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Spence RN, Au VH, Zhao Y, Feng AL, Juliano AF, Goss D, Varvares MA. Intraoperative Ultrasound for the Management of Oral Tongue Cancer: a Systematic Review and Meta-Analysis. OTO Open 2024; 8:e147. [PMID: 38846015 PMCID: PMC11154832 DOI: 10.1002/oto2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/17/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective To evaluate for correlation between intraoperative ultrasound (IOUS)-measured tumor thickness (TT) (uTT) and histopathological TT (hTT), and to compare IOUS-assisted resection with conventional resection in patients with oral tongue cancers. Data Sources Ovid MEDLINE (1946-2023), Embase.com (1947-2023), and Web of Science (All Databases 1900-2023). Review Methods Inclusion criteria were the use of IOUS for the management of oral tongue cancer. Studies that did not report quantitative data were excluded. Additionally, studies that were not contributory to meta-analysis, or a narrative analysis of pooled results were excluded. Selection was carried out by 2 reviewers. A total of 2417 studies were initially identified, with 12 ultimately being included in this review, and 7 included in the meta-analysis. Data were extracted by 2 investigators and were pooled using a random-effects model. Results Our meta-analysis reveals a pooled correlation coefficient of 0.92 (95% confidence interval: 0.80-0.96) for studies comparing uTT to hTT. Studies comparing IOUS-assisted resection to conventional resection found IOUS-assisted resection yielded wider nearest margins in all studies reporting this outcome. Conclusion IOUS reliably measures TT, similarly to that of histopathology measurement. IOUS-assisted resection, which allows the surgeon to view the deep extent of tumor invasion, may increase closest radial margin distance compared to conventional resection. IOUS-assisted resection may represent a more reliable approach to achieving clear margins than conventional resection.
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Affiliation(s)
- Ryland N. Spence
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Vivienne H. Au
- Department of Otolaryngology–Head and Neck SurgeryNew York‐Presbyterian Hospital, Columbia University and Weill Cornell Schools of MedicineNew YorkNew YorkUSA
| | - Yan Zhao
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - Allen L. Feng
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - Amy F. Juliano
- Department of RadiologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Deborah Goss
- Library Services, Massachusetts Eye and EarBostonMassachusettsUSA
| | - Mark A. Varvares
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
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Brouwer de Koning SG, Schaeffers AWMA, Schats W, van den Brekel MWM, Ruers TJM, Karakullukcu MB. Assessment of the deep resection margin during oral cancer surgery: A systematic review. Eur J Surg Oncol 2021; 47:2220-2232. [PMID: 33895027 DOI: 10.1016/j.ejso.2021.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
The main challenge for radical resection in oral cancer surgery is to obtain adequate resection margins. Especially the deep margin, which can only be estimated based on palpation during surgery, is often reported inadequate. To increase the percentage of radical resections, there is a need for a quick, easy, minimal invasive method, which assesses the deep resection margin without interrupting or prolonging surgery. This systematic review provides an overview of technologies that are currently being studied with the aim of fulfilling this demand. A literature search was conducted through the databases Medline, Embase and the Cochrane Library. A total of 62 studies were included. The results were categorized according to the type of technique: 'Frozen Section Analysis', 'Fluorescence', 'Optical Imaging', 'Conventional imaging techniques', and 'Cytological assessment'. This systematic review gives for each technique an overview of the reported performance (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, or a different outcome measure), acquisition time, and sampling depth. At the moment, the most prevailing technique remains frozen section analysis. In the search for other assessment methods to evaluate the deep resection margin, some technologies are very promising for future use when effectiveness has been shown in larger trials, e.g., fluorescence (real-time, sampling depth up to 6 mm) or optical techniques such as hyperspectral imaging (real-time, sampling depth few mm) for microscopic margin assessment and ultrasound (less than 10 min, sampling depth several cm) for assessment on a macroscopic scale.
