Transoral Ultrasound Outperforms MRI in Cancer Detection

TOPLINE:

A trial including 162 patients showed that surgeon-performed transoral/transcervical ultrasonography (USG) achieved a diagnostic accuracy of 86%, outperforming clinical examination and MRI (68% and 76%, respectively), in detecting oropharyngeal squamous cell carcinoma (OPSCC).

METHODOLOGY:

• This prospective, multicentre diagnostic clinical trial included 162 participants with suspected OPSCC (median age, 63 years; 35% women) in Denmark from 2023 to 2024.
• After clinical examination, participants underwent transoral and transcervical USG performed by surgeons, followed by blinded cross-sectional MRI evaluation.
• Transoral USG involves using small high-frequency ultrasound probes placed directly onto the oropharyngeal mucosa, which produce higher-resolution images than traditional cross-sectional imaging.
• Researchers compared accuracies of detecting OPSCC between clinical examination, USG, and MRI, with final histopathologic results and T staging being used as reference standards.

TAKEAWAY:

• A total of 65% of participants were diagnosed with oropharyngeal tumours and 35% were diagnosed without those. USG achieved significantly higher overall accuracy (86%) than clinical examination (68%; odds ratio [OR], 0.31; 95% CI, 0.18-0.52) and MRI (76%; OR, 0.48; 95% CI, 0.28-0.82) in diagnosing OPSCC.
• Among patients without tumours, USG demonstrated superior specificity than clinical examination and MRI (79% vs 41% and 46%, respectively), while maintaining comparable sensitivity (90% vs 82% and 92%, respectively).
• Grouping of surgeons on the basis of their experience as 0-10, 10-20, and ≥ 20 cases yielded diagnostic accuracies of 80%, 79%, and 87%, respectively.
• Surgeons rated higher image quality in 45% vs 17% of OPSCC cases with transoral vs transcervical USG.

IN PRACTICE:

“Transoral ultrasonography was well tolerated and can be performed as an extension of the clinical examination to improve diagnostic evaluation and to inform biopsy procedures,” the authors wrote. “Transoral ultrasonography may have a role in identifying early-stage OPSCCs and improving patient selection for transoral robotic surgery,” they added.

SOURCE:

This study was led by Martin Garset-Zamani, MD, PhD, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. It was published online on July 17, 2025, in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

This study was conducted in tertiary centres with specialised head and neck surgeons experienced in USG, which may have limited generalisability. Considering inconclusive cases as positive may have led to overdiagnosis, especially in patients with asymmetric tonsils. Additional limitations included the absence of a true reference standard for T staging.

DISCLOSURES:

This study was supported by a grant from the Novo Nordisk Foundation. One author reported having a patent pending for a 3D USG imaging device at Rigshospitalet.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.