What are the various examination methods for tongue cancer

What are the various examination methods for tongue cancer? If we have tongue cancer, it will be accompanied by some typical symptoms, such as large-area oral ulcers. Such oral ulcers are not easy to heal and may even gradually worsen. In this case, we need to consider tongue cancer. So what are the various examination methods for tongue cancer?

1. Laboratory examination

Routine blood tests are generally normal, but patients in the late stage often have changes such as erythropenia and accelerated erythrocyte sedimentation rate.

2. Imaging examination

(1) Routine X-ray examination

Mandibular surface X-rays are used to understand the bone destruction of the mandible, and chest X-rays are used to understand whether there are any metastatic lesions in the lungs.

(2) Ultrasound

Evaluate the size, shape, number and relationship of the metastatic lymph nodes with the important blood vessels in the neck. Ultrasound images show that the metastatic lymph nodes are mostly round and low-echoic, and sometimes have uneven echoes.

(3) CT

CT has a low soft tissue resolution and is difficult to show small or tongue body tumors. It mainly shows the scope of tumor infiltration and is the best means to determine cortical bone invasion, which is manifested as cortical bone interruption or erosion. The normal tongue CT shows that the tongue septum, midline, and median suture are the midlines, the bilateral structures are symmetrical, and there are oblique longitudinal strips of low-density areas. The location and size are saddle-symmetrical. The typical manifestation of tongue cancer CT is a round low- or slightly high-density area of ​​the tongue, and the enhancement is ring-shaped or uneven. Enhanced scanning helps to determine the internal knots and number of metastatic lymph nodes in the neck and whether they invade the carotid artery and vein. If there is invasion, preparations for arterial resection should be made before surgery.

(4) MRI

It has the characteristics of high soft tissue resolution, multi-plane and multi-sequence imaging, can show the whole picture of soft tissue lesions and stereoscopic positioning, can show lesions early, and is superior to CT in terms of vascular invasion and tumor staging. It is a better imaging examination method for the oropharynx. Tongue cancer can be easily found according to MRI signal and morphological changes. Enhanced scanning can further clarify the scope of the tumor, and the histological nature of the tumor can be identified according to the curve of enhancement over time. Various types of tongue cancer may have different MR signal characteristics and invasion patterns, so their histological properties can be inferred: squamous cell carcinoma is more common in the tongue body, T1WI is similar to muscle signal, T2WI signal is higher, and the signal is uneven when cystic necrosis occurs. Direct peripheral invasion and lymph node metastasis are common. Adenoid cystadenocarcinoma has more cystic components, T2WI signal increases significantly, and the invasion pattern to the periphery is similar to squamous cell carcinoma. Lymphoma is mostly located at the root of the tongue, with clear boundaries, medium-long T1 and long T2 signals, and more uniform, often accompanied by lymph node enlargement, and does not directly invade deep tissues. In terms of evaluating the tumor's external invasion or lymph node enlargement, the above abnormal MRI signals are obviously different from normal tissues. In addition, the flow void effect of the arteries and veins in the vascular spaces enables it to accurately reflect the direct external invasion and lymph node metastasis of tongue cancer. MRI is not sensitive to the invasion of cortical bone and less cancellous bone. In short, the main purpose of imaging examination of tongue cancer is to understand the invasion range of the tumor and whether there is lymph node or distant metastasis. In terms of showing tongue cancer and its spread to surrounding soft tissues and lymph node metastasis, MRI is better than CT, while CT is better at showing bone invasion.

(5) PET

It can specifically identify tumors or inflammatory lymph nodes, and its sensitivity and specificity in detecting metastatic lymph nodes in the neck are superior to those of CT and MRI. PET-CT can also provide precise positioning of lesions.

3. Special inspection

(1) Pathological biopsy

Qualitative diagnostic criteria for tongue cancer. Under block anesthesia, 0.5-1 cm of tissue is cut from the junction of normal tissue and tumor for examination. The sutures do not need to be too tight and should be removed as soon as possible. Surgery should be performed as soon as possible after pathological diagnosis.

(2) Ultrasound Doppler

For patients who are planning to undergo vascular anastomosis with a free tissue flap to repair postoperative defects, an ultrasonic Doppler examination can be performed to determine the direction of the arterial and venous branches and blood flow conditions in the donor and recipient areas to ensure the success of the operation.