Oral cancer imaging: the principles of interpretation on dental radiograph, CT, CBCT, MRI, and USG


Rini Widyaningrum(1*), Arif Faisal(2), M. Mitrayana(3), Munakhir Mudjosemedi(4), Dewi - Agustina(5)

(1) Departemen Radiologi Dentomaksilofasial, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Radiologi, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Fisika, Fakultas Matematika dan ilmu Pengetahuan, Universitas Gadjah Mada, Yogyakarta
(4) Departemen Radiologi Dentomaksilofasial, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(5) Departemen Ilmu Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Oral cancer is a malignant neoplasia on the lip and oral cavity. It is generally late-detected, locally invasive, and it has a high propensity for cervical lymph node metastases as well as blood-borne distant metastases. Diagnostic imaging for oral cancer is generally performed using conventional radiography, Cone Beam Computed Tomography (CBCT), Computed Tomography (CT), ultrasonography (USG), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Single-Photon Emission Computed Tomography (SPECT), and bone scintigraphy. This review provides a general overview of oral cancer imaging and basic principles of interpretation for oral cancer using several imaging modalities. The selection of imaging modalities for oral cancer must be based upon clinical condition, availability of imaging modalities, and cost effectivity. Despite the limited availability of modern imaging modalities in Indonesia, understanding on the major concept of various oral cancer imaging and its interpretation are certainly required by the dentists. Imaging and its interpretation are required to assist the diagnosis and determine the most appropriate treatment plan. Thus, the survival rate can be improved.


imaging; interpretation; oral cancer

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1. Thomson P. Oral precancer: diagnosis and management of potentially malignant disorders. 1st ed. Thomson P, editor. West Sussex, UK: John Wiler&Sons; 2012.

2. Waal IVD. Are we able to reduce the mortality and morbidity of oral cancer: some considerations. Med Oral Patol Oral Cir Bucal. 2013; 18(1): e33 - 37.

3. Rao SVK, Mejia G, Roberts TK, Logan R. Epidemiology of oral cancer in Asia in the past decade - an update (2000-2012). Asian Pacific J Cancer Prev. 2013; 14(10): 5567 – 5577.

4. Fedele S. Diagnostic aids in the screening of oral cancer. Head Neck Oncol. 2009; 6: 1 – 6.

5. Ye X, Zhang J, Tan Y, Chen G, Zhou G. Meta-analysis of two computer-assisted screening methods for diagnosing oral precancer and cancer. Oral Oncol. 2015; 51(11): 966 – 975.

6. Cekanova M, Rathore K. Animal models and therapeutic molecular targets of cancer: utility and limitations. Drug Des Devel Ther. 2014; 8: 1911 – 1922.

7. Torske KR. Malignant lessions of the oral cavity. In: Werning JW, editor. Oral Cancer: Diagnosis, Management, and Rehabilitation. New York: Thieme Medical Publisher; 2007. 18 – 30.

8. Scully C, Bagan J. Oral squamous cell carcinoma overview. Oral Oncol. 2009; 45: 301 – 308.

9. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol. 2015; 8(9): 11884 – 11894.

10. WHO. Control of oral cancer in developing countries: a WHO meeting. Bull World Health Organ. 1984; 62(6): 817 – 830.

11. Wimardhani YS, Walker DM, Gibbins JR, Veness MJ, Morga GJ, Kalnins II. Prediktor rekurensi kanker pada pasien dengan karsinoma sel skuamosa di daerah kepala dan leher. Indones J Dent. 2006; Special Ed: 362 – 367.

12. Olivo M, Bhuvaneswari R, Keogh I. Advances in bio-optical imaging for the diagnosis of early oral cancer. Pharmaceutics. 2011; 3: 354 – 378.

13. Poh CF, Macaulay CE, Laronde DM, Williams PM, Rosin MP, Thakker N. Squamous cell carcinoma and precursor lesions: diagnosis and screening in a technical era. Periodontol 2000. 2011; 57(1): 73 – 88.

