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Effect of Biopsy on MRI Accuracy in Preoperative Assessment of Tongue Squamous Cell Carcinoma
Lin-Song Lu1, Ke-Yue Liu1, Tian-Cheng Jiang1
1Physician, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Background:
The effect of biopsy on magnetic resonance imaging (MRI) measurement accuracy in preoperative assessment of tongue squamous cell carcinoma (TSCC) remains unclear.
Purpose:
To quantify the MRI-intraoperative measurement discrepancy of primary tumor and evaluate whether biopsy affects this discrepancy.
Study Design, Setting, And Sample:
This prospective cohort study included TSCC patients undergoing first-time resection of primary lesions at the Second Xiangya Hospital of Central South University between June 2023 and March 2025. Patients with previous head and neck radiotherapy/chemotherapy, prior oral cancer surgery, or inadequate MRI data were excluded.
Predictor Variable:
The MRI timing categorized as prebiopsy MRI and postbiopsy MRI.
Main Outcome Variable:
The primary outcome variable was the discrepancy between MRI-based and intraoperative specimen measurements (MRI minus intraoperative) for depth of invasion (DOI), largest diameter, and tumor lingual septum distance.
Covariates:
Sex, age, biopsy-MRI interval, T stage, tumor location, and tumor morphology.
Analyses:
Subgroup comparisons used parametric or nonparametric tests as appropriate. Univariable and multivariable linear regression assessed associations between MRI timing and measurement discrepancies; 2-sided P < .05 was considered significant.
Results:
The sample comprised 203 subjects (mean age 52.7 ± 9.4 years; 176 males, 86.7%). Seventy five (36.9%) had prebiopsy MRI and 128 (63.1%) had postbiopsy MRI. Contrast-enhanced T1-weighted imaging (CE-T1WI) demonstrated a smaller DOI discrepancy than T2-weighted imaging (1.44 ± 2.06 mm vs 1.67 ± 2.19 mm, P = .002). In early-stage tumors, the CE-T1WI DOI discrepancy was smaller in the prebiopsy group than in the postbiopsy group (0.78 ± 1.49 mm vs 2.25 ± 2.22 mm, P < .001). For postbiopsy imaging on CE-T1WI, DOI discrepancies were 2.26 ± 2.14 mm at 0 to 7 days and 2.64 ± 2.60 mm at 8 to 14 days. MRI excluded lingual septum invasion in all MRI-negative cases (114 of 114), while only 53.8% (21 of 39) of MRI-indicated involvement was confirmed intraoperatively. No significant biopsy-related effects were observed for largest diameter or tumor lingual septum distance discrepancy.
Conclusions:
CE-T1WI demonstrated superior accuracy for DOI assessment compared with T2-weighted imaging. For early-stage TSCC, MRI should be performed before biopsy or delayed for at least 2 weeks, and MRI can safely rule out lingual septum involvement.
