Pre‐Operative Intraoral Ultrasound Features of Benign and Malignant Oral Lesions: An Exploratory Pilot Study

ABSTRACT Objective To evaluate intraoral‐ultrasound (ioUS) features of benign and malignant oral lesions. Methods In this prospective cross‐sectional study, patients with oral soft tissue lesions underwent ioUS followed by biopsy within 2 weeks. Sonographic features: size, echogenicity, cystic areas, calcifications, margins, and vascularity were compared with histopathology. Associations between sonographic features and malignancy were explored using univariate and multivariable analyses. ROC analysis was used descriptively to explore discriminatory ability. Results Fifty‐one patients with 52 lesions (24 females, 27 males; mean age 60.1 ± 16.7 years, range 18–90) were recruited. Following exclusions, the study comprised 23 histologically confirmed malignant cases (squamous cell carcinoma, SCC) and 23 benign cases. Multivariate analysis identified maximal diameter (> 12 mm; sensitivity 0.76 [95% CI: 0.53–0.90], specificity 0.77 [95% CI: 0.57–0.90]), ill‐defined margins ( p < 0.001), and increased vascularity ( p = 0.002) as being associated with SCC in this cohort. Combinations of these features showed high apparent discrimination (AUC 0.92 [95% CI: 0.84–1.00]), but likely reflect optimistic bias given the small sample size and lack of validation. Conclusions This pilot study describes ioUS features in benign and malignant oral lesions and identifies sonographic features potentially associated with malignancy. These findings are exploratory and hypothesis‐generating and require validation in larger, more diverse cohorts before any clinical application.