Stiffness as measured with strain elastography is a prognostic factor for pT1/T2 tongue squamous cell carcinoma with muscle-layer invasion

Oral Surg Oral Med Oral Pathol Oral Radiol. 2023 Apr;135(4):558-566. doi: 10.1016/j.oooo.2022.11.001. Epub 2022 Nov 11.


Objective: The objective was to evaluate stiffness as a prognostic factor for tongue squamous cell carcinoma (TSCC).

Study design: This retrospective study included 55 patients with pathologic stage pT1 or T2 TSCC with muscle-layer invasion who underwent preoperative strain elastography of the tongue, followed by surgery, as the primary treatment modality at our cancer center. The stiffness of TSCC was semi-quantified as the ratio of the strain value of a non-tumor site to the strain value of the tumor site (strain ratio [SR]) using ultrasound strain elastography findings.

Results: SR cutoff values that maximized the significance of the difference for prognosis of delayed cervical lymph node metastasis (DCLNM) and overall survival (OS) were 7.10 and 7.49, respectively. In univariate analysis, SR, age, depth of invasion, pT stage, and perineural invasion were significant risk factors for DCLNM, whereas SR, sex, and DCLNM were identified as having an association with OS. In multivariate analysis, SR was a significant risk factor for DCLNM (hazard ratio [HR] = 3.102; P = .021) and a non-significant but relevant risk factor for OS (HR = 8.774; P = .073). Age also had an association with OS (HR = 0.382; 95% CI 0.127-1.152; P = .088).

Conclusion: Tongue stiffness is a prognostic factor in patients with pT1/T2 TSCC with muscle-layer invasion. SR values >7.10 indicate a poor prognosis, thereby warranting a strict follow-up regimen in these cases.

MeSH terms

  • Carcinoma, Squamous Cell* / pathology
  • Elasticity Imaging Techniques*
  • Humans
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Tongue
  • Tongue Neoplasms* / diagnostic imaging
  • Tongue Neoplasms* / surgery