14. Lee HS, Lee CR, Kristina Rigas N, Kim RH, Kang MK, Park NH, Shin KH. Human papillomavirus 16 (HPV16) enhances tumor growth and cancer stemness of HPV-negative oral/oropharyngeal squamous cell carcinoma cells via miR-181 regulation. Papillomavirus Res [Internet]. 2015; 16: 1–10. Available from: http://linkinghub.elsevier.com/retrieve/pii/S2405852115000142

15. Shin D, Vigneswaran N, Gillenwater A, Kortum RR. Advances in fluorescence imaging techniques to detect oral cancer and its precursors. Futur Oncol. doi102217fon1079. 2010; 6(7): 1143 – 1154.

16. Sirait AM. Faktor risiko tumor/kanker rongga mulut dan tenggorokan di Indonesia (Analisis Riskesdas 2007). Media Litbangkes. 2013; 23(3): 122 – 129.

17. Zhao J, Wang Z, Han J, Qiu X, Pan J, Chen J. Increased frequency of CD4+ CD25+ FOXP3+ cells correlates with the progression of 4-nitroquinoline1-oxide-induced rat tongue carcinogenesis. Clin Oral Investig. 2014; 18(7): 1725 – 1730.

18. Pavlova I, Williams M, El-Naggar A, Richards-kortum R, Gillenwater A. Understanding the biological basis of autofluorescence imaging for oral cancer detection: high-resolution fluorescence microscopy in viable tissue. Clin Cancer Res. 2008; 14(8): 2396 – 2404.

19. de Paiva RR, Figueiredo PT de S, Leite AF, Silva MAG, Guerra ENS. Oral cancer staging established by magnetic resonance imaging. Braz Oral Res. 2011; 25(6): 512 – 518.

20. Perez MGS, Bagan JV, Jimenez Y, Maria M, Marzal C. Utility of imaging techniques in the diagnosis of oral cancer. J Cranio-Maxillo-Facial Surg. 2015; 43: 1880 – 1894.

21. Arya S, Chaukar D, Pai P. Imaging in oral cancers. Indian J Radiol Imaging. 2012; 22(3): 195 – 208.

22. Valluru KS, Willmann JK. Clinical photoacoustic imaging of cancer. Ultrasonography. 2016; 35: 267 – 280.

23. White SC, Pharoah MJ. Oral radiology: principles and interpretation. 7th edition. White SC, Pharoah MJ, editors. St. Louis, Missouri: Elsevier Mosby; 2014.

24. Law CP, Chandra RV, Hoang JK, Phal PM. Imaging the oral cavity: key concepts for the radiologist. Br J Radiol. 2011; 84: 944 – 957.

25. Neville B, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin. 2002; 52: 195 – 215.

26. Afonso PD, Mascarenhas V. Imaging techniques for the diagnosis of soft tissue tumors. Rep Med Imaging. 2015; 8: 63 – 70.

27. Razek AA, Huang BY. Soft tissue tumors of the head and neck: imaging-based review of the WHO classification. Radiographics. 2011; 31(7): 1923 – 1954.

28. Manaster BJ. Soft-tissue masses: optimal imaging protocol and reporting. Am J Roentgenol. 2013; 201(3): 505 – 514.

29. Figueiredo PTDS, Leite AF, Barra FR, Anjos RF, Freitas AC, Nascimento LA, Melo NS, Guerraet ENS. Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists. Dentomaxillofacial Radiol. 2012; 41: 396 – 404.

30. Langland OE, Langlais RP, Preece JW. Principles of Dental Imaging. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002. 52

31. Alamri HM, Sadrameli M, Alshalhoob MA, Sadrameli M, Alshehri MA. Applications of CBCT in dental practice: a review of the literature. Gen Dent. 2012; 390 – 400.

32. Mudjosemedi M, Widyaningrum R, Gracea RS. Perbedaan hasil pengukuran horizontal pada tulang mandibula dengan radiograf panoramik. Majalah Kedokteran Gigi Indonesia. 2015; 1(1): 78 – 85.

33. Kau CH, Richmond S. Three-dimensional imaging for orthodontics and maxillofacial surgery. Singapore: Blackwell Publishing Ltd; 2010.

34. Whaites E, Drage N. Essentials of dental radiography and radiology. 5th ed. Whaites E, Drage N, editors. London: Churchill Livingstone Elsevier; 2013.

