologic differentiation; lymph node status; pathologic stages.