Contrast-Enhanced Ultrasound Guided Transoral Core Needle Biopsy: A Novel, Safe and Well-Tolerated Procedure for Obtaining High-Quality Tissue in Patients with Oral Cancer

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

BACKGROUND

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology.

METHODS

A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity.

RESULTS

A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed.

CONCLUSIONS

Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.

Ultrasound-guided microwave ablation in the treatment of early-stage tongue cancer

Background

Tongue cancer is a common malignant tumor of the head and neck. Its treatment methods include surgery, radiotherapy, and chemotherapy. However, these treatments have serious side effects and poor cosmetic effect, so it is urgent to find new treatment methods. We pioneered the use of microwave ablation (MWA) in the treatment of early tongue cancer and achieved good results.

Case Presentation

A 67-year-old woman (Han nationality) was admitted to the hospital because of progressive aggravation of tongue pain. She had a history of tongue pain of more than 1 year. Pathological biopsy showed squamous cell carcinoma; following this, radical operation of the tongue cancer was planned. The preoperative examination showed thyroid occupation in the upper mediastinum region compressing the airway; hence, the risk of general anesthesia was high. Consent was obtained from the patient and her family. Ultrasound-guided MWA was successfully performed under the lingual nerve block. The patient was followed for 1 year. She recovered well with no dysphagia and unclear articulation symptoms, and the cosmetic effect was excellent.

Conclusion

To our knowledge, this is the first case of using MWA for the treatment of early-stage tongue cancer (ESTC). Ultrasound-guided MWA may be used for ESTC that can completely ablate the tumor and retain the function of the tongue, further improving the quality of life of the patient. However, it is only a case report and needs more research to verify the use of MWA in ESTC.

Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome

OBJECTIVE

This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.

METHODS

A series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including "lesion perforating", "aspiration", "cutting-and-scraping" and "biopsy forceps utilization" were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.

RESULTS

Eight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow-up period (1-39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.

CONCLUSION

With a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well-tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.

Comparative study on efficacy and safety of ultrasound guided transoral and transcutaneous core needle biopsy in patients with oral masses

Background

Ultrasound (US) guided transoral biopsy is a novel and safe procedure for obtaining tissue in patients with oral masses. However, this procedure is less commonly used in comparison to US guided transcutaneous biopsy. The aim of this study is to compare the efficacy and safety of US-guided transoral and transcutaneous core needle biopsy (CNB) in patients with oral masses.

Methods

From November 2019 to March 2021, consecutive patients with oral masses were randomly assigned to undergo US-guided transoral CNB (transoral group) and US-guided transcutaneous CNB from a submental approach (transcutaneous group). During the operation, procedure time, intra‑operative blood loss volume, diagnostic performance, rate of complications and pain level were recorded and compared.

Results

There were 112 patients (62 in the transoral group and 50 in the transcutaneous group) evaluated in this study. The postprocedural complication rate of the transcutaneous group was significantly higher than the transoral group (24% vs. 0%, P = 0.000). There was no significant difference in accuracy (95.2% vs. 88%, P = 0.30), biopsy time (76 ± 12 s vs. 80 ± 13 s, p = 0.09), blood losses (2.6 ± 0.5 mL vs. 2.7 ± 0.4 mL, p = 0.17) and visual analogue score (p = 0.327 and p = 0.444 before and after the sampling procedure) between the two groups.

Conclusion

US-guided transoral CNB results in high rates of technical success and lower rates of postprocedural complications.

A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection

Background: Early identification of the stage of oral cancer development can lead to better treatment outcomes and avoid malignant transformation. Therefore, this review aims to provide a comprehensive overview that describes the development of standardized procedures for oral sample collection, characterization, and molecular risk assessment. This can help investigators to choose the appropriate sampling method and downstream analyses for different purposes. Methods: This systematic review was conducted according to the PRISMA guidelines. Using both PubMed and Web of Science databases, four independent authors conducted a literature search between 15 and 21 June 2021. We used key search terms to broaden the search for studies. Non-conforming articles were removed using an EndNote-based and manual approach. Reviewers used a designed form to extract data. Results: This review included a total of 3574 records, after eliminating duplicate articles and excluding papers that did not meet the inclusion criteria. Finally, 202 articles were included in this review. We summarized the sampling methods, biopsy samples, and downstream analysis. The biopsy techniques were classified into tissue and liquid biopsy. The common sequential analysis of tissue biopsy includes histopathological examination such as H&E or IHC to identify various pathogenic features. Meanwhile, liquid samples such as saliva, blood, and urine are analyzed for the purpose of screening to detect mutations in cancer. Commonly used technologies are PCR, RT-PCR, high-throughput sequencing, and metabolomic analysis. Conclusions: Currently, tissue biopsies provide increased diagnostic value compared to liquid biopsy. However, the minimal invasiveness and convenience of liquid biopsy make it a suitable method for mass screening and eventual clinical adoption. The analysis of samples includes histological and molecular analysis. Metabolite analysis is rising but remains scarce.

Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy?

BACKGROUND

Due to the discomfort and incidence of complications increases with the increasing number of biopsy cores, the protocol of prostate biopsy has been promoted from systematic biopsy (SB) to targeted biopsy (TB) in many studies. However, the optimal prostate sampling scheme to balance the incidence of biopsy complications and accuracy of biopsy remains controversial. Our objective is to explore an optimal prostate cancer (PCa) sampling scheme with fewer SB cores.

METHODS

Patients with at least one lesion of Prostate Imaging Reporting and Data System ≥3 were prospectively enrolled. TB and SB were performed for each patient as reference. The hypothetical biopsy sampling schemes were TB only, SB only, and TB followed by SB of the nontargeted sector (TB+nSB). The PCa and clinically significant PCa (csPCa) detection rates and cores of the three hypothetical biopsy schemes were compared with TB+SB.

RESULTS

Among 165 patients, 107 (64.8%) were diagnosed with PCa and 91 (55.2%) with csPCa via TB+SB. There were 54 (50.5%) and 42 (46.2%) magnetic resonance imaging (MRI) true negative cases and 53 (49.5%) and 49 (53.8%) false negative cases of nontargeted sectors among PCa and csPCa patients, respectively. The maximal cancer proportion in positive biopsy cases differed significantly between the true and false groups of these cohorts. There was no difference between TB+nSB and TB+SB for PCa or csPCa detection.

CONCLUSIONS

The optimal sampling scheme TB+nSB with fewer SB cores showed same PCa and csPCa detection rates as that of standard TB+SB with MRI/ultrasound fusion biopsy.