Omitting elective neck dissection in cT1/2N0 oral squamous cell carcinoma with sentinel lymph node metastasis: A prospective study

Objective

To examine the distribution of non-sentinel lymph nodes (SLNs) and to determine the feasibility of omitting elective neck dissection (END) in cases of cT1/2N0 oral cancer presenting with SLN metastasis.

Methods

A prospective cohort of patients with cT1/2N0 oral cancer underwent SLN biopsy using a γ-probe alongside methylene blue staining, followed by subsequent END. The primary outcome variable was non-SLN metastasis, with its predictors evaluated through logistic regression analysis.

Results

A total of 200 patients with detectable SLNs were analyzed. Logistic regression revealed a significant odds ratio of 4.28 [95 % confidence interval: 2.11–14.56] for predicting non-SLN metastasis when comparing a depth of invasion greater than 4.0 mm to a DOI of 4.0 mm or less. Among the six cases of non-SLN metastasis, three patients with negative SLN biopsy results exhibited metastasis; one was found in ipsilateral level V and two in contralateral level Ib. In contrast, all three patients with positive SLN biopsy results had a DOI surpassing 4.0 mm, presenting with at least two positive SLNs. Non-SLN metastasis was detected in ipsilateral level III for one patient and at level IV for two others.

Conclusion

END may be judiciously omitted in cases where only one positive SLN is identified in early-stage oral cancer with a depth of invasion of ≤ 4.0 mm.