Diagnostic Accuracy of Contrast-Enhanced Computed Tomography (CECT) in Detecting Mandibular Invasion in Oral Squamous Cell Carcinoma: A Prospective Study Using Histopathology as the Gold Standard
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1353Abstract
Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, particularly prevalent in South Asian populations, where risk factors such as tobacco use and betel quid chewing are widespread. Mandibular invasion is a critical determinant of disease staging, surgical planning, and prognosis, necessitating accurate preoperative assessment. Although contrast-enhanced computed tomography (CECT) is routinely employed for this purpose, variability in its diagnostic performance has been reported.
Objective: To evaluate the diagnostic accuracy of CECT in detecting mandibular invasion in patients with OSCC, using histopathological examination as the gold standard.
Methodology: This prospective diagnostic accuracy study was conducted at a tertiary care center in Peshawar over six months. A total of 154 patients with biopsy-confirmed OSCC underwent standardized CECT imaging. Two blinded radiologists independently assessed the scans for mandibular invasion based on predefined criteria. Histopathological evaluation of surgically resected specimens served as the reference standard. Diagnostic parameters including sensitivity, specificity, predictive values, likelihood ratios, and overall accuracy were calculated.
Results: The mean age of participants was 48.5 ± 10.2 years, with a male predominance (65%). Histopathology confirmed mandibular invasion in 53.2% of cases. CECT demonstrated a sensitivity of 69.2% (95% CI: 58.1–78.8%) and specificity of 78.4% (95% CI: 68.2–86.2%), with an overall accuracy of 73.3%. Positive and negative predictive values were 80.4% and 66.7%, respectively. Diagnostic performance was significantly higher for posterior tumors compared to anterior lesions (p = 0.039). Interobserver agreement was substantial (κ = 0.72).
Conclusion: CECT demonstrates moderate diagnostic accuracy for detecting mandibular invasion in OSCC. While it remains a valuable tool for preoperative evaluation, its limited sensitivity necessitates cautious interpretation of negative findings, particularly in clinically suspicious cases. Integration of imaging with histopathological assessment remains essential for optimal management.
Keywords: Bone invasion, Computed tomography, Diagnostic imaging, Mandible, Oral cancer, Sensitivity and specificity, Squamous cell carcinoma.
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