Imaging and Classification of Staging

Fig. 5.1

Axial T1-weighted MRI
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Fig. 5.2

Axial T1-weighted MRI
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Fig. 5.3

Axial T1-weighted MRI
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Fig. 5.4

Axial T1-weighted MRI
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Fig. 5.5

Axial T1-weighted MRI
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Fig. 5.6

Axial T1-weighted MRI
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Fig. 5.7

Axial T1-weighted MRI
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Fig. 5.8

Axial T1-weighted MRI
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Fig. 5.9

Axial T1-weighted MRI
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Fig. 5.10

Axial T1-weighted MRI
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Fig. 5.11

Axial T1-weighted MRI
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Fig. 5.12

Axial T1-weighted MRI
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Fig. 5.13

Axial T1-weighted MRI
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Fig. 5.14

Axial T1-weighted MRI
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Fig. 5.15

Coronal T1-weighted MRI
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Fig. 5.16

Coronal T1-weighted MRI
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Fig. 5.17

Coronal T1-weighted MRI
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Fig. 5.18

Coronal T1-weighted MRI
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Fig. 5.19

Coronal T1-weighted MRI
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Fig. 5.20

Coronal T1-weighted MRI
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Fig. 5.21

Axial CECT
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Fig. 5.22

Axial CECT
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Fig. 5.23

Axial CECT
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Fig. 5.24

Axial CECT
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Fig. 5.25

Axial CECT
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Fig. 5.26

Axial CECT
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Fig. 5.27

Axial CECT
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Fig. 5.28

Axial CECT
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Fig. 5.29

Axial CECT
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Fig. 5.30

Axial CECT
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Fig. 5.31

Axial CECT
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Fig. 5.32

Axial CECT
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Fig. 5.33

Axial CECT
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Fig. 5.34

Axial CECT
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Fig. 5.35

Axial T1-weighted MRI at the level of the maxillary alveolar process
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Fig. 5.36

Axial T1-weighted MRI at the level of the mental foramen
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Fig. 5.37

Coronal T1-weighted MRI of the pharyngeal airway
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Fig. 5.38

Transverse neck US, right superior internal jugular node (left, fine flow Doppler; right, B-mode)
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Fig. 5.39

Transverse neck US, right middle internal jugular node
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Fig. 5.40

Transverse neck US, right inferior internal jugular node
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Fig. 5.41

Transverse intraoral US, right lateral margin of the tongue (left, fine flow Doppler; right, B-mode)
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Fig. 5.42

Axial CECT of the right normal submandibular lymph node
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Fig. 5.43

Axial T1-weighted MRI of the right normal submandibular lymph node
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Fig. 5.44

Axial fat-saturated T2-weighted MRI of the right normal submandibular lymph node
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Fig. 5.45

Axial post-contrast fat-saturated T1-weighted MRI of the right normal submandibular lymph node
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Fig. 5.46

Sagittal ultrasonography of the right normal submandibular lymph node (left, fine flow Doppler; right, B-mode)
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Fig. 5.47

Photomicrograph of histopathological specimen of the right normal submandibular lymph node (hematoxylin-eosin stain)

5.3 Oral Cancer Staging

5.3.1 TNM (UICC Staging)

(Mainly cited from: 2010 American Joint Committee on Cancer Definitions of TNM for the Lip and Oral avity [4])

5.3.2 Primary Tumor (T)

T factor
TX

Primary tumor cannot be assessed
 
T0

No evidence of primary tumor
 
Tis

Carcinoma in situ
 
T1

Tumor 2 cm or less in greatest dimension
 
T2

Tumor more than 2 cm but not more than 4 cm in greatest dimension
 
T3

Tumor more than 4 cm in greatest dimension
 
T4a

Moderately advanced local disease; tumor invades adjacent structures
(according to the 2012 General Rules for Clinical and Pathological Studies on Oral Cancer by the Scientific Committee of Japan Society for Oral Tumors [5]):

1.

Tongue: invasion into the mandibular bone marrow, invasion into the submandibular space, and invasion into the extrinsic muscles of the tongue
 
2.

Upper gingiva: invasion into the maxillary sinus and nasal cavity and invasion into the buccal space or subcutaneous fat
 
3.

Lower gingiva: invasion reaching the mandibular canal, invasion into the buccal space or subcutaneous fat, invasion into the submandibular space, and invasion into the extrinsic muscles of the tongue
 
4.

Buccal mucosa: invasion into the subcutaneous fat, invasion into the maxillary and mandibular bone marrow, and invasion into the maxillary sinus
 
5.

Floor of the mouth: invasion into the mandibular bone marrow, invasion into the submandibular space, and invasion into the extrinsic muscles of the tongue
 
6.

Hard palate: invasion into the maxillary sinus and nasal cavity
 
 
T4b

Very advanced local disease; tumor invasion into the masticator space, invasion into the pterygoid plate, invasion into the skull base, and invasion circumferentially surrounding the internal carotid artery
 

5.3.3 Regional Lymph Nodes (N)

The classification and range of cervical lymph nodes are the same as described in the Rules Regarding Lymph Nodes by the Japan Society of Clinical Oncology (JSCO), and lymph node metastasis is evaluated according to the UICC classification. Internationally, the level classification system by the Academy’s Committee for Head and Neck Surgery and Oncology (ACHNSO) based on the area of neck dissection is widely used, and the AAO-HNS classification, a fragmented version of the ACHNSO classification, has also been proposed [5].

N factor
NX

Regional lymph nodes cannot be assessed
 
N0

No regional lymph node metastasis
 
N1

Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest diameter
 
N2

Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
 
N2a

Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
 
N2b

Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
 
N2c

Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
 
N3

Metastasis in a lymph node, more than 6 cm in greatest dimension
 

5.3.4 Distant Metastasis (M)

M Factor
M0

No distant metastasis
 
M1

Distant metastasis present
 
Staging
    0

Tis, N0, M0
     I

T1, N0, M0
  II

T2, N0, M0
   III

T3, N0, M0
T1, T2 or T3, N1, M0
IVA

T4a, N0 or N1, M0
T1, T2, T3 or T4a, N2, M0
IVB

Any T, N3, M0
T4a and any N, M0
IVC

Any T and any N M1
Level Classification (Fig. 5.48)
Level IA

Submental lymph nodes; they lie between medial margins of the anterior bellies of the digastric muscles.
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Sep 17, 2015 | Posted by in General Dentistry | Comments Off on Imaging and Classification of Staging
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