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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 959-963. doi: 10.19723/j.issn.1671-167X.2019.05.028

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Diagnostic test for detection of cervical lymph node metastasis from oral squamous cell carcinoma via infrared thermal imaging

Chuan-si-bo TAO,Fan DONG,Dian-can WANG,Chuan-bin GUO()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2017-10-08 Online:2019-10-18 Published:2019-10-23
  • Contact: Chuan-bin GUO E-mail:guodazuo@vip.sina.com

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Abstract:

Objective: To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test. Methods: This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 ℃ compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes. Results: The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%. Conclusion: Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.

Key words: Infrared thermal imaging, Oral squamous cell carcinoma, Cervical lymph node metastasis, Diagnostic test

CLC Number: 

  • R739.8

Table 1

Baseline information and result of clinical, pathological examination of all subjects included"

Title Subtitle Number Percentage
Number of patients 74
Average age/years 58.9±12.3
Gender Male 50 67.6
Female 24 32.4
Physical examinateion cN0 41 55.4
cN+ 33 44.6
Site of the primary tumor
ICD10-C00 Lip 1 1.3
ICD10-C01 Base of Tongue 6 8.1
ICD10-C02 Tongue 29 39.2
ICD10-C03 Gum 13 17.6
ICD10-C04 Floor of mouth 6 8.1
ICD10-C05 Palate 2 2.7
ICD10-C06.0 Buccal mucosa 11 14.9
ICD10-C06.2 Retromolar area 4 5.4
ICD10-C10 Oropharynx 2 2.7
Primary tumor diameter
dmax≤2.0 cm 33 44.6
2.0 cm<dmax≤4.0 cm 35 47.3
4.0 cm<dmax≤6.0 cm 5 6.8
dmax>6.0 cm 1 1.3
Primary tumor pathology
SCC level Ⅰ 28 37.8
SCC level Ⅰ-Ⅱ 27 36.5
SCC level Ⅱ 14 18.9
SCC level Ⅱ-Ⅲ 4 5.4
SCC level Ⅲ 1 1.4
Pathological N staging
pN0 42 56.8
pN1 12 16.1
pN2a 2 2.7
pN2b 13 17.6
pN2c 5 6.8
pN3 0 0

Figure 1

Infrared examination A, frontal photograph of face and neck; B, frontal photograph of fully exposed neck, submental region and submandibular region by heads up."

Figure 2

Positive signs of infrared thermal imaging A, asymmetric thermographic pattern including vascular pattern in region of interest (ROI); B, thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; C, surface temperature of ROI raised over 1 ℃ than opposite side; D, changes of neck profile with abnormal temperature pattern."

Table 2

Performance of conventional pre-operative examinations and infrared thermal imaging"

Title pN+ pN0 Total
2.1 Commmon cN+ 21 12 33
pre-operative cN0 11 30 41
examinations Total 32 42 74
2.2 Infrared irN+ 24 13 37
thermal imaging irN0 8 29 37
Total 32 42 74
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