Imaging: A Veritable Game-Changer in Predicting Deep Surgical Margins for Gingivobuccal Cancers

A recent pilot study by researchers from the Department of Head and Neck Surgical Oncology at Health Care Global Enterprises Ltd. in Bangalore has shed guiding light on the potential of imaging in assessing deep surgical margins and skin preservation in gingivobuccal complex cancers. Published in the Indian Journal of Otolaryngology and Head & Neck Surgery, the study compared the efficacy of imaging vis-à-vis conventional skin pinch test. The study included patients with histologically verified buccal mucosa and gingivobuccal complex cancer without gross skin involvement.

Traditionally, deep surgical margins for buccal mucosa cancers are assessed by palpating the skin for induration and pinchability, a subjective method which is prone to bias. Here, , a senior radiologist preoperatively measured the distance between the tumor's base and the skin using CT and MRI. Intraoperatively, the surgeon assessed skin involvement by palpation and a skin pinch test.

The study found that imaging had a sensitivity and specificity of 100% and 75%, respectively, in predicting skin preservation, compared to the skin pinch test's sensitivity and specificity of 82.6% and 50%, respectively. Notably, imaging accurately identified all patients who required skin preservation and 75% of those who required skin excision, while the skin pinch test identified 82% and 50% of patients, respectively.

The study findings highlight the role of imaging is a more effective tool for guiding surgeons in deciding between skin preservation and excision, compared to the conventional skin pinch test. The adoption of imaging as a standard preoperative assessment tool could potentially revolutionize the surgical management of gingivobuccal complex cancers, leading to better oncological outcomes and improved quality of life for patients.

Given that this pilot study featured a small sample size, the results call for a larger prospective interventional study to decisively validate the role of imaging in predicting deep surgical margins and skin preservation.

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