35. Gahleitner A, Watzek G, Imhof H. Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws. Eur Radiol. 2003; 13: 366 – 376.

36. Hanazawa T, Sano T, Seki K, Okano T. Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images. Clin Oral Impl res. 2004; 15: 226 – 232.

37. Akdeniz BG, Oksan T, Kovanlikaya I, Genc I. Evaluation of bone height and bone density by computed tomography and panoramic radiography for implant recipient sites. J Oral Implantol. 2000; 26(2): 114 – 119.

38. Zarch SH, Bagherpour A, Langaroodi AJ, Yazdi AA, Safaei A. Evaluation of the accuracy of panoramic radiography in linear measurements of the jaws. Iran J Radiol. 2011; 8(2): 97 – 102.

39. Iannucci JM, Howerton LJ. Dental Radiography: Principles and Techniques. 4th ed. USA: Elsevier; 2012.

40. Lestón JS, Dios PD. Diagnostic clinical aids in oral cancer. Oral Oncol. 2010; 46: 418 – 422.

41. Rumboldt Z, Day TA, Michel M. Imaging of oral cavity cancer. Oral Oncol. 2006; 42: 854 – 865.

42. Linz C, Muller-Richter UD, Buck AK, Mottok A, Ritter C, Schneider P, Metzen D, Heuschmann P, Malzahn U, Kübler AC, Herrmann K, Bluemel C. Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer. Int J Oral Maxillofac Surg. 2015; 44: 8 – 15.

43. Lam P, Au-yeung KM, Wei WI, Yuen AP, Trendell-smith N, Li JHC, Li R. Correlating MRI and histologic tumor thickness in the assessment of oral tongue cancer. AJR. 2004; 182: 803 – 808.

44. Shetty D, Jayade BV, Joshi SK, Gopalkrishnan K. Accuracy of palpation, ultrasonography, and computed tomography in the evaluation of metastatic cervical lymph nodes in head and neck cancer. Indian J Dent. 2015; 6(3): 121 – 124.

45. Lodder WL, Teertstra HJ, Tan IB, Pameijer FA, Smeele LE, Velthuysen M-LF van, et al. Tumour thickness in oral cancer using an intra-oral ultrasound probe. Eur Radiol. 2011; 21: 98 – 106.

46. Joshi PS, Pol J, Sudesh AS. Ultrasonography – A diagnostic modality for oral and maxillofacial diseases. Contemp Clin Dent. 2014; 5(3): 345 – 351.

47. Law CP, Chandra RV, Hoang JK, Phal P. Imaging the oral cavity: key concepts for the radiologist. Br J Radiol. 2011; 84(1006): 944 – 957.

48. Oraevsky AA. Optoacoustic tomography of the breast. In: Wang L.V., editor. Photoacoustic Imaging and Spectroscopy. USA: CRC Press; 2009. 411 – 429.

49. Arya S, Chaukar D, Pai P. Imaging in oral cancers. Indian J Radiol Imaging. 2012; 22(3): 195 – 208.

50. Sureshkannan P, John R. Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer. Indian J Dent Res. 2011; 22(3): 419 – 423.

51. Dayanand SMC, Desai R, Reddy PB. Efficiency of ultrasonography in assessing cervical lymph node metastasis in oral carcinoma. Natl J Maxillofac Surg. 2010; 1(2): 117 – 122.

52. de Paiva RR, Figueiredo PT de S, Leite AF, Silva MAG, Guerra ENS. Oral cancer staging established by magnetic resonance imaging. Braz Oral Res. 2011; 25(6): 512 – 518.

53. Ain K, Kurniadi D, Trisnobudi A. Studi pendahuluan sistem tomografi listrik-akustik untuk mendeteksi kanker paru-paru. J Oto Ktrl Inst. 2011; 3(2): 47 – 55.

54. Shantiningsih RR, Diba SF. Efek aplikasi patch gingiva mukoadesif β-carotene akibat paparan radiografi panoramik. Majalah Kedokteran Gigi Indonesia. 2015; 1(2): 186 – 192.

55. Bagan J, Sarrion G, Jimenez Y. Oral cancer : clinical features. Oral Oncol. 2010; 46: 414 – 417.

DOI: https://doi.org/10.22146/majkedgiind.22050

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