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Affiliation(s)
- S G Brouwer de Koning
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - A W M A Schaeffers
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W Schats
- Scientific Information Service, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands; Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Ultrasound aids in intraoperative assessment of deep resection margins of squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg 2020; 58:285-290. [DOI: 10.1016/j.bjoms.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/15/2019] [Indexed: 11/22/2022]
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Tarabichi O, Bulbul MG, Kanumuri VV, Faquin WC, Juliano AF, Cunnane ME, Varvares MA. Utility of intraoral ultrasound in managing oral tongue squamous cell carcinoma: Systematic review. Laryngoscope 2018; 129:662-670. [PMID: 30151976 DOI: 10.1002/lary.27403] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Adequate surgical resection of early stage oral tongue cancer provides the best chance at preventing locoregional disease recurrence. Determination of tumor dimensions and margin location is challenging and can lead to inadequate resections with close/positive margins. Ultrasonography has proven its utility in determining the thickness and extent of tongue tumors. Preoperative tumor dimension measurements carry increased significance with the addition of depth of invasion (DOI) to the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. We report the results of a systematic review of the literature pertaining to the use of ultrasound in the diagnosis and management of oral tongue carcinoma. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement checklist was used to inform the design of this systematic review. All studies that utilized ultrasound in the diagnosis/management of primary carcinoma of the oral tongue were included. PubMed, Embase, and Cochrane were reviewed to identify eligible studies. RESULTS Nineteen articles were included in our analysis. Six hundred seventy-eight patients were studied in the articles included. Ultrasound tumor thickness measurements correlate well with those on histopathology and show promise as a predictor of cervical lymph node metastasis. Ultrasound can be safely used intraoperatively for deep margin assessment. CONCLUSIONS Ultrasound is useful in the evaluation of oral tongue malignancies. More experience is needed to determine if it is reliable in determining preoperative DOI in light of the role this tumor parameter plays in the eighth edition of the AJCC staging manual. Laryngoscope, 129:662-670, 2019.
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Affiliation(s)
- Osama Tarabichi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mustafa G Bulbul
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vivek V Kanumuri
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - William C Faquin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Amy F Juliano
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mary E Cunnane
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, the Department of Otology and Laryngology, the Department of Pathology, and the Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR. Int J Comput Assist Radiol Surg 2017; 12:821-828. [PMID: 28130702 PMCID: PMC5420007 DOI: 10.1007/s11548-017-1524-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Abstract
Purpose Purpose of this feasibility study was (1) to evaluate whether application of ex-vivo 7T MR of the resected tongue specimen containing squamous cell carcinoma may provide information on the resection margin status and (2) to evaluate the research and developmental issues that have to be solved for this technique to have the beneficial impact on clinical outcome that we expect: better oncologic and functional outcomes, better quality of life, and lower costs. Methods We performed a non-blinded validation of ex-vivo 7T MR to detect the tongue squamous cell carcinoma and resection margin in 10 fresh tongue specimens using histopathology as gold standard. Results In six of seven specimens with a histopathologically determined invasion depth of the tumor of \documentclass[12pt]{minimal}
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\begin{document}$${\ge }3$$\end{document}≥3 mm, the tumor could be recognized on MR, with a resection margin within a 2 mm range as compared to histopathology. In three specimens with an invasion depth of \documentclass[12pt]{minimal}
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\begin{document}$${<}1$$\end{document}<1 mm, the tumor was not visible on MR. Technical limitations mainly included scan time, image resolution, and the fact that we used a less available small-bore 7T MR machine. Conclusion Ex-vivo 7T probably will have a low negative predictive value but a high positive predictive value, meaning that in tumors thicker than a few millimeters we expect to be able to predict whether the resection margin is too small. A randomized controlled trial needs to be performed to show our hypothesis: better oncologic and functional outcomes, better quality of life, and lower costs.
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Open questions and novel concepts in oral cancer surgery. Eur Arch Otorhinolaryngol 2015; 273:1975-85. [PMID: 26003319 DOI: 10.1007/s00405-015-3655-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/17/2015] [Indexed: 01/05/2023]
Abstract
The persistence of cancerous cells after surgery in oral squamous cell carcinoma (OSCC) represents a major challenge, as it often leads to local recurrences and secondary primary tumors, which are eventually responsible for a large proportion of deaths. This persistence is currently evaluated by histological analyses. In this review we discuss some important pitfalls of the histopathological analysis, such as margin evaluation, specimen shrinkage and T staging. In addition, we critically analyze the appropriateness of current surgical techniques in relation to the concept of field cancerization. Finally, we describe some novel imaging and molecular approaches, which might be useful in tailoring surgical resections and encourage the use of OSCC animal models to explore and provide proof of concept of the feasibility and potential clinical utility of innovative surgical protocols.
