Diş Hekimliğinde Ultrasonografi ve Malign Dokularda Kullanımı

Yıl 2020, Cilt: 11 Sayı: 4, 486 - 493, 31.12.2020

Ayşe Taş , Selmi Yılmaz

Öz

Ultrasonografi (USG), yumuşak dokuları incelemede kullanılan faydalı bir radyolojik teşhis yöntemidir. USG’de görüntü oluşumunda yüksek frekanslı ses dalgaları kullanılır. Yüksek frekanslı ses dalgaları bir dönüştürücü tarafından vücuda iletilir ve doku ara yüzünden yansıyan ekolar algılanarak bir ekranda görüntülenir. USG’nin gerçek zamanlı görüntü oluşturması, sık tekrarlanabilir olması ve iyonizan radyasyon içermemesi gibi birçok avantajı vardır. Tüm bunların yanında bazı dezavantajları da vardır. Görüntülerin yorumlanması ilgili hekimin tecrübesine ve bilgi birikimine bağlıdır, hava içeren yapılarda kullanılamaz ve kemik içi dokularda kullanımı çok faydalı değildir. USG teknolojisinde ilerleyen zamanla birlikte birçok gelişme meydana gelmiştir ve renkli Doppler USG, ultrason elastografi gibi kan akımı konusunda bilgi veren ve doku elastisitesini gösteren farklı türleri ortaya çıkmıştır. Maksillofasiyal bölgede tükürük bezi hastalıkları, yumuşak doku kitleleri, lenfadenopatiler, temporomandibular eklem (TME) hastalıkları, dil kanserleri ve intraosseöz lezyonlar gibi birçok alanda kullanımı mevcuttur. Lenf nodu muayenesi yapılırken, metastatik lenf nodlarının tespitinde ve takibinde USG’den yararlanılır. İntraoral USG’nin, sonraki lenf nodu metastazlarının tespiti de dahil olmak üzere dil kanserlerinin uygun tedavi planlamasını belirlemek için tümör invazyonunun derinliğinin değerlendirilmesinde rutin bir teknik olarak kullanılmaya başlanması yararlı olacaktır. USG kullanımı yüzeyel tükürük bezi tümörlerinin teşhisinde de oldukça faydalıdır. Malign tükürük bezi tümörlerinin genellikle düzensiz sınırlı olması ve heterojen iç yapıda olması tükürük bezi tümör değerlendirmelerinde USG kullanımını ön plana çıkarır. Ayrıca USG ince iğne aspirasyon biyopsisinde rehber olarak kullanılmaktadır. Bu makalenin amacı servikal lenf nodu metastazları, dil kanserleri ve malign tükürük bezi tümörleri gibi maksillofasiyal bölge malignitelerinde USG’nin teşhis, tedavi planlaması ve takipteki kullanımı ve uygulamadaki etkinliği konusunda ilgili güncel literatürü değerlendirerek bilgi vermektir.

Anahtar Kelimeler

Dil kanseri, maksillofasiyal bölge, ultrasonografi, servikal lenf nodu metastazı, tükürük bezi tümörü

Ultrasonography in Dentistry and Its Use in Malignant Tissues

Öz

Ultrasonography (USG) is a useful radiological diagnostic method used to examine soft tissues. High frequency sound waves are used in image formation. High frequency sound waves are transmitted to the body by a transducer and echoes reflected from the tissue interface are detected and displayed on a screen. USG has many advantages such as real-time image creation, frequent repeatability and not containing ionizing radiation. On the other hand there’re some disadvantages. The interpretation of the images depends on the experience and knowledge of the relevant specialist, they cannot be used in structures containing air and their use in intra-bony tissues isn’t useful. USG has evolved over time and different types such as color Doppler USG, ultrasound elastography have emerged that provide information about blood flow and show tissue elasticity. USG is used in many areas such as salivary gland diseases, soft tissue masses, lymphadenopathies, temporomandibular joint, tongue cancers and intraosseous lesions in the maxillofacial region. USG is used in the determination and follow-up of metastatic lymph nodes while performing lymph node examination. It would be beneficial to start using intraoral USG as a routine technique in evaluating the depth of tumor invasion to determine the appropriate treatment planning of tongue cancers, including the detection of subsequent lymph node metastases. USG is very useful in the diagnosis of superficial salivary gland tumors. Malign salivary gland tumors are usually irregularly demarcated and heterogeneous internal structure. This situation highlights the use of USG in salivary gland tumor evaluations. USG is used as a guide in fine needle aspiration biopsy. The purpose of this article is to provide information by evaluating the current literature about the use of USG in diagnosis, follow-up and treatment planning, and its effectiveness in practice in maxillofacial malignancies such as cervical lymph node metastases, tongue cancers and malignant salivary gland tumors.

