Modern approaches to differential diagnosis of chronic tongue ulcer

The aim of the study was to improve the diagnosis of chronic ulcers of the mucous membrane (MM) of the tongue using high-frequency ultrasound transoral scanning (HUTS).

Material and methods. We examined and treated 22 patients with chronic ulcer of the tongue mucosa aged 30 to 75 years: men – 10, women – 12, in 2020-2021. Dental status was registered. To determine the nature of the pathological process, patient flow and selection of a further treatment strategy, HUTS of the ulcerative tongue lesion was performed on an expert class apparatus with a 22 MHz linear sensor with a scanning surface size of 30 mm. The assessment was performed in B-mode, the pathological focus, its size in three planes, contour, homogeneity, blood flow in Doppler color mapping mode were determined. Based on the medical history, clinical examination and HUTS data, a preliminary diagnosis was established and the patients were divided into groups according to the disease nature: 1 – benign – 13 patients; 2 – malignant – 9 patients. Patients of the first group were referred to the dental surgical department. The group 2 patients were referred to the Head and Neck Tumors Department of the FSBI NMRCO named after N.N. Blokhin. Biopsy was taken in all patients during surgical treatment with further pathological verification of the diagnosis. The diagnostic efficiency of HUTS was calculated using descriptive statistics (sensitivity and specificity) based on the set of diagnostic and pathological data.

Results. In group 1, the ulcers were located on the lateral surface of the tongue in the middle (46.2%) and anterior thirds (53.8%). Benign ulcers are characterized by a homogeneous hypoechogenic zone with even contours seen with ultrasound examination. The degree of vascularization was insignificant, the blood flow was observed along the outer perimeter of the lesions. In group 2, the ulcers were located in the middle part of the tongue – 44.4%, in the distal part, or closer to the root – 55.6%. According to the HUTS, the pathological foci of the tongue had characteristic signs of malignancy: non-uniform hypoechoic areas with uneven, fuzzy, “torn” contours and hyperechoic inclusions inside. The blood flow was increased, multiple “vascular stalks”-like small vessels and the feeding vessels were observed. The biopsy data confirmed the preliminary diagnoses of patients in groups 1 and 2 established based on examination and HUTS.

Conclusion. The diagnostic technique of HUTS allows to establish the true size of the ulcer, the MM lesion nature. In all the cases, HUTS of the tongue lesions revealed foci of reduced echogenicity compared with the surroundingtissues. The concordance of HUTS and histological examination reached 100% in both groups. HUTS of the tongue mucosa ulcers was useful in determining the treatment strategy and the volume of surgical intervention. Thus, the diagnostic technique of ultrasound transoral scanning can be used to obtain reliable diagnostic data about tongue mucosa ulcers, to make a correct decision on referring the patient to a medical care department and to determine the treatment strategy.

Key words: “decubitus” ulcer of the oral mucosa, chronic ulcer, oral mucosa ulcer diagnosis, high-frequency transoral ultrasound scanning

Conflict of interest. The authors declare that there