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Ravi SB, Annavajjula S. Surgical margins and its evaluation in oral cancer: a review. J Clin Diagn Res 2014; 8:ZE01-5. [PMID: 25386547 PMCID: PMC4225999 DOI: 10.7860/jcdr/2014/9755.4836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 01/22/2023]
Abstract
The main surgical goal while treating cancer is to remove all local malignant disease with no residual malignant cells left. Overall benefits of achieving negative resection margins in terms of disease free local recurrence and overall survival has been discussed in many studies. The quantity of normal tissue to be removed during surgical procedure has not been standardised. Local recurrence can also occur among tumours with extensive histological demonstration of adequate resection margins. Oral cavity, submandibular region, tonsil and pharynx are the sites which have high chances of recurrence, even after showing negative margins. Therefore, the current approaches for histological risk assessment and various methods of evaluation of the surgical margins with their limitations are briefed in the present article.
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Affiliation(s)
- Spoorthi Banvar Ravi
- Reader, Department of Oral Pathology, M.S.Ramaiah Dental College, New Bel Road, MSR Nagar, Bangalore, India
| | - Saileela Annavajjula
- Postgraduate Student, M.S.Ramaiah Dental College, New Bel Road, MSR Nagar, Bangalore, India
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Thake M, Kalantzis A. Excision margins in squamous cell carcinoma of the tongue: A retrospective audit and review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojst.2013.31013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matsumoto-Takeda S, Yamamoto N, Nishida I, Saeki K, Oda M, Yamauchi K, Miyamoto I, Tanaka T, Kito S, Wakasugi-Sato N, Seta Y, Shiiba S, Matsumoto Y, Yamashita Y, Maki K, Takahashi T, Morimoto Y. Importance of magnetic resonance imaging for evaluation of a child with prominent swelling of the facial region after trauma: report of a case. Dent Traumatol 2011; 27:300-4. [DOI: 10.1111/j.1600-9657.2011.00985.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Kodama M, Khanal A, Habu M, Iwanaga K, Yoshioka I, Tanaka T, Morimoto Y, Tominaga K. Ultrasonography for Intraoperative Determination of Tumor Thickness and Resection Margin in Tongue Carcinomas. J Oral Maxillofac Surg 2010; 68:1746-52. [DOI: 10.1016/j.joms.2009.07.110] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 04/19/2009] [Accepted: 07/26/2009] [Indexed: 01/03/2023]
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Wakasugi-Sato N, Kodama M, Matsuo K, Yamamoto N, Oda M, Ishikawa A, Tanaka T, Seta Y, Habu M, Kokuryo S, Ichimiya H, Miyamoto I, Kito S, Matsumoto-Takeda S, Wakasugi T, Yamashita Y, Yoshioka I, Takahashi T, Tominaga K, Morimoto Y. Advanced clinical usefulness of ultrasonography for diseases in oral and maxillofacial regions. Int J Dent 2010; 2010:639382. [PMID: 20445749 PMCID: PMC2860579 DOI: 10.1155/2010/639382] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 02/02/2010] [Indexed: 12/16/2022] Open
Abstract
Various kinds of diseases may be found in the oral and maxillofacial regions and various modalities may be applied for their diagnosis, including intra-oral radiography, panoramic radiography, ultrasonography, computed tomography, magnetic resonance imaging, and nuclear medicine methods such as positron emission tomography. Of these modalities, ultrasound imaging is easy to use for the detection of noninvasive and soft tissue-related diseases. Doppler ultrasound images taken in the B-mode can provide vascular information associated with the morphology of soft tissues. Thus, ultrasound imaging plays an important role in confirming the diagnosis of many kinds of diseases in such oral and maxillofacial regions as the tongue, lymph nodes, salivary glands, and masticatory muscles. In the present article, we introduce three new applications of ultrasonography: guided fine-needle aspiration, measurement of tongue cancer thickness, and diagnosis of metastasis to cervical lymph nodes.
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Affiliation(s)
- Nao Wakasugi-Sato
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Masaaki Kodama
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Kou Matsuo
- Department of Bioscience, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Noriaki Yamamoto
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Masafumi Oda
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Ayataka Ishikawa
- Department of Bioscience, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Tatsurou Tanaka
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Yuji Seta
- Department of Bioscience, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Manabu Habu
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Shinya Kokuryo
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Hisashi Ichimiya
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Ikuya Miyamoto
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Shinji Kito
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Shinobu Matsumoto-Takeda
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Tetsuro Wakasugi
- Department of Otorhinolaryngology, University of Occupational and Environmental Health, Kitakyushu, 807-8555, Japan
| | - Yoshihiro Yamashita
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Izumi Yoshioka
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Tetsu Takahashi
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Kazuhiro Tominaga
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
| | - Yasuhiro Morimoto
- Department of Oral Diagnostic Science, Kyushu Dental College, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan
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Poster 089: Intraoperative Surgical Clearance Confirmation of Soft Tissue Carcinomas Using Ultrasonography. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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