Anahtar Kelimeler

Tongue cancer, maxillofacial region, ultrasonography, salivary gland tumor, cervical lymph node metastasis

Kaynakça

• 1. Chaya M, Tiwarı R. Ultrasound in maxillofacial imaging: A review. Journal of Medicine, Radiology, Pathology and Surgery. 2015;1.4: 17-23.
• 2. Orloff, Lisa A, ed. Head and neck ultrasonography: essential and extended applications. Plural Publishing, 2017. p. 1-10.
• 3. Tuncel E. Klinik radyoloji. 2. Baskı. Nobel Tıp Kitabevleri, 2012.
• 4. Marotti J, Heger S, Tinschert J, Tortamano P, Chuembou F, Radermacher K, Wolfart S. Recent advances of ultrasound imaging in dentistry – a review of the literature. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2013;115: 819-832.
• 5. Harorlı A, Akgül M, Yılmaz AB, Bilge OM, Dağistan S, Çakur B, et al. Görüntüleme yöntemleri. In: Harorlı A, editör. Ağız, Diş ve Çene Radyolojisi. 1. Baskı. İstanbul: Nobel Tıp Kitapları; 2014. p.225-8.
• 6. Kocasarac HD, Angelopoulos, C. Ultrasound in dentistry: toward a future of radiation-free imaging. Dental Clinics. 2018;62.3: 481-89.
• 7. Akgünlü F, İçöz D. Doppler ve Renkli Doppler Ultrasonografinin Fiziksel Özellikleri ve Oral Vasküler Anomalilerde Kullanımı. Turkiye Klinikleri Oral and Maxillofacial Radiology-Special Topics. 2016, 2.3: 80-84.
• 8. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography, a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13: 111-34.
• 9. Onur MR, Göya C. Ultrason Elastografi: Abdominal Uygulamalar. Turkiye Klinikleri Journal of Radiology Special Topics. 2013;6: 59–69.
• 10. Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013;34: 169–84.
• 11. Duymuş, M, Menzilcioğlu MS, Gök M, Avcu S. Böbrek Ultrason Elastografisi: Derleme. Kafkas Tıp Bilimleri Dergisi, 6.2: 121-29.
• 12. Arda K, Ciledag N, Aktas E, Arıbas BK, Köse K. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am Roentgenol. 2011;197: 532-536.
• 13. Okasha HH, Mansour M, Attia KA, Khattab, HM, Sakr AY, Naguib M. et al. Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy Endoscopic Ultrasound. 2014;3.1: 58-62.
• 14. Shung KK. Diagnostic ultrasound: Past, present, and future. J Med Biol Eng. 2011;31: 371-4.
• 15. Sarkar S, Ghosh S, Ghosh SK, Collier A. Role of transcranial Doppler ultrasonography in stroke. Postgrad Med J. 2007;83: 683-9.
• 16. Fenster A, Bax J, Neshat H, Kakani N, Romagnoli C. 3D Ultrasound Imaging in Image-Guided Intervention. Gunti Gunarathe ed. Advancements and Breakthroughs in Ultrasound Imaging. InTech, 2014. p.1-26.
• 17. Taljanovic MS, Gimber LH, Becker GW, Latt LD, Klauser AS, Melville DM, et al. Shear-Wave elastography: Basic physics and musculoskeletal applications. Radiographics. 2017;37: 855-70.
• 18. Wakasugi-Sato N, Kodama M, Matsuo K, Yamamoto N, Oda M, Ishikawa A, et al. Advanced clinical usefulness of ultrasonography for diseases in oral and maxillofacial regions. International journal of dentistry, 2010. 2010.
• 19. Kagawa T, Yuasa K, Fukunari, Shiraishi T, Miwa K. Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size. Dentomaxillofacial Raology. 2011;40.7: 415-21.
• 20. Joshi PS, Pol J, Sudesh AS. Ultrasonography - a diagnostic modality for oral and maxillofacial diseases. Contemp Clin Dent. 2014;5: 345-51.
• 21. Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol 2014;6: 794-807.
• 22. White SC, Pharoah MJ. Other imaging modalities. Oral Radiology: Principles and Interpretation. 7th ed. St Louis, Missouri: Elsevier, Mosby; 2014. p. 246-7.
• 23. Caglayan F, Bayrakdar IS. The intraoral ultrasonography in dentistry. Nigerian journal of clinical practice. 2018;21.2: 125-133.
• 24. Petrovan C, Nekula DM, Mocan SL, Voidazan TS, Coşarca A. Ultrasonography-histopatology correlation in major salivary gland lesions. Rom J Morphol Embryol. 2015;56.2: 491-7.
• 25. Çelenk P, Sapancı İ, Çelenk Ç. Dil Kanserlerinin Ultrasonografik Tanısı. Turkiye Klinikleri Oral and Maxillofacial Radiology-Special Topics. 2016;2.3: 7-10.
• 26. Regezi JA, Sciubba J, Jordan RC. Oral pathology: clinical pathologic correlations. Elsevier Health Sciences, 2016. p. 58
• 27. Kolokythas A, Park S, Schlieve T, Pytynia, K, Cox D. Squamous cell carcinoma of the oral tongue: histopathological parameters associated with outcome. Int J Oral Maxillofac Surg. 2015;44.9: 1069–74.
• 28. Hayashi T, Ito J, Taira S, Katsura K. The relationship of primary tumor thickness in carcinoma of the tongue to subsequent lymph node metastasis. Dentomaxillofac Radiol 2001;30: 242-5.
• 29. Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck. 2005;27: 1080-91.
• 30. Nulent TJK, Noorlag R, Van Cann EM, Pameijer FA, Willems SM, Yesuratnam A, et al. Intraoral ultrasonography to measure tumor thickness of oral cancer: A systematic review and meta-analysis. Oral oncology. 2018;77: 29-36.
• 31. Liu Y, Li J, Tan YR, Xiong, P, Zhong LP. Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta­analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119: 238­245.
• 32. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol. 2008;66: 419­36.
• 33. Evirgen Ş, Kamburoğlu K. Review on the applications of ultrasonography in dentomaxillofacial region. World Journal of Radiology. 2016;8.1: 50.
• 34. Gong X, Xiong P, Liu S, Xu Q, Chen Y. Ultrasonographic appearances of mucoepidermoid carcinoma of the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114.3: 82-7.
• 35. Regezi JA, Sciubba JJ, Jordan RC. Salivary gland diseases. In: Dolan J, ed. Oral Pathology: Clinical Pathologic Correlations. 5thed. Louis, Missouri: Elsevier Saunders; 2008. p. 194-202
• 36. Bhatia KS, Rasalkar DD, Lee YP, Wong KT, King AD, Yuen HY, et al. Evaluation of real-time qualitative sonoelastography of focal lesions in the parotid and submandibular glands: applications and limitations. Eur Radiol 2010;20: 1958-64.
• 37. Li J, Gong X, Xiong P, Xu Q, Liu Y, Chen Y, et al. Ultrasound and computed tomography features of primary acinic cell carsinoma in the parotid gland: a retrospective study. Eur J Radiol. 2014;83: 1152-6.
• 38. Burke CJ, Thomas RH, Howlett D. Imaging the major salivary glands. Br J Oral Maxillofac Surg. 2011;49: 261-9.
• 39. Bhatia KSS, Dai YL. Routine and advanced ultrasound of major salivary glands. Neuroimaging Clinics, 2018;28.2: 273-93.
• 40. Dumitriu D, Dudea SM, Botar-Jid C. Ultrasonographic and sonoelastographic features of pleomorphic adenomas of the salivary glands. Med Ultrason. 2010;12: 175-83.
• 41. Ahuja A, Ying M. An overview of neck node sonography. Invest Radiol 2002;37: 333-42.
• 42. Hayashi T. Application of ultrasonography in dentistry. Japanese Dental Science Review. 2012;48: 5-13.
• 43. Ryu KH, Lee KH, Ryu J, Baek HJ, Kim SJ, Jung, HK, et al. Cervical lymph node imaging reporting and data system for ultrasound of cervical lymphadenopathy: a pilot study. AJR Am J Roentgenol. 2016;206.6: 1286-91.
• 44. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 2005;184.5: 1691-9.
• 45. Castelijns JA, van den Brekel MW. Imaging of lymphadenopathy in the neck. Eur Radiol. 2002;12: 727-38.
• 46. Hayashi T, Ito J, Taira S, Katsura K, Shingaki S, Hoshina H. The clinical significance of follow-up sonography in the detection of cervical lymph node metastases in patients with stage I or II squamous cell carcinoma of the tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96: 112-7.
• 47. Doyley MM, Parker KJ. Elastography: general principles and clincial applications. Ultrasound Clin. 2014;9: 1-11.
• 48. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Insana MF, et al. Cervical lymph node metastases: diagnosis at sonoelastographyinitial experience. Radiology. 2007;243: 258-67.