An update on the latest evidence for managing the clinically negative neck (cN0) in oral squamous cell carcinoma

Abstract

The single most important prognostic indicator for survival in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastases in the neck. While the treatment of the clinically node positive (cN+) neck is well established, the management of the clinically negative neck (cN0) is controversial. Various strategies have been advocated including close observation including regular ultrasound imaging, elective neck dissection and sentinel lymph node biopsy. Neck dissection surgery is not without potential morbidity with shoulder dysfunction being the main complication. A number of factors are associated with increased risk of neck node metastasis including primary tumour thickness and peri-neural invasion. A recent prospective randomised trial has found survival benefit following neck dissection even in patients with a cN0 neck at presentation. We discuss the latest evidence for managing the cN0 in OSCC and include our own experience on the role of neck dissection in certain cases.

Diagnostic accuracy of contrast‐enhanced computed tomography for assessment of mandibular and medial retropharyngeal lymph node metastasis in dogs with oral and nasal cancer

“…Invasive techniques such as elective neck dissection or sentinel node biopsy with subsequent histopathology and step sectioning remain the standard of care for humans . Both elective dissection and sentinel lymph node techniques have been reported in dogs; however, their therapeutic and diagnostic value have not been directly assessed .…”

“…Repeat cross-sectional imaging can allow equivocal lesions to be re-assessed Invasive techniques such as elective neck dissection or sentinel node biopsy with subsequent histopathology and step sectioning remain the standard of care for humans. [39][40][41][42][43] Both elective dissection and sentinel lymph node techniques have been reported in dogs; however, their therapeutic and diagnostic value have not been directly assessed. 12,32,[44][45][46] Until other techniques are validated as sufficiently sensitive alternatives, lymph node excision and histopathology (whether sentinel or regional) remains the standard of care for lymph node staging in dogs, not least due its ability to identify small metastatic aggregates.…”

Efficacy of postoperative neck irradiation for regional control in patients with pN0 oral tongue cancer: Propensity analysis

“…The absence of metastatic lymph nodes (pN0) after END necessitates consideration of adjuvant RT being in mind, while balancing between clinical efficacy and morbidity. In clinical practice, decisions for adjuvant RT are made, mostly based on individual clinicopathological data . However, it is still controversial whether RT in pN0 OSCC is beneficial or not, and if RT is deemed necessary, the appropriate extent of the radiation field (primary site only or primary site as well as the neck) is also unclear .…”

“…In clinical practice, decisions for adjuvant RT based on individual clinicopathological data. 3,[14][15][16][17] However, it is still controversial whether RT in pN0 OSCC is beneficial or not, and if RT is deemed necessary, the appropriate extent of the radiation field (primary site only or primary site as well as the neck) is also unclear. 18,19 The purpose of the present study was to determine whether the application of postoperative RT as well as an irradiation field that includes the neck are associated with the locoregional control rate and the regional recurrence-free survival (RRFS) rate in patients with pN0 oral tongue cancer.…”

Sentinel Lymph Node Centered Selective Neck Dissection Does Not Have Benefits Over Supraomohyoid Neck Dissection in Patients with cT1T2N0 Tongue Cancer

“…Perilymphatic invasion and tumor thickness are widely accepted risk factors for neck node metastasis. 19) In the pathological analysis of 66 cN0 patients, Tsushima, et al 18) reported that the probability of nodal metastasis is increased in patients with tumor thicknesses ≥6 mm (48%) compared with tumor thicknesses ＜6 mm (20%).…”