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Computed tomography (CT) is widely used, but its diagnostic performance may vary with tumor localization and image quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, patients with OSCC who underwent preoperative CT imaging and subsequent surgical resection with histopathological evaluation were identified. Bone invasion was assessed on CT using a graded and dichotomous classification. Histopathology served as reference standard. Diagnostic performance was analyzed overall and stratified by tumor localization, radiological severity, and image quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      572 patients were included. Histologically confirmed bone invasion was present in 134 cases (23.6%). Overall, CT demonstrated a sensitivity of 63.4% and a specificity of 90.8%, with an overall diagnostic accuracy of 84.3%. The probability of bone invasion increased stepwise with increasing radiological severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Diagnostic performance varied by tumor localization, with significant differences in specificity and overall accuracy (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while sensitivity did not differ significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.597). Radiological grading correlated with pathological stage; nevertheless, 12.3% of pT2 tumors were interpreted as showing bone involvement, while 36.6% of histologically confirmed pT4 tumors remained radiologically occult. Exclusion of cases with relevant imaging artifacts resulted in improved diagnostic performance (AUC 0.80 vs. 0.78).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative CT provides clinically relevant information for assessing bone invasion in OSCC. However, diagnostic performance varies across anatomical subsites, as well as radiological severity and image quality. A localization-aware interpretation may help to avoid under- and overtreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00432-026-06472-2","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T13:37:34Z","timestamp":1776865054000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative computed tomography for assessment of bone invasion in oral squamous cell carcinoma: diagnostic accuracy and anatomical subsite dependency"],"prefix":"10.1007","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5520-4635","authenticated-orcid":false,"given":"Jannik","family":"Ketschau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0028-6654","authenticated-orcid":false,"given":"Yannik","family":"Leonhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Grabenhorst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0200-8652","authenticated-orcid":false,"given":"Hannes","family":"Singer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8081-4877","authenticated-orcid":false,"given":"Helena","family":"Kram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7085-6874","authenticated-orcid":false,"given":"Nils","family":"Krautkremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Leopold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2518-4583","authenticated-orcid":false,"given":"Jonathan","family":"Mohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Stimmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Dietrich","family":"Wolff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-0344","authenticated-orcid":false,"given":"Lucas M.","family":"Ritschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"6472_CR1","first-page":"93","volume":"67","author":"MB Amin","year":"2017","unstructured":"Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP (2017) The